We inspected Woodlea Residential Care Home on 8 and 29 September 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting the first day or exactly when in the following weeks.

Woodlea Residential Care Home is a registered service providing accommodation and support to 15 adults with mental health needs. They are also registered to provide personal care to people living outside the home but at present are not offering this service. However, the registered provider anticipates that they will in the near future as they are in the process of refurbishing some flats they have purchased in order to create a supported living service. The philosophy of the service is to maximise the potential of each resident and to develop and maintain independence.

The registered manager and has been in this role for over four years. 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.

At the time of the inspection 15 people lived at the service and we met seven of the people who used the service. They told us that they were very happy with the service and found it met their needs.

Most of the people we met had lived at the service of a number of years and some had been there for 20 years. We found that the registered provider, registered manager and staff consistently ensured people were supported to lead an independent lifestyle. We found that most of the people did not require support with personal care and led independent lifestyles.

Three of the people we met needed assistance to manage their care needs and required a high level of emotional support when dealing with every aspect of day-to-day life. We saw that staff were very skilled at meeting people’s needs and reducing the distress they may experience. Staff could identify triggers that would suggest people’s mental health was deteriorating. We found that the staff’s extensive knowledge of people had enabled them to readily spot changes in people’s presentation and this had led to the staff taking prompt action to contact the person’s doctor and community psychiatric nurse.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

We saw that the care staff cooked the meals for people and encouraged them to eat a healthy diet. Some of the people were being supported to learn the skills to cook their own meals and complete the shopping.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff were aware of how to respect people’s privacy and dignity.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who had mental health disorders and the use of Mental Health Act 1983 (amended 2007).

Staff had also received training around the application of the Mental Capacity Act 2005. The staff we spoke with understood the requirements of this legislation. When people had capacity staff correctly did not complete capacity assessments or make best interest decisions but for those people who lacked capacity this was in place.

People and the staff we spoke with

During our visit, we spoke with three of the thirteen people who used the service. They shared some of their experiences at the home. We spoke with one care worker, the manager and the deputy manager.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Is the service safe?

We saw people were being cared for in an environment which was safe and clean. Processes for the prevention and control of infection were in place. The numbers of items such as knives were checked twice daily. Visitors were asked to sign in and out.

The people we spoke with who used the service told us they felt safe. One person said “They look after me well.”

We saw training records and certificates which showed staff had received training to enable them to meet the needs of the people who used the service. This meant the people who used the service were supported by staff who had the necessary skills and experience. We saw staff rotas which showed appropriate numbers of staff were on duty each shift.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

We saw quality assurance questionnaires had been circulated to professional visitors. One had commented “Safeguarding issues have been dealt with appropriately.”

Is the service effective?

People’s health, social and care needs were assessed with them and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly every six months and when people's needs changed.

From the training records we viewed we found staff had received training to enable them to meet the needs of the people who used the service. Discussion with staff and examination of records confirmed a programme of training was in place so all members of staff were kept up to date with current practice.

The people we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the care they received and the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included “I like living here” and “The staff are very good.”

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

Is the service responsive?

People’s needs had been assessed before they moved into the home. The records we saw confirmed people’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw documentary evidence that the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home’s values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, satisfaction questionnaires had been completed by people who used the service and by professional visitors which showed people were satisfied with the service.

We visited the home on 5 July 2103 to follow up non compliance at our last inspection on 23 April 2013. This identified people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage the safe administration of medicines. The provider sent us an action plan to address the non compliance identified.

One person who used the service we spoke with told us “I always have my medicines on time, the staff always supervise me and they sign the chart. I know what I am taking; the staff have gone through my file”.

We saw there were policies and procedures in place for example medications, adverse drug reactions, controlled drugs and sharps for staff to follow. The manager told us staff had read the policies.

The manager is registered with the Care Quality Commission and we saw evidence of their registration certificate on display in the entrance hall.

We looked at two care files and saw evidence of people being involved in their care planning. We saw that decisions had been signed, dated and agreed by people who used the service.

We spoke with two people who used the service. They confirmed that they had been involved in the planning of their care with staff. One person told us “I have seen my care file”. We were told by people that they were happy with their care. One person said “I am happy, I can get up when I want, the staff are alright, they look after me”.

We observed staff completing the morning medication round. We noted that staff signed the entire MAR chart’s after the medication round in the office. We asked the manager about this. We were told that this was not normal practice but a person who used the service had needed assistance from staff which had impacted on the MAR (Medication Administration Record) charts not being signed at the time of administration.

We spoke with three people who used the service. One person told us they were “happy” in the home.

We saw evidence of a complaint and compliments policy in the home for staff to follow.

One person told us “if a person made a complaint I would reassure them, inform the manager, speak to the relatives and I would document it”.

“I like it here; they (the staff) look after me ok”.

“Its alright here, I like the staff”.

“X is great, I am fine here”.

“Yes, I do feel safe here”.

“The staff do look after me. I never feel frightened”.