William Wood House

William Wood House provides personal care to people living in specialist 'extra care' housing. Personal care is help with tasks related to personal hygiene and eating, we also consider any wider social care provided. At the time of our inspection there were 26 people using the service. They lived in separate flats with shared areas including gardens and a large lounge and dining room. Not everyone who lived at William Wood House received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

The provider’s quality assurance system had not been effective in identifying the issues we found during the inspection. Audits had not always been completed. Risk assessments were not always in place for known risks to people. Accidents and incidents were not always analysed to see if action needed to be taken to prevent a reoccurrence.

Medicines were administered in a timely manner and in a way that respected people’s preferences. Recruitment procedures had been followed to ensure new staff were suitable.

People told us they enjoyed living at William Wood House and that the registered manager and staff team were caring.

There was a new registered manager in post, they told us they had been concentrating on dealing with staffing issues since their appointment. Staff felt supported to carry out their roles effectively. People and staff were asked their opinions on the quality of the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 this service was good(report published November 2017).

Why we inspected

We received concerns in relation to staffing and management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The registered manager implemented a monthly colour coded incident analyst form so that accidents and incidents could be easily analysed for trends and themes. The registered manager wrote to us after the inspection and told us that they had implemented a risk profile across the service to ensure all risks are assessed.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for William Wood house on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to keeping people safe and identifying when improvements are needed at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The inspection took place on 12 and 14 September 2017 and was unannounced.

There was a registered manager 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.

The manager was passionate and committed in their role. They worked well with their new area manager and they had put a detailed action plan in place which was improving the quality of support being provided, and addressing concerns in an open and effective manner. They prioritised risk well and continued to address poor practice despite the on-going staffing challenges.

The manager had focused on improving the safe administration of medicines over the last six months. Staff had been retrained, medicine care plans revised and other systems improved. However, during our inspection we became aware of a medicine error during which staff had not responded effectively and in a timely manner when a person’s medicines had run out. This example highlighted areas where the improvements put in place by the manager had not yet become firmly established.

The manager was also facing concerns around staffing levels. Where no staff were available, they had prioritised direct care to ensure people’s needs were met and were often providing care themselves. At our inspection we were told a new additional team leader role had been created and there was on-going recruitment to ensure the manager had a full staff team and could focus on running the service. Despite the pressure on staffing levels, recruitment processes remained robust. There was some reliance on agency staff, however systems to improve the induction for these staff had been revised to help them understand better the aims of the service and people’s needs.

Risk was well assessed and measures put in place to support people to stay safe. Staff knew what to do if they had concerns regarding people’s safety. People were supported to communicate their preferences and to remain as independent as possible. Staff had developed positive relationships with people and treated them with dignity.

Staff were experienced and confident in their role. They were well trained and supported, though the recent staffing pressures had led to a dip in morale. The needs of people at the service were becoming more complex, especially in the area of dementia. The manager was working well with professionals to support staff to develop skills and to adapt the support people received to ensure it continued to meet their changed needs.

Staff enabled people to access outside health and social care agencies where necessary and worked well with other professionals to promote people’s wellbeing. People choose what they ate and drank in line with their preferences.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005. While most people at the service had capacity to make choices about their care support, the manager knew of the need to consider any legal requirements where people’s capacity was becoming more variable. Staff respected people’s right to make their own decisions about their life and support.

Detailed assessments of need were carried out and personalised care plans were in place which provided staff with guidance on peoples’ needs. Staff followed a schedule of visits as agreed with people and their families, where appropriate. People were supported to develop person-centred routines in line with their preferences. They also benefited from the 24/7 presence of staff if they needed one-off or urgent support.

There were varying opportunities to provide feedback about the service and to raise concerns and complaints. The manager and provider were open with people where there were issues at the service and consulted them on any proposals for change.

There were robust systems in place to check the quality of the service and make improvements, where necessary. These usually worked well, however recent staffing issues meant they were not functioning as well as usual during the period of our inspection. However, this was addressed immediately after the inspection by the creation of a new additional team leader role.

We found that staff had received comprehensive and updated training which meant that they demonstrated a good understanding of the principles of effective care and support. Staff we spoke with knew how to store and administer medication safely, although we did find an error in medication recording during our inspection.

There were effective recruitment and selection processes in place to ensure that people were receiving safe care from staff with relevant qualifications and track records.