Woodlands is a residential care service providing accommodation and personal care for up to 22 people. The service provides rehabilitative care for people with severe and enduring mental health illnesses and learning disabilities. At the time of our inspection there were 16 people using the service. The service is situated in a residential area of Southport near to local amenities.

Woodlands is a ‘care home’. People in ‘care homes’ receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

This was an unannounced inspection which took place on 21 January 2019. The last inspection was in June 2016 when the service was rated as ‘Good.' At this inspection we found evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons.' Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

We found that staff’s suitability to work with vulnerable adults at the service had been checked prior to employment. For instance, previous employer references had been sought and criminal conviction checks undertaken.

Medication was managed safely and was administered by staff who were competent to do so. People who wished to self-medicate were supported by staff to do so safely, this helped to promote their independence.

Appropriate arrangements were in place for checking the environment was safe. For example, health and safety audits were completed on a regular basis and accidents and incidents were reported and recorded appropriately.

Care records contained detailed information to identify people’s requirements and preferences in relation to their care. People we spoke with told us that they had a choice in how they lived their lives at the service.

Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) to ensure people consented to the care they received. The MCA is legislation which protects the powers of people to make their own decisions.

Staff had received training which equipped them with the knowledge and skills to ensure people received adequate care. Staff had also received more specific training to meet the needs of people living with mental health illnesses and learning disabilities.

People were involved in their care and there was evidence in their care records to show that they had been consulted about decisions. We saw evidence that people’s hobbies and interests were recorded and catered for. For example, one person enjoyed attending the gym and staff actively supported them with this.

Quality assurance processes were in place to seek the views of people using the service and their relatives.

We asked people about how they thought the service was managed and their feedback was positive.

This unannounced inspection was conducted on 17 June 2016.

Situated close to the promenade and the town centre in Southport, Woodlands provides accommodation and care for up to 22 people with a learning disability and/or mental health needs. Accommodation is provided over three floors, with bedrooms located on each floor.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People we spoke with told us they felt safe and staff knew what actions to take if they thought that anyone had been harmed in any way.

People received their medicines as prescribed and safe practices had been followed in the administration and recording of medicines.

People confirmed there were enough staff available to meet their needs, people were not rushed or pressured when being supported.

Staff we observed delivering support were kind and compassionate when working with people. They knew people well and were aware of their history, preferences and dislikes. People’s privacy and dignity were upheld. Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed.

People told us there were enough suitably trained staff to meet their individual care needs. Staff were only appointed after a thorough recruitment process. Staff were available to support people to go on trips or visits within the local and wider community and attend medical appointments.

Staff understood the need to respect people’s choices and decisions if they had the capacity to do so. Assessments had been carried out and reviewed regarding people’s individual capacity to make care decisions. Were people did not have capacity, this was documented appropriately and decisions were made in their best interest with the involvement of family members where appropriate and relevant health care professionals. This showed the provider understood and was adhering to the Mental Capacity Act 2005.This is legislation to protect and empower people who may not be able to make their own decisions.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005).

People’s bedrooms were individually decorated to their own tastes. People showed us their bedrooms and were proud of them.

People told us they liked the food. We observed there was a choice of menu for people if they did not like what was cooked that day.

People who lived at the home, their relatives and other professionals had been involved in the assessment and planning of their care. Care records were detailed and gave staff the information they required so that they were aware of how to meet people’s needs.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff, the deputy manager or the registered manager.

Staff were trained and skilled in all mandatory subjects, and additional training which was taking place within the organisation. Staff we spoke with were able to explain their development plans to us in detail and told us they enjoyed the training they received. Staff told us they could approach the management team anytime and ask for additional support and advice.

Staff spoke highly of the organisation’s values and all of the staff we spoke with told us they were proud to work for the organisation. Staff said they benefited from regular one to one supervision and appraisal from their manager. Staff spoke highly about the registered manager and the provider.

There was a safeguarding and a whistleblowing policy in place, which staff were familiar with.

Quality assurance audits and

This was a follow up to our inspection of October 2013, to check the provider had made improvements required to the accommodation and facilities used by the people who lived at Woodlands. In the October 2013 inspection, we reported improvements were needed to bathrooms, bedrooms and corridors in the home. We also reported in October 2013 that the complaints policy of the provider required improvement to ensure a complaint could be escalated if it was not resolved by the manager of the home.

We returned to the home on 2nd January 2014 to check improvements had been made to the accommodation and facilities at the home. Bathrooms we had reported as being in a poor state of repair, had been refitted. All tiling, flooring and decoration was of a good standard, for example flooring was non-slip, reducing the possibility of injury from falls. The newly appointed bathrooms were cleared of any debris, materials and tools used to carry out the work. We did note a leak to one of the newly installed toilets, which we brought to the attention of the provider who told us this would be addressed immediately.

Following our visit on 2nd January 2014, the provider confirmed they had appointed additional contractors to assist with the decoration of bedrooms and plastering work in the home. This meant the required improvements could be delivered within the time limit agreed with the Commission, which was 10th February 2014.

A new, easy read complaints policy had been created, which was displayed in the hallway. This contained the contact details of the provider which meant family members could escalate concerns if not adequately dealt with by the manager of the home. Complaints had previously been made about the lack of co-ordinated activities and events for people to take part in. The manager had advertised the vacant activities co-ordinator post. In doing this, the provider had taken positive steps to address the complaints people had made about the lack of activities.

When we inspected Woodlands, people who were able to express their views indicated they were happy with the care they received. We saw some of the varied projects completed by people when supported by the activities co-ordinator. Staff told us of other activities in the community that people were involved with, for example, a local farm were people helped out on a daily basis.

People's care plan's were up to date and reviewed regularly. Details of other clinicians who supported the treatment and wellbeing of people were also listed in people's care records.

We found people enjoyed a varied menu. Meals were freshly prepared on a daily basis. The chef at the home was open to suggestions made by people on the meals prepared, and people indicated that they enjoyed the meals offered. We found that tea, coffee and soft drinks were available throughout the day.

We found parts of the building remained in a poor state of repair. Concern's about this had been raised in 2011 and the provider gave assurances that upgrade work required at the premises would be completed. We reviewed improvements made to the building but noted very little progress had been made since December 2012. We have told the provider to address this as a matter of urgency.

When we asked relatives how they raised any concerns or issues with the provider, we found feedback was mixed. All relatives we spoke with expressed that the standard of care received by a their family member was good. However, relatives told us when they had requested updates, for example, on the progress of a planned care review or a review of medication for their family member, they had not received sufficient response.

We spoke with six people who lived at Woodlands and one visiting relative. People were very positive about the care they received. One person said "I like the staff here. They help me all the time." Another person said "The staff ask me what I want to do. I like to go out when the weather is nice.” People told us that they felt able to discuss any issues or complaints with staff or the manager. The people we spoke with told us that they had no complaints.

We found that people felt safe, were cared for appropriately and were encouraged to be as independent as possible. We found people had detailed assessments of their needs and appropriate support plans had been developed to meet their assessed needs. One person told us "I am well looked after here.”

We found that staff worked well with people and had a good understanding of people’s needs. Staff received relevant training and were effectively supported to undertake their roles. The provider also had systems in place to monitor and improve the quality of care that was delivered.

We did not visit Woodlands during this review to speak with the people living there. Sefton Social Services and Merseyside Fire Service visited Woodlands to look at the issues raised as they were within their remit. We looked at the information we gathered from various sources to establish whether the service were complying with the regulations of the Health and Social Care Act 2008.

We did not announce this inspection prior to our visit. We set out to answer our five questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives and staff and by looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by the staff. People told us if they had any concerns they would raise these with the staff or with the manager.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed and risks to people's safety were assessed and managed.

The provider had systems in place to monitor staff practices and to ensure risks to people's health and wellbeing were managed.

People's capacity to make decisions had been assessed and the manager was aware of their responsibility, in line with the Mental Health Act 2005, to refer to external professionals if it was felt that a person was being deprived of their liberty.

Is the service effective?

People's needs were assessed prior to them moving into the home. Care was then planned and delivered in line with people's assessed needs.

People received the care and support they required to meet their needs and maintain their health and welfare. Checks were in place to monitor and review the care that people received to make sure people received the right care and support that met their needs.

The registered manager ensured staff received training. Staff told us they felt well supported and we saw that they were receiving regular supervision and appraisals.

Is the service caring?

People who lived at the home told us staff were caring. People's comments included: "They are a great bunch of staff” and “The staff are fantastic."

Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity. We saw that staff were respectful and warm in their interactions with people.

Is the service responsive?

The service worked well with other agencies to make sure people received the care and treatment they needed. The staff contacted GPs and other health professionals promptly when people required support with their health care needs.

We spoke with a visiting social care professional and they gave us good feedback about the home.

We found that people had their own activities they took part in, in the community, as well as activities that took place within the home. There were staff to support people with activities and health appointments.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on areas of practice such as health and safety, medication management, care planning, infection control, fire safety, staff supervision and training.

People who lived at the home and their relatives were asked about the quality of the service and their feedback was acted on.