Wood Hill House

Wood Hill House is a care home that provides accommodation, nursing, and personal care for adults. People living in the home had a range of care and support needs including people living with physical disabilities, mental health needs, learning disabilities, and autism. The home can accommodate up to 83 people in one purpose-built building over 4 floors. At the time of this inspection there were 13 people residing at Wood Hill House.

People’s experience of the service and what we found:

People’s medicines were not always managed safely. There were environmental safety concerns in the building which placed people at risk of harm. Safety concerns identified through risk assessment were not acted upon, therefore we could not be assured the risk had been mitigated. Plans to support people with safe evacuation in the event of a fire were not detailed and did not reflect advice from the fire and rescue service. There were policies and processes in place for managing safeguarding concerns, however we found concerns were not always identified by managers reviewing incidents. There were enough staff to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider did not work in line with the Mental Capacity Act. Not all people had capacity assessments and best interest decisions where a need was identified. There were delays in applications for Deprivation of Liberty Safeguards (DoLS) authorisation. The system in place for monitoring DoLS applications, authorisation, and conditions was ineffective. A significant number of the staff team had not completed mandatory training. Staff did not have up to date training or competencies to meet complex health needs including tracheostomy, Percutaneous Endoscopic Gastrostomy (PEG), and catheter care. Not all staff had received supervisions or appraisals as per the provider’s policy.

We found care plans lacked person-centred detail. Some positive behaviour support plans had not been devised for people where there was an identified need. The service was not meeting the Accessible Information Standard. There was a lack of support for people to access meaningful activities. Managers were working to improve this, however, did not audit or have oversight of what activities were taking place.

Systems for identifying, capturing, and managing organisational risks were ineffective. The provider did not have a clear and consistent system of audit in place. The provider had not fully acted on feedback from professionals for continually evaluating and improving the service or for assessing, monitoring, and mitigating risks to the safety and welfare of people. Staff told us managers were making improvements and felt there was an open and positive culture.

We received mixed feedback from people about the care they received. There was no system in place to seek feedback from people about their care. Our observations of care provided were positive. Staff spoke passionately about the support they provide for people. There were enough staff to meet people’s needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The service was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. These principles were highlighted as not being met at the time of the last inspection and we found minimal improvements had been made to the clinical environment and lack of personalisation. Managers told us work was ongoing to reduce occupancy from 83 to 42 people. We found the size, scale, and design of the current and future premises compromise quality of care and does not facilitate person-centred care. The provider had not carried out any audit or benchmarking against right support, right care, right culture to show how the service meets the needs of people in line with this current best practice. Audits in place were not fully checking whether the service was meeting the principles within the guidance: the size, setting, and design; community participation and having the right model of care; and policies and procedures. Managers told us work was ongoing to implement an audit, however we did not receive this as part of information requested following the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service under the previous provider was good, published on 10 July 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches in relation to person centred care, need for consent, safe management of medicines, the premises, governance, and staffing. As a result of concerns found at this inspection we served Warning Notices and a Notice of Proposal. The provider submitted representations against this proposal and following review of these representations, a Notice of Decision to impose conditions was served. This was not appealed by the provider. Therefore the conditions placed on the provider's registration mean that they cannot provide regulated activities to anyone with a primary need of a learning disability and/or autism at Wood Hill House.

Follow Up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.