About the service: Woodley Court is a residential care home for people with a learning disability. At the time of the inspection, 16 people were living at the service. Although this is larger than current best practice guidance, the impact on people was mitigated by the fact that accommodation was provided in three houses; the cottage, the bungalow and the main house. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. The accommodation was built around a large central courtyard which was secure and well maintained. Each building was accessible from the courtyard. This meant that people were able to move from building to building and to interact with one another when they chose.

People’s experience of using this service:

People were relaxed and happy with staff and showed by their actions , they trusted them. We saw reminders for staff that were centred on improving people’s experience and staff were encouraged to plan holidays and activities for people in a timely way. The outcomes for people using the service reflected the principles and values of Registering the Right Support in that people were involved in the local community and staff promoted individual choice.

People continued to be safe at the service. Staff completed risk assessments and people were supported to stay safe, whilst not unnecessarily restricting their freedom. Staff reported incidents and accidents and they were investigated and reviewed, to reduce the risk of them happening again. Medicines were managed effectively and safely.

Staff were knowledgeable about people’s care and support needs and received training to maintain their knowledge and skills. Care plans contained detailed information about each person’s individual support needs and preferences in relation to their care and we found evidence of good outcomes for people. When people did not have the capacity to make their own decisions, staff maximised their involvement and made decisions in their best interests, in accordance with legislation.

Staff were caring in their approach and protected people’s privacy, dignity and promoted their independence. People were treated equally, without discrimination and information was presented to them in a way they could understand.

People continued to receive a service that was responsive to their individual needs and preferences. Most people had complex needs and staff involved other professionals, to ensure they gained a full understanding of the factors influencing each person and further developed an individualised approach to their care. They had access to a range of activities and were encouraged to participate in events in the local community.

The registered manager, deputy manager and staff were open and committed to learning and improving the service further. They monitored the care provided and had an action plan outlining the improvements they were working on. A example of a recent improvement was the refurbishment of the central courtyard that provided a pleasant place for people to spend time and chat with others.

Rating at last inspection: Good (report published September 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We inspected Woodley House on 5 and 6 July 2016. The inspection was unannounced.

Woodley House is situated in the village of Ruddington in Nottinghamshire. The service comprises of three separate buildings, the house, cottage and bungalow and provides care and support for up to 20 people with a learning disability. At the time of our inspection 16 people lived at the service.

The service had a registered manager in place at the time of our visit. 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 told us they felt safe at Woodley House and did not have any concerns about the care they received. Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began work at Woodley House.

People received their prescribed medicines when required and these were stored and administered safely. Procedures were in place to ensure people received their medicines safely when they were away from the service.

People received effective care from staff who received training and support to ensure they could meet people’s needs. On going training and assessment for all staff was scheduled to help maintain their knowledge.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

People were treated with dignity and respect and their privacy was protected. We observed positive, caring relationships between staff and people using the service. Where possible people were involved in making decisions about their care and daily activities.

Staff understood people’s support needs and ensured they received personalised responsive care. People had the opportunity to take part in enjoyable, constructive activities and maintain family and social relationships. When a complaint or concern was raised this was acted on quickly and investigated thoroughly by the service.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Robust quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.

We found that medicines were handled appropriately. New policies and procedures for the safe handling of medicines had been introduced by the new manager in May 2013 which covered all aspects of medicine handling. A full audit of medicines handling had also been carried out.

Where medicines were prescribed to be given ‘only when needed’ or where they were to be used only under specific circumstances, detailed care plans were in place.

Appropriate arrangements were not in place in relation to the recording of medicines. We were not able to tell from the records whether or not people who use the service were always getting their medicines when they should and that they were getting the correct dose.

We found that people were receiving their medicines at the right times and that staff handled medicines in a safe way. People living in the home could not talk to us about their care but we saw that staff were kind and respectful when administering medicines.

We found that in spite of our warning notice, insufficient steps had been taken to make sure that people were protected against the risk of harm. We found that the culture amongst staff and managers of the home did not encourage open reporting of incidents of concern. The local safeguarding procedures had not always been followed and as a result we could not be assured that people living at the service were properly safeguarded from harm or abuse.

Where areas of non compliance have been identified during inspection they are being followed up and we will report on any action when it is completed.

We found mixed evidence about how much people were involved in their care. We observed that the staff interacted well with people who could communicate with them verbally, but observed that there was limited and sometimes no interaction with people who did not use verbal speech. Two people told us the staff offered them choices in terms of what they ate and what they did with their time. We saw that one person we spoke with was actively involved in doing their laundry, washing up and shopping.

We found mixed evidence about how people's care and welfare needs were met. We saw clear evidence in the care plans to show that people's healthcare needs were met well. We found the care plans were not up to date, appropriately reviewed and our evidence indicated some staff did not follow them. This meant the manager could not be assured that the plans in place gave staff the guidance they needed to meet people's needs, or if they did that staff were following them at all times.

We were very concerned that the arrangements in place to prevent abuse and respond appropriately if allegations were made were ineffective. This placed people at risk of harm or abuse.

We found that the staff were trained and supported to do their jobs and to understand their role.

Our evidence indicated that the systems in place to protect people from risk and to monitor the quality of the care being provided were not effective.

We observed the care being delivered to three people in the house for one and a half hours; we also spoke with a person living at the service, seven staff, the manager and a consultant employed by the company to help us assess compliance.

We found there had been a lot of improvements in the way people were supported with their needs and we saw the staff treated people with dignity and respect and communicated with them to help them make choices.

The care plans were much better and had information to help staff understand how people should be supported with their needs. We saw that people had assessment and treatment from health care professionals when this was needed and that the staff could see their expert advice in people's care plans. This meant their health was well looked after. There were more activities and this was a significant improvement. Steps were taken to make sure people's recreational needs were being met.

People told us they were safe and we saw steps were taken to make sure people were protected from the risk of harm or abuse.

We were concerned that the medicines in the bungalow were not always safely stored and administered which meant people may not get their medicines as their doctor intended.

We found the provider had put new ways of working in place and this meant they watched staff supporting people and told them what they did well and what needed to be better. This meant better quality care was provided.