Brendoncare Woodhayes is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Brendoncare Woodhayes provides nursing care and accommodation for up to 25 older people who may also be living with dementia. At the time of this inspection, 18 people were living at the home, mostly over the age of 90. The Brendoncare Foundation provides support from their head office to ten homes nationally.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

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 registered manager had recently been on long term sick leave so an acting manager was in place and the provider had kept us up to date with management arrangements. The registered manager was due to return the next day and had kept in touch with staff and people living at Brendoncare Woodhayes.

People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. Assessments were regularly undertaken to review people's needs and any changes in the support they required.

People had access to a wide range of group and individual activities and events they could choose to participate in, which were tailored to meet their specific social needs and interests. This enabled people to live an active and fulfilling life.

People who preferred or needed to stay in their bedroom were protected from social isolation. People regularly participated in outings and activities in the local community. The service also had strong links with local community groups and institutions.

When people were nearing the end of their life, they received compassionate and supportive care. People's end of life wishes were sensitively discussed and recorded.

Staff were aware of people's communication methods and provided them with any support they required to communicate in order to ensure their wishes were identified and they were enabled to make informed decisions and choices about the care and support they received.

The service had appropriate arrangements in place for dealing with people's complaints if they were unhappy with any aspect of the support provided at the home. People and their relatives said they were confident any concerns they might have about the home would be appropriately dealt with by the managers.

People were kept safe at the home, cared for by staff that were appropriately recruited and knew how to highlight any potential safeguarding concerns. Risks to people were clearly identified, and ongoing action taken to ensure that risks were managed well.

People's medicines were managed safely and the provider ensured that incidents and accidents were fully investigated. The home was well kept and hygienic. There was ongoing investment in the older style building.

Staff were well supported through training, supervision and appraisal. Staff worked effectively together to ensure people's needs were communicated and supported them to access healthcare professionals when they needed them.

People enjoyed the meals available to them and were appropriately supported with eating and drinking. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home was dementia friendly and met the needs o

Brendoncare Woodhayes is registered to provide accommodation for 25 people who require nursing and/ or personal care. At the last inspection in April 2015 there was a registered manager. They left the service in September 2015. The deputy manager, at this inspection in May 2016 has now been employed as the manager and registered with the CQC in February 2016. A registered manager is a person who has registered with the 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 Brendoncare Foundation has ten care homes across the country which includes Woodhayes.

At the last inspection carried out in April 2015 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care plans did not reflect how care and treatment was designed with a view to achieving people’s preferences and ensuring their needs were met. There were not enough staff to ensure people’s needs could be met in a person centred way. Staff did not receive appropriate support, supervision and appraisal to enable them to carry out the duties they were employed to do. People were not involved about their care plans and relevant persons were not provided with the information they needed relating to care plans. Quality assurance systems were not robust to ensure they assessed, monitored and improved the quality and safety of the services provided. Records did not always ensure that people’s hydration and nutrition was monitored robustly. We rated the service as ‘Requires Improvement’.

Following the last inspection we received a satisfactory action plan from the provider. This addressed all the issues we raised. We carried out this inspection in May 2016 to check whether these actions were in place and people’s needs were being met. We found the service had worked hard to ensure all the above areas had been addressed and we rated the service ‘Good’ overall.

On the day of the inspection there was a calm and happy atmosphere throughout the home. People were going about their day as they wished and were enjoying and engaging with staff taking part in activities. People were well looked after and staff were knowledgeable about their needs and how to meet them. Staff were kind and interacted with people in a friendly and respectful way.

There had been an increase in staffing levels which had been adjusted to ensure people’s needs could be met using a dependency score tool. This ensured that staff had time to meet people’s care needs in a holistic way including their social needs.

A new senior care worker role had been developed and staff were valued and supported to carry out their roles. One senior care worker was the training lead with responsibility for ensuring staff understood their roles and was involved in care planning. Staff told us they were much happier and able to meet people’s needs effectively. Comments included, “It feels like we are well supported and work together as a team”, “We feel like one big family”, “I’ve been to other homes and come back here, it’s so much better” and “It’s so much better, we have lots more staff and we are really happy.” One registered nurse said, “We have better support and it’s a real improvement on last time.” People who were able to speak to us commented positively saying, “I like the activities. I am happy to live here” and “I like everything about the home. I like the care and kindness of the staff.”

A new activity programme had been developed involving staff at the home rather than solely the activities co-ordinator. Staff felt empowered to offer and arrange activities and events and felt able to spend time with people in a way that they wanted. The new deputy manager said, “Staff can spend time with people, for example we use everyday objects to create a moment. Staff can sit a

We carried out this inspection unannounced on 9 August 2013. There were 22 people living at the home at the time of the inspection with one vacancy and a flat on the second floor was being refurbished. We spoke to the manager, four staff and six people living at the home. People living at the home were very positive about the care they received. Comments included “It’s lovely here, everything. I’m lucky to be here, lovely room, lovely all round.”

We found that people’s care was comprehensively assessed prior to admission and that information from external health professionals and families as appropriate was used to ensure that personalised care planning was in place. Staff were knowledgeable about people’s needs and had easy access to clear information so that these needs could be met.

The home was well maintained with a rolling maintenance programme and any issues had been identified and quotes obtained, for example. There was an on-going programme of replacing all the windows in progress. Vacant rooms were being refurbished and the home had policies in place to ensure that the home was kept clean and hygienic.

There was a robust complaints and recruitment system overseen by the providers’ head office staff. These ensured that people were able to voice any concerns and that they would be listened to and that people were protected from unsuitable staff through effective recruitment processes. Records were well kept and stored securely.

On the day of our visit there were 23 people living at Brendancare Woodhayes and we spoke with five people living at the home, four staff members and looked at four people's care files.

People told us what it was like to live at the home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by Expert by Experience; people who have experience of using services and who can provide that perspective.

Some of the people who used the service at Brendancare Woodhayes were living with dementia and therefore some were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

People we spoke with told us that they were very happy with the care and support they received. Comments included ‘’ they go out of their way to help you’’. ‘’They’re very good, kind, gentle and friendly,’’ ‘’they listen to what you say’’

People were complimentary about the food and choices available to them. One person described the food as ‘‘excellent,’’ others as ‘‘very good’’ with ‘’plenty of choice.’’ We saw that there was a good range and choice of meals available for people to choose from. Those people who needed assistance to eat and drink were supported in a discreet and respectful manner.

We found that there were sufficient qualified and experienced staff available to meet people’s needs. We observed care and support being delivered in a kind and respectful way.

We found that records were accurate, up to date and stored securely.

Brendoncare Woodhayes is registered to provide accommodation for 25 people who require nursing and/or personal care. There is a registered manager who is responsible for the home. A registered manager is a person who has registered with the 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 Brendoncare Foundation has ten care homes which include Woodhayes.

At the last inspection carried out on 9 August 2013 we did not identify any concerns with the care provided to people who lived at the home. Prior to this inspection in April 2015 we received some concerns from two sources about lack of staff and concerns about the quality of care. We found that although people using the service, who were able to comment, felt the service was safe we found this was not always the case. Although there were enough staff to meet people’s basic needs there were not enough staff available to meet people’s needs fully in a person centred way. Care was delivered which focussed on tasks and time frames. People did not have their individual emotional, social and mental health needs met.

Care plans did not provide adequate information for staff to be clear about how to meet people’s needs or reflect the care provided. One person with complex needs had no care plan and staff relied on verbal knowledge. Nursing updates in general were communicated through a communal handover sheet. Care planning did not involve people using the service or their representatives.

On the day of the inspection the home was busy. Staff were unable to spend any time with people other than during tasks. There was a high level of people with complex needs. For example, 10 people required two staff and a hoist to mobilise and six people required assistance with feeding. However, we saw staff were managing to meet people’s basic needs such as assisting people to get up in a timely way and ensuring their hygiene needs were met. Staff were kind and interacted with people in a friendly and respectful way.

There was an activity programme three days a week for 18 hours assisted by a care worker for four allocated hours. Although this provided a range of activities and was well organised this only met the needs for people who were able to or chose to attend these activities. Care staff had little time to offer engagement and stimulation for people such as chatting, going into the garden or to the nearby shops or to spend time with people in their rooms. This was despite isolation being highlighted as a risk in some people’s care plans. People who chose to or required assistance mainly in their rooms did not have their emotional and mental health needs met.

Staff had a good understanding of people’s legal rights, and understood the correct processes regarding the Deprivation of Liberty Safeguards and use of restrictive measures intended to keep people safe.

The provider had systems in place to make sure people were protected from abuse and avoidable harm. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally.

People were not involved in planning and reviewing their care. Some relatives had requested to see care plans but this had not happened. The home was changing the care plan format but this was taking some months and there was poor recording in care plans generally. This meant staff would not know how to care for people in a person centred way by referring to care plans.

However, there were regular reviews of people’s health and staff responded promptly to changes in need. Nurses were knowledgeable about people’s needs and health professional advice was sought appropriately. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

Staff had good knowledge of people including their needs and preferences but did not have time to ensure care records reflected these or that information was used to ensure these needs were met. Staff felt frustrated that they did not have enough time to meet people’s needs.

Staff were well trained and training was up to date or booked, there were good opportunities for on-going training and for obtaining additional qualifications. However, staff did not receive formal one to one supervision sessions on a regular basis. This did not ensure that any issues were monitored or discussed formally.

People’s privacy was respected. Staff ensured people kept in touch with family and friends. Visitors said they were made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.

There was a management structure in the home which provided clear lines of responsibility and accountability.

There were some effective quality assurance processes in place to monitor care and plan on-going improvements. Some of the issues above had been identified in audits but had not improved. This had been shared by the registered manager with Brendoncare head office.

There were systems in place to share information and seek people’s views about the running of the home. People’s views were acted upon where possible and practical. However, although the registered manager was aware of some of the issues raised above there had not been sufficient improvement.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.