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 told us that there were enough staff on duty. We found that on the whole there were sufficient staff on duty to meet people’s needs. However, we discussed the impact three people’s need for constant reassurance was having. The registered provider agreed that these people would benefit from the ability to access personal assistants who could support them to use local community resources and become engaged in activities in the home. The registered provider discussed the steps they were taking to access this type of support.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
We saw that the provider had an effective system in place for dealing with any complaints. We found that people felt confident that staff would respond and take action to support them.
We found that systems were in place to ensure the building was well-maintained. On the first day of our visit we noted that the extractor fan in the lounge was ineffective and pointed this out to the staff. When we visited on the second day this had been repaired and the registered manager had reviewed all the extractor fans and made sure, where necessary, these were cleaned and repaired.
Most people who used the service smoked. In light of this the home had received an exemption from the smoking regulations to provide a lounge where people could smoke. A second non-smoking lounge was provided and this was located in the basement. Although tastefully furnished and decorated we found it was not used and the three people who did not smoke sat in the dining room. Dining room seats were used in this area and we noted that for one person this was potentially exacerbating the swelling to their ankles. We discussed this with the registered provider who promptly obtained a reclining chair and also looked at how people could be encouraged to use the downstairs lounge.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the service.
The registered provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the provider had implemented these and used them to critically review the service.