This inspection took place on 19 September 2017 and was unannounced. At the last inspection in August 2016 we rated the service as requires improvement. At this inspection we found the required improvements had been made.

Woodhouse hall is registered to provide accommodation and personal care for up to 19 people who have a learning disability and or autism spectrum disorder related conditions. The service is divided into two units and is located in the East Ardsley area of Leeds with good access to transport and local amenities.

The service had a registered manager in post at the time of the 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 service is run.

People told us they felt safe living in the home, and staff were aware of their responsibilities to protect people’s health and wellbeing. The property was secure and appropriately decorated, with all relevant maintenance documents and certificates in place.

There were enough staff to deliver care safely, and staff were recruited appropriately. Staff received good support through induction, training and continuous supervision and appraisal. Staff knew how to deal with challenging behaviours appropriately and demonstrated good knowledge of the Mental Capacity Act 2010. All incidents were recorded and investigated as required.

People were supported to access healthcare professionals appropriately and this was clearly documented in people’s care records. People were supported with their nutrition and hydration needs and were encouraged to get involved with food preparation.

People were cared for by kind and attentive staff who clearly understood how to communicate with people, and knew and understood their individual needs.

The service promoted people’s independence and respected their choices. Staff were trained to recognise and protect people’s rights under the Equality Act 2010.

Care plans were written in a person centred way which meant that their care was delivered in accordance with their preferences, interests and diverse needs. People and their relatives were encouraged to get involved with care, and people were supported to maintain relationships with those who mattered to them.

The service had recently appointed a registered manager to the service. Staff told us there was a positive working culture with strong leadership from senior staff. All staff we spoke with recommended the service as a place to work.

There were effective quality assurance systems in place to continually review and improve the service, including medicines administration, incidents, safeguarding concerns and daily notes.

This inspection took place on 11 and 15 August 2016. Day one was unannounced and day two was announced. At the last inspection in December 2015 we rated the service as inadequate and it was placed into ‘Special measures’ by CQC. The provider was breaching five regulations. They did not have suitable arrangements to manage medicines, meet people’s nutritional needs, prevent the spread of infection and provide person centred care. Systems were not effective to assess, monitor and improve the quality and safety of services. There were not enough suitable, competent, skilled and experienced staff to meet people’s needs. Staff were not supported to do their job well. At this inspection we found the provider had taken action sufficient to meet regulations although further development was still required in some areas to ensure these were fully effective. The service is no longer rated as inadequate for any of the five key questions and therefore we have taken it out of special measures.

Woodhouse Hall is registered to provide accommodation and personal care for up to 19 people who have a learning disability. The service is divided into three units. The service had a manager who was registered as the manager soon after the 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 service is run.

People felt safe. The provider had improved and continued to develop systems to help keep people safe, which included protecting them from abuse. Better plans to support people when they displayed behaviours that challenged were being introduced. There were enough staff to keep people safe. A lot of new staff had started working at the service which sometimes resulted in a high percentage of inexperienced staff working on shift. Recruitment checks were carried out before staff started working at the service although this did not always include a full employment history. The management team were going to do a full audit of staff files to make sure this information had been provided. Appropriate systems were in place to manage medicines.

Staff were trained and supported to do their job well. The provider continued to improve arrangements for supervising staff. People received a more varied and nutritious diet; menus were being further developed. A range of other professionals were involved to help make sure people stayed healthy. People made their own decisions as far as possible and were helped to do so when needed.

People’s care records were personalised and provided information so staff understood what was important to them. Staff knew the people they were supporting and how to meet their individual needs. During the inspection we observed staff were caring but there were occasions when some staff showed a lack of interest in the people they were supporting.

The care and support planning system had improved although this was being further developed to make sure people’s needs were identified and staff had clear guidance around supporting people. The support plan files were being audited and areas that required changes were identified. Arrangements for reviewing care with people were inconsistent. Each person had an activity record that showed they had engaged in a variety of activities.

We received very positive feedback about the service manager and were told they were making definite improvements to the service. The management team at Woodhouse Hall were supported by senior managers and everyone was working through agreed actions to make sure all necessary improvements were made. It was evident from reviewing documentation and discussions that following the inspection in December 2015 initial progress had been slow. People who used the service attended ‘Your V

This inspection took place on 8 December 2015 and was unannounced. At the last inspection in November 2013 we found the provider was meeting the regulations we looked at.

Woodhouse Hall provides care for up to 19 people who have a learning disability. At the time of the inspection, the service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service was divided into three distinct areas, and the inspection highlighted that people had a different experience which depended on where they lived within the service. Some people were happy with the service and we saw that they were comfortable in their surroundings. Others experienced a lack of consistency in how their care was delivered. Care plans were not followed, activity planners were not implemented and menus were not in place so we could not establish whether people received a nutritional and varied diet.

There were not enough, experienced staff to keep people safe and meet their needs. Some people received funding for one to one staff support but they did not always receive this.

Systems were not in place to ensure staff were appropriately trained and supervised.

The provider’s system to monitor and assess the quality of service provision was not effective. Actions that had been identified to improve the service were not always implemented. There was a lack of management and leadership and staff did not feel supported.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

The environment in which people lived promoted their privacy and dignity and supported their rights to choose and retain a level of independence. It was noted however, that people did not have access to private facilities for personal care. The regional manager informed us that there were plans in place to refurbish the home in July 2014 and each person living in the home would have their own en suite facilities.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at three care records and saw that records recorded information on people’s daily routine. They described what time people liked to get up, what they liked to eat and drink and how they liked to spend their day.

All of the staff we spoke with during our visit were familiar with safeguarding procedures and had experience of abuse being carried out. One staff member said “We had an incident where one person made a gesture to another person which resulted in them hitting that person”. The staff member said that this incident had been reported to the manager who had then informed the local safeguarding team and CQC.

We looked at the training files of staff which showed that staff were up to date and had received training in areas such as infection control, health and safety, moving and handling, safeguarding and managing violence. All of the staff we spoke to were either trained to NVQ level 2 or 3 or were undergoing the training. They were given time to do this.

We asked how the provider monitored the quality of care they delivered. We were told that the home carried out monthly monitoring and were shown documentation of audits being carried out on internal quality monitoring. This covered areas such as; staff communication and involvement with service users, respect for privacy and dignity and respect for quality and diversity. Audits were also carried out on; records, documentation and quality of the environment.

At the time of our visit there were six people living at Woodhouse Hall. The general manager, who was responsible for the day to day running of the home, was on a training course throughout the majority of our visit. We therefore spoke with the registered manager and senior member of staff.

We spoke with two people who used the service, one family member and an Independent Mental Capacity Advocate (IMCA) to help us understand the views of the people who used the service.

One person we spoke with told us; “The staff are good.” Another person said; “The staff are alright.”

People told us there were things to do. One person commented; “I like to bake cakes.” Another person said they “went out to museums but I can’t always do what I want.” This person told us; “I have key worker meetings and can discuss things.”

The relative spoken with said; “There are some good staff. I have seen vast improvements in my relative over the last five to six months.” They also confirmed that other health care professionals were involved in their relative’s care.

We found that the staff we spoke with understood the needs of the people they cared for. Staff were clear on how they would respond if abuse was suspected or happening.

We did not speak with people who used the service because the people using the service had complex needs which meant they were not able to tell us their experiences.

The last time we visited the service in September 2011 we found that the decoration and environment of the home was unclean, uncomfortable and unpleasant.

We issued compliance actions for regulation 12 (Outcome 8: Cleanliness and infection control) and regulation 15 (Outcome 10: Safety and suitability of premises) because the communal areas of the home were not pleasant or comfortable, with many of the areas of the home being unclean.

We also used an improvement action for regulation 1 (Outcome 7: Safeguarding people use services from abuse) because we found that staff had not reported properly to the local authority and the CQC allegations of abuse to ensure action could be taken if needed.

The purpose of this review was to see what action the care provider has taken in order to comply with these regulations.

We did speak with the manager and staff who were very pleased with the redecoration that had been done and felt that the home was brighter and had a better environment for the users of the service.

People told us they liked their own bedrooms and enjoyed being able to have their own things in them. Some people took great pride in their rooms and were pleased to show them to us.

People who live at the home said their own bedrooms were kept “Nice and clean.” Some people said they did not think the communal parts of the home such as toilets and corridors were kept clean.

Some people who use the service said they were not happy at the home and wanted to move to other homes run by the care provider. (We have passed this information on to the local authority).

Others said they enjoyed living at the home and staff were good to them.

People also told us they enjoyed spending time in the garden.

People who use the service said they enjoyed living at the home. Their comments included:

“It’s great here, we have good fun”

“There’s nothing wrong with this home”

“I like it here”.

Staff gave good examples of how they make sure people are treated with dignity and respect. They said:

“We make sure all personal care is carried out in private. If people have problems in maintaining their own dignity we have care plans in place to support them”

“We always knock on people’s doors and wait to be asked in to people’s rooms”

“We make sure we speak nicely to people, ask them for their choices and how they want things to be done”.

It was clear that people who use the service were comfortable with staff and had a good lively rapport with them. Staff were friendly and chatty with people and clearly knew them well.

People who use the service told us they are involved in planning their care and support. One person told us they can write their own daily notes. Another told us about a recent review meeting they had attended.

People said they received the care and support they needed. One person said, “They all look after us well” and “The staff do a good job for us”. Another said, “(name of staff) is a lovely, a wonderful person and great company”.

People said they had enough to do and enjoyed the activity at the home. One person told us how much they had enjoyed their birthday celebrations. Staff said that there had recently been an increased emphasis on activity and making sure people were not bored. They said they had seen positive effects in that incidents between people who use the service had decreased.

Although people generally said they were satisfied with the décor and furnishings in the home. Most people said it would benefit from some decorating. Staff also said this, saying the home could be more comfortable and pleasant for people and it should be made more homely.