Woodland Care Home

• People were safe living in the service. Risks had been identified and people told us they felt safe and well looked after. Staff administered medicines as prescribed.

• Staff were kind and caring and supported people to be as independent as possible. Staff asked for consent before delivering care.

• People had access to healthcare professionals when required, and staff followed recommendations when needed.

• Staff knew how to care for people and received training in their roles, and support from the management team.

• Staff supported people to have a range of healthy balanced meals and enough to drink.

• The registered manager had clear oversight of the service and supported an effective staff team, who communicated well. The registered manager was approachable and available to people and staff.

• We found the service continued to meet the characteristics of a “Good” rating in all areas. ;

More information is available in the full report.

Rating at last inspection: Good (published16 July 2016)

About the service: Woodland Care Home is a care home with nursing for up to 46 older people. There were 34 people living in the home when we inspected. There was a manager who is registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the services are run and for the quality and safety of the care provided.

The service is a care home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Why we inspected: We inspected this service in line with our inspection schedule for services currently rated Good.

Follow up: We will continue to monitor this service according to our inspection schedule.

This inspection was unannounced and took place on 16 June 2016.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had received training and had an understanding to ensure that where people lacked the capacity to make decisions they were supported to make decisions that were in their best interests.

The provider had a robust recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

People’s privacy and dignity were respected at all times. Staff sought, and obtained, permission before entering people’s rooms to provide personal care.

People’s health, care and nutritional needs were effectively met. People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines and medicines were stored in a safe way.

Wherever possible people or their families were involved in the planning of the care people received.

People were encouraged to maintain hobbies and interests and join in the activities provided at the home and in the community

The provider had an effective complaints process in place which was accessible to people, relatives and others who used or visited the service.

The provider had effective quality assurance systems in place to identify areas for improvement and appropriate action to address any identified concerns. Audits, completed by the provider and registered manager, showed the subsequent actions taken, which helped drive improvements in the home.

We reviewed the evidence we obtained during our inspection and used this to answer our five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of our findings. If you would like to see further evidence supporting this summary please read the full report.

Is the service safe?

We saw that there were detailed risk assessments in place that covered many aspects of people's daily life and each of these had been completed specifically for the individual they referred to. The risk assessments we looked at were up to date and had been regularly reviewed.

For three people who required intensive care and support, we saw that all the records had been completed appropriately. For example, all the records showed that people were consistently being assisted to change positions in bed every two hours. This was to ensure pressure areas were relieved and reduce the risk of pressure sores developing.

In addition, we saw clear records of people's fluid intake, with daily totals recorded on the sheets at the end of each day. We also noted that people were receiving drinks at varying times throughout the day and night, with one person having records of drinks being taken at 5am, during the day and at 6pm and 8pm.

We saw from the training records that 36 out of a total of 39 staff had completed infection control training in recent months. We also saw evidence that appropriate action was being taken to ensure that all staff were up to date with training in this area.

Staff we spoke with told us that there were always sufficient supplies of personal protective equipment in the home now, such as gloves and aprons. Our observations during this inspection also confirmed this to be the case.

During our tour of the premises, no unpleasant odours were detected in any of the communal areas, nor in people's personal rooms. All the areas of the home that we inspected on this occasion, including individual and communal toilet and bathing areas, were found to be clean and hygienic.

Our observations during this inspection, together with the discussions we had with people living in the home, assured us that there were sufficient qualified, skilled and experienced staff to meet people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We saw that people's care records and assessments of risk were being regularly reviewed and updated, as needed, on a regular basis. All the information we saw was clear, detailed and individual. It was also easily accessible by staff, providing clear guidance with regard to how each person required support, in accordance with their needs and wishes.

We discussed the staffing arrangements with the manager, who explained that the staffing levels were regularly reviewed and adjusted accordingly. For example, when the occupancy levels increased or decreased or when individuals' care and support needs changed.

We saw evidence that where improvements had been suggested, appropriate action had been taken. We also noted that residents and their relatives were informed of the action that would be taken in response to any concerns or issues raised.

Is the service caring?

While we were spending time talking with one person in their room, a member of the kitchen staff respectfully asked the person if they wished to have lunch in their room, to which the person responded with: 'No thank you, I'd like to eat in the dining room today.' The member of staff then replied, with a cheery smile: 'That's fine, I'll put your cutlery and set a place for you in there then.'

Another person said: 'is a marvellous cook and does the fish especially as I need to have it' This person also told us: 'They're a nice lot of staff here, my family come regularly and I can do exactly what I want. They never make me do anything I don't want to. It's brilliant here ' honestly, it's brilliant!'

The manager told us how the activities coordinator always met people on arrival at the home, to help them settle in. We observed this to be the case during this inspection and one person we spoke with told us how the activities coordinator had introduced themselves and spent time with them on their arrival at the home. They added, 'made me feel very welcome and was so friendly when I first arrived'

People we spoke with, who were living in the home, were very complimentary about the staff. One person told us: 'They're all a nice lot of staff here - ever so nice. They're not frightened to work either. We all have a good laugh together.' This person also said: 'They're always taking people out for a walk and we do all sorts of different things. It's my second home now.'

We saw that the home had received numerous 'thank you' letters and cards from people's relatives. All of these were very complimentary and praising of the staff and the levels of care provided.

Is the service responsive?

One person we spoke with said: 'I've certainly got no complaints about anything I've experienced in the time I've been here.' They also said: 'When I need to ring the bell, the times can be somewhat variable but that's quite understandable, as some people here need such a lot of support; the staff can't just leave them if someone else's bell starts ringing. I've never had to wait an intolerable length of time though.'

We noted that some people received some specific one-to-one time with staff. For example, some of the time was spent with people chatting with them in their own rooms, reading a book or the newspaper to them, listening to music together or providing a hand massage.

We looked at the minutes from residents' meetings held on 23 January and 27 March 2014 and the residents' and relatives' meeting, which was held on 27 February 2014. We noted that people had the opportunity to make their views known during these meetings and we saw evidence that appropriate action was taken to meet people's requests. For example, changes to the menus, meal times, entertainment and activities.

We saw from some of the records we looked at that staff knew how to report incidents and there was evidence that learning from incidents took place and appropriate changes were implemented.

Is the service well led?

One person told us: 'I'm hoping to go home again soon; there's no place like home but if I wasn't able to, I'd certainly choose here.'

Since our previous inspection, a new registered manager and a deputy manager had been appointed. In addition, two new care staff had commenced work and two nurses had been interviewed.

The manager told us that the whole staff team had worked really hard since our last inspection, to ensure the necessary improvements were made and maintained within the home. The manager said: 'We all work as one big team. The staff have done so well; they've wanted this (compliance) as much as me. Everyone has always given me 110%.'

During our visit we saw that the manager had an 'open door policy' and actively encouraged comments, suggestions and feedback from the people living in the home, their friends and family and relevant professionals.

The manager told us that they did a 'walk-around' in the home each afternoon, in order to have a chat and catch up with the people living in the home. Some of the people we met and spoke with confirmed this was the case and said that it was 'nice to see the manager each day'.

We saw that quality assurance, covering all aspects of the service provision, was being monitored on a regular basis by members of the organisation's senior management team.

Generally, people's needs had been assessed and described in their care plan. However, the planned care, treatment and support was not always given in a timely manner. We saw evidence that there were significant gaps in people's care records including a lack of up to date information to demonstrate that people's needs were being met.

We reviewed how the service maintained the necessary standards in relation to hygiene and the prevention of infection. The home did have adequate procedures in place but there was evidence that a proportion of these were not being followed. A number of bedrooms, communal toilets and sluice areas did not meet required hygiene standards.

All of the people we spoke with regarding the care staff told us that the staff were kind to them. One person said, 'The carers are very good and work hard. I get cared for and helped. They are very kind.' During this visit we found evidence that there were not enough staff to meet people's needs on a significant number of occasions. The staff we spoke with told us that they felt more nursing and care staff were required.

The home had methods to assess and monitor the quality of service provision. We found that a number of these methods were not effective.

Confidential information was stored and kept correctly. We found that care records and documentation relating to people's care and treatment had not been consistently reviewed with evidence of gaps in people's records.

We spoke with three members of staff who had different roles and responsibilities within the service. They confirmed that they were up to date with their mandatory training. They were also able to demonstrate an understanding of how they met the care needs of the people they were looking after. This demonstrated to us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.