The inspection took place on 8 May 2018 and was unannounced. The service was rated as Requires Improvement at our last inspection with two breaches of regulation. The breaches of regulation related to Regulation 13 – the service had not been meeting the conditions on a person’s DoLS authorisation, and Regulation 17 – Quality assurance systems.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Effective and Well Led to at least good. At this inspection we found improvement had been made and the service was rated as Good.

The service provides care and accommodation to people who have learning difficulties and autism. At the time of our inspection there were seven people living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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 our last inspection, we found that the conditions on people’s DoLS authorisations were not always being met. At this inspection we saw that improvements had been and the service had taken action to ensure they were complying with any such conditions. We also found that improvements had been made to the quality assurance systems.

People at the service were safe. There were sufficient numbers of staff to meet people’s needs and ensure their safety. Occasional agency staff were used but in the main people were supported by a consistent and well established team of staff. People received safe support with their medicines; these were stored securely and stock checks taken regularly.

The service was effective, staff worked with healthcare professionals to meet people’s health needs. People had health action plans in place that detailed the appointments they had for example, to check their eyesight. People received nutritional support in accordance with their needs. The service met people’s dietary needs and preferences. The service understood and implemented the principles of the Mental Capacity Act 2005.

The service was caring. People were supported by staff who understood their needs well and had built positive working relationships. Staff spoke warmly about the people in the home. People were able to maintain contact with their families and loved ones.

People were able to take part in a range of activities including swimming, arts activities and walks in the local area.

The service was well led. The staff team were positive and worked well together to ensure people’s needs were met. There was a system in place to monitor the quality and safety of the service.

We undertook an unannounced inspection of Woodwell House on 7 March 2017. When the service was last inspected in January 2015, no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified.

Woodwell House provides accommodation and personal care for up to 12 people with learning disabilities. At the time of our inspection, there were seven people living at the service.

A registered manager was in post at the time of our inspection. 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 home is run.

The Deprivation of Liberty Safeguards (DoLS) is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. Appropriate applications had been made for people. However, we found that conditions attached to three people’s DoLS authorisations were not being fully met. Mental capacity assessments and related best interest decisions were not decision specific in regards to any restrictions in place.

Quality audits required improvement as they did not identify the shortfalls we identified such as DoLS conditions not being met, mental capacity assessments not being decision specific and where language used in people’s care records was not always person centred.

People had assessments in place to minimise risks and there was suitable guidance for staff in risk management. Staffing levels were safe and consistent. Appropriate recruitment procedures were in place. Staff were knowledgeable in regards to identifying signs of abuse and the procedures to follow. Medicines were stored and administered safely.

Staff completed an induction programme when they started at the service. Staff were supported to be effective in their roles through regular training and supervision. People had good access to healthcare. We saw people were referred for support from health and social care professionals where appropriate.

We observed good relationships between people and staff. Staff knew people well and how they preferred their care and support delivered. Staff ensured there was a positive and calm atmosphere within the service. Positive comments were made by relatives about the staff’s kind and caring approach.

Staff were responsive to people’s care and support needs. Care records described people’s personal preferences and individual support needs. Staff supported people to be fully involved in a wide range of activities. Staff and relatives told us how people benefited from the programme of activities and how important it was to them.

We received positive feedback about the registered manager. Staff felt valued and supported in their roles. Positive comments were made by staff and relatives about the calm and happy atmosphere of the service. Feedback was sought from people and staff.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also made a recommendation in regards to working in accordance with the Mental Capacity Act 2005 Code of Practice. You can see what action we told the provider to take at the back of this report.

The inspection was unannounced and took place on 31 January 2015. The last inspection of the home took place in September 2013 and no breaches of regulations were found at this time.

The home provides care and accommodation for six people who have autism and learning difficulties.

There was a registered manager in place. 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.

We found that people in the home were safe. Staff were trained in safeguarding adults and reported feeling confident about identifying and reporting any issues of concern. People weren’t able to speak with us about their experiences, however we observed that they looked settled and at ease in the presence of staff.

People received safe support with their medicine which were stored and administered safely and clear records were kept.

There were systems in place to support people in a safe way. This included having risk assessments in place to guide staff in the best ways to support people. There were also systems in place to manage risks to the environment, for example by checking fire safety equipment and having regular drills.

There were sufficient numbers of suitably trained staff to ensure that people’s needs were met.

People received care that was effective. Staff were trained and received regular supervision to help them carry out their roles. Training was tailored to the needs of people with autism; for example training in hypersensitivity and behaviour that challenges was provided.

People’s nutritional needs were met and people were supported to maintain a healthy diet. Where people had particular dietary requirements, these were supported by staff.

Staff worked with other healthcare professionals when necessary, for example dentists and psychiatrists. This ensured that people received specialist support when required.

Staff had training in the Mental Capacity Act 2005. This is legislation that protects the rights of people who are unable to make decisions independently about their own care and treatment. We saw that the principles of this legislation were followed; for example when consenting to the support that the staff provided. The provider had also protected people’s rights by applying for Deprivation of Liberty Safeguards (DoLS) authorisation from the local authority for people in the home. DoLS applications are made when it is felt that a person needs to be deprived of their liberty in order to keep them safe and there are no other less restrictive options available.

Staff were kind and caring in their approach and encouraged people to maintain their independence where possible. People were treated with dignity and respect. People were given opportunity to express their opinions about the support they received.

People were supported by staff who were knowledgeable about their particular needs. People had support plans in place which were evaluated regularly to ensure they were up to date.

People had regular opportunities to go out in the community and to attend day services at another home run by the provider.

There had been no formal complaints received by the registered manager; however there were policies and procedures in place to manage complaints if needed.

Staff were very positive about the organisation and the support they received. Staff felt confident about raising any issues or concerns and had opportunity to discuss these at staff meetings.

The registered manager identified and responded to concerns about people in the home through regularly reviewing people’s support.

We found that notifications were not always made when required. Without receiving notifications, the Commission cannot effectively monitor people’s safety and whether their rights are being protected.

It was difficult for us to engage with the people living in the home due to their diagnosis of autism. However, we observed staff who they were familiar with, engage in conversations and activities.

Staff told us how people were involved in making decisions about their everyday lives. People living at the home had limited verbal communication. Methods people used to communicate were described in their care plans. Staff were knowledgeable about the communication methods people used.

We saw that people’s needs were assessed and that care plans were put in place to ensure that people’s needs were met. People were involved in reviews of their care and where appropriate relatives were invited.

Staff met with the people living at the home individually on a monthly basis. They discussed if the person had any suggestions, comments or complaints.

Staff told us that they felt supported in their roles and received regular training. They said the management of the home were very approachable. If staff had an issue they felt confident to raise it with them.

In the event of abuse being witnessed or suspected the homes safeguarding policy contained guidelines for staff to follow. Staff were able to explain to us what they would do if they witnessed or suspected that abuse was occurring in the home.

The home had procedures in place to ensure that where people were assessed to lack capacity to make more complex decisions, these were made in people’s best interest.

On the day of our visit all the people living in the home were out at their day centre. However 2 people agreed to return to the home to meet with us.

Due to the complex needs of the people living in Woodwell House it was difficult to gain an insight into how they felt about the service provided. Both of the people we met were observed moving freely around their home and were supported in an inclusive way by the staff, the manager and the provider.

We were told that the care was tailored to the person and that it was important that they were supported by familiar staff and in a consistent manner.

People benefit from a structured daily activity plan which takes into account the person’s interests and this was kept under review.

The people living in Woodwell House were encouraged to maintain contact with family and friends and this was seen as an important aspect of the care and support to the individuals.

We were unable to talk to people in detail about their experience of living at the home. This was because people living at the home had a diagnosis of autism and had communication difficulties. However, one person told us that they liked living at Woodwell and they liked the staff.

We spoke with three relatives of people living at the home. They told us they were pleased with the service their relative received. One relative said that their relative was much more independent during home visits than they were before they lived at Woodwell.

Records showed that when a specific need was identified care plans were developed to ensure that these needs were met. The records were person centred and reflected the individuality of people.

Procedures were in place to manage effective transition for people moving into the service. The home liaised with health services when required. They had systems in place to provide information to enable people to receive effective care and treatment from other providers when necessary.

The environment was clean and tidy. There were policies and procedures in place to protect people from the risks of infection.

Relatives said staff had a good understanding of their relative’s needs and a good knowledge of working with people on the autistic spectrum. Staff told us they received good training and support from the provider.

We found that the provider was monitoring the quality of their service effectively.