Woodhall House

Woodhall House is a children’s home providing treatment of disease disorder or injury to up to three children. The service provides support to children and young people aged between 10 and 18 years with their emotional and mental health. At the time of our inspection there were 3 children using the service.

Ofsted are the lead regulator for Woodhall House as it is a children’s home. The service is also registered with the Care Quality Commission for the regulated activity of treatment of disease, disorder or injury (TDDI).

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Children 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

CQC do not rate services that are defined as being a children’s home and which are also registered with Ofsted.

Why we inspected

The inspection was prompted in part due to concerns CQC received about medicines processes. A decision was made for us to inspect and examine those risks.

We completed a targeted inspection to examine those risks and looked at parts of the key questions; Safe, Responsive and Well Led.

We found medicines were stored safely within the home. Medicines were administered in a way that respected young people’s preferences. However, improvements are required regarding the oversight of medicines optimisation, incident reporting, the medicines policy and multi-agency working including working in partnership with families and carers.

You can see what action we have asked the provider to take at the end of this report.

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

Enforcement [and Recommendations]

We have identified breaches in relation to:

HSCA 2008 (RA) Regulations 2014. Regulation 9(3)(a) Person centred care.

HSCA 2008 (RA) Regulations 2014. Regulation 17 (2)(a) Good governance.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations that the provider should;

• improve the oversight of medicines processes

• review processes to include multi-agency partners and parents and carers in care planning

Follow Up

We will meet with the provider following this report being published to discuss how they will make changes to the services provided. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Woodhall House is a children’s home providing treatment of disease, disorder or injury to up to three people. The service provides support to children and young people aged between 10 and 18 years who have difficulties with emotional wellbeing and mental health. At the time of our inspection there were three children using the service.

Ofsted are the lead regulator for Woodhall House as it is a children’s home. The service is also registered with the Care Quality Commission for the regulated activity of treatment, disease, disorder or injury.

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

The provider had taken steps to make improvements to the services provided since the last inspection visit.

Prescribed observations of children were better documented, and records reviewed indicated that these had been undertaken consistently, reducing the risk of potential harm to children who used the service.

Risk management plans reflected the most up to date information about known risks and provided enough guidance for staff to follow in keeping children safe from harm.

Investigations into reported incidents were more detailed and had been reviewed by managers. Actions had been identified to reduce the risk of similar incidents happening again. This could be further strengthened if the provider considered ways to make sure that there was a formal policy or procedure to support staff in how to manage lower level incidents.

The provider had strengthened the systems that were used to maintain oversight of the services provided. For example, audits had been used in a meaningful way so that further improvements had been made when needed.

Managers had a better understanding of risks that were present at Woodhall House and steps had been taken to reduce these as much as practicably possible.

Since our last inspection, managers had developed a better understanding of the risks that were present at Woodhall House. Although overall risks had been better managed, further work was needed to make sure that there were clear policies and procedures in place to support staff in how to document and manage all levels of risk.

Rating at last inspection and update

CQC do not currently rate services that are defined as being a children’s home and which are also registered with Ofsted.

Following our last inspection, the provider had taken steps to improve the services provided.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Recommendations

We have made a recommendation that the provider consider ways in which to better document the expectations of how lower level incidents should be managed in appropriate policies and procedures, providing better guidance for staff to follow.

We have made a recommendation that the provider consider implementing formal policies and procedures to support staff which clearly outline the expectation of how organisational risks are identified, documented, escalated and managed.

Follow up

We will meet with the provider following this report being published to discuss how they will make further changes to the services provided. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Woodhall House is a children’s home providing treatment of disease, disorder or injury to up to three people. The service provides support to children and young people aged between 10 and 18 years who have difficulties with emotional wellbeing and mental health. At the time of our inspection there were three people using the service.

Ofsted are the lead regulator for Woodhall House as it is a children’s home. The service is also registered with the Care Quality Commission for the regulated activity of treatment, disease, disorder or injury.

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

The provider had taken steps to make improvements to the services provided since the last inspection visit.

Systems and processes had been strengthened to make sure that children had been kept safe from avoidable harm. This included the risk of sharps as well as ligatures.

Additional steps had been taken to make sure that appropriate procedures were in place for staff and children to be able to exit the home safely in the event of an emergency.

The management team had made sure that policies and procedures used by staff were in date and contained references to the most up to date best practice guidance and legislation.

However, we found that the provider remained in breach of regulations 12 and 17.

Risk management plans did not always reflect up to date information about known risks or provide enough guidance for staff to follow in keeping children safe from harm.

Although overall improvements had been made in the way that ligature risks had been identified and managed, prescribed observations had not been consistently completed. This meant that there was an increased risk of potential harm to children who used the service.

Incident investigations had not always identified important areas of improvement or demonstrated that all identified actions had been completed. This limited the opportunity for learning as well as to reduce the risk of similar incidents happening again.

Although the provider had been successful in strengthening some systems to monitor the services provided, this had not been yet been fully effective.

An effective system to manage identified risks had not been used, limiting the ability of the provider to demonstrate that they had been mitigated as much as practicably possible.

Rating at last inspection and update

The last inspection of this service was 6 July 2022.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Although some improvements had been made, at this inspection we found the provider remained in breach of regulations.

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

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Enforcement and Recommendations

We have identified breaches at this inspection and have issued warning notices in relation to safety and governance.

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 and will re-inspect the service to make sure that improvements have been made.

About the service

Woodhall House is a children’s home providing treatment of disease, disorder or injury to up to three people. The service provides support to children and young people aged between 10 and 18 years who have difficulties with emotional wellbeing and mental health. At the time of our inspection there were three people using the service.

Ofsted are the lead regulator for Woodhall House as it is a childrens home. The service is also registered with the Care Quality Commission for the regulated activity of treatment, disease, disorder or injury.

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

Staff had received enough training to keep service users safe and to undertake their jobs effectively. Safeguarding was taken seriously and timely actions to protect service users had been taken when needed.

Service users, parents and carers spoke highly of staff, telling us that they were respectful, kind and that they felt comfortable raising concerns when needed. Service users also told us that they felt like they had been included when making decisions about the care that they had received.

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.

Risks had not always been identified or had not always been mitigated as much as practicably possible. For example, the provider had not assessed and mitigated all potential risks associated to ligaturing, fire safety as well as the management of sharps.

Incidents of self-harm had not always been investigated in a way which minimised the risk of similar incidents reoccurring, meaning that service users had not always been protected from the possible risk of further harm.

Systems had not always been effective in monitoring the service provided. For example, making sure that important daily, weekly and monthly checks had been completed.

An effective system had not been used to make sure that all provider policies that were being used were up to date, included the most up to date best practice guidance and legislation and contained up to date information that reflected current systems and processes.

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.

The service was able to demonstrate how they would meet the underpinning principles of Right support, right care, right culture:

Right support: Model of care and setting maximises people’s choice, control and Independence. The service adopted the least restrictive practices underpinned by a positive behaviour approach. Right care: Care is person-centred and promotes people’s dignity, privacy and human rights. Staff knew children well and responded to them appropriately and sensitively. Children took part in activites and pursued interests tailored to them. The service gave children opportunities to try new activities. Staff acted appropriately as advocates for children when they were best placed to do so.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Staff knew and understood children well. They got to know children well and considered this a key element of personal care.

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

This service was registered with us on 17 September 2020 and this is the first inspection.

Why we inspected

We undertook a full inspection of the service as it is newly registered and has not been inspected previously.

Enforcement and Recommendations

We have identified breaches at this inspection and have issued and have issued warning notices in relation to safety and governance. Although the provider took actions to address the concerns we identified both during and after the inspection, further improvements are still required.

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 and will re-inspect the service to make sure that improvements have been made.