This inspection took place on 27 July 2018 and was unannounced. At our last inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Need for consent as the provider did not always operate in line with the principles of the Mental Capacity Act (2005). At this inspection we found that improvements had been made and the service was no longer in breach of the regulation.

The Woodlands Residential Home provides personal care for up to 14 people; the home provides support specifically for older people and is situated in a residential area of Meols, Wirral. There is a small car park and garden available at the rear of the property. All bedrooms are single occupancy and are provided over two floors. At the time of the inspection there were 14 people living at the home.

The Woodlands Residential Home 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.

The Woodlands Residential Home had a registered manager who has worked at the home for a number of 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.

We looked at how the service managed it’s recruitment of new staff and saw that this was done well and all of the required checks were carried out before staff commenced working at the home.

We spoke with five people who lived in the home who all gave positive feedback about the home and the staff who worked in it. They told us that the staff supported people to live their lives in the way that they had chosen to do so. We saw that warm, positive relationships with people were apparent and many people described the staff as “like family.”

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw they knew people well and how they liked to be cared for.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were kept safely with appropriate arrangements for storage in place. The improvements that we found at our previous inspection had been sustained and more improvements made.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

Care plans were person centred and driven by the people who lived who lived in the home. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also regularly spoke with the people who lived in the home. The provider also provided close scrutiny of the service and was a regular presence in the home providing activities for people such as mini bus outings and canal barge trips and providing support for the manager.

The inspection took place on Thursday 8 and Friday 9 June, 2017 and was unannounced.

The Woodlands Residential Home provides personal care for up to 14 people; the home provides support specifically for older people and is situated in a residential area of Meols, Wirral. There is a small car park and garden available at the rear of the property. All bedrooms are single occupancy and are provided over two floors. At the time of the inspection there were 14 people living at the home.

A passenger lift enables access to bedrooms which are located on the first floor for people with mobility issues. On the ground floor, there is a communal lounge and a dining room for people to use.

At the time of the inspection there was a registered manager in post. The registered manager has been in post since 2013. 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 previous comprehensive inspection which took place in December, 2015 found that the service was not meeting all of the regulations which we inspected. We identified breaches in Regulation 12 ‘Safe Care and Treatment’, Regulation 14 ‘Meeting nutritional Needs’ and Regulation 17 ‘Good Governance’ of the Health and Social Care Act 2008 (Regulated Activities) 2014. These breaches related to the provision of safe and appropriate care being provided to those who lived in the home, medication management, nutritional needs and the overall management of the service.

At this inspection we found that improvements had been made in all areas but some areas required further improvement.

At this inspection we found a breach of Regulation 11 ‘Need for Consent’ of the Health and Social Care Act 2008 (Regulated Activities) 2014

The provider did not always operate in line with the principles of the Mental Capacity Act, 2005 (MCA). Mental capacity assessments were completed, the necessary Deprivation of Liberty Safeguards (DoLS) had been submitted to the local authority but there was no evidence to show any best interest decisions or meetings had taking place and the least restrictive options had been explored.

At the last inspection we found the provider to be in breach of the regulation regarding good governance. Care plan audits, financial audits, maintenance audits and medications audits which were in place were found to be ineffective and did not evidence how safe, quality care was being measured, monitored and managed. Audits which were conducted were not robust enough, did not support a consistent approach to quality or standards of care and did not evidence how improvements were being made.

The provider was no longer in breach of this regulation but we have made a recommendation in relation to the standards of audits and their effectiveness.

We found that there was a good level of support being offered to all staff within The Woodlands Residential Home. Staff felt they were supported with their professional development; they were provided with the necessary training and skills to deliver the correct and appropriate level of care which needed to be provided and they received consistent supervisions and appraisals. It was evident that the manager operated an ‘open door’ policy and staff expressed they could seek support and guidance whenever they needed to.

Staff were familiar with the support needs of the people they were caring for. Staff could explain the different levels of support which needed to be provided, different preferences of people, specialist dietary needs and likes and dislikes of some of the people living in the home.

Accidents and incidents were routinely recorded on an internal database system. These were discussed as part of the daily handovers which took place and helped to inf

This was a follow up visit undertaken to look at the areas where compliance actions had been made at the previous visit on 30 September 2013. These areas included infection control and quality assurance.

We looked at infection control and found that equipment was clean, in good working order and had been serviced. During a tour of the home we found the home was clean, free from offensive odours and maintenance and redecoration had been undertaken since the previous visit.

We looked at the quality assurance and found that this area had improved and people who lived at The Woodlands and their families and friends views were sought and acted upon.

On the day of the visit we spoke with four people who lived at the home, two staff, the manager and deputy and a visiting professional. People who lived at the home commented: “I like it here”, “The staff are lovely” and “The staff are kind.”

We looked at three care plans and other care records and they all had an assessment of their health and social needs completed. The care plan documentation was up to date and reviewed on a monthly basis.

We spoke with six people who used the service, three relatives, two staff and three professionals involved in the service. People who used the service said: “The staff are lovely”, “I like the food” and “The staff are kind.”

We observed interactions between the people who used the service and staff during the day and found there was a relaxed and friendly atmosphere between them.

During a tour of the building we found it was clean and odour free. However concerns were raised regarding stained and worn carpet on the first floor and in the office and some documentation regarding the home.

We saw that although improvements had been made with regard to supervision and appraisals of the staff team, most staff had not fully completed mandatory training. This meant that staff were not fully trained to support people who lived at the home.

Policies and procedures seen were not dated or signed. Also they referred to out of date legislation. There was no policy for pressure ulcer care and prevention or staff training.

There was very little quality monitoring undertaken within the home and people who lived there were not consulted on a regular basis so that their views could be used to inform service provision. Generally records were not up to date.

We spoke with four people living at the home and one relative. They all told us that they were very happy with the home and had no concerns about the care they received. One person said “the staff are wonderful.” Everyone we spoke with told us the staff were always respectful and very helpful. One person said “the food is very good” and another said “there is plenty to eat.”

We found that the home was generally clean however, the manager was not aware of the guidance for the prevention and control of infections and there was no infection control policy in place. We found that staff had not received regular supervisions or training in order to support them to carry out their role. We also found that there was a lack of quality assurance monitoring systems in place. This meant that when incidents occurred involving people's welfare, there were no mechanisms in place to prevent the same issues re-occurring.

At this visit we spoke to people who use the service and their relatives.

People told us they were happy living here and felt they were well looked after. They made comments such as:

“Its very good here”

“Very nice and quite pleasant”

Relatives we spoke with told us;

“Mum is very happy here”, “It’s all lovely”.

People who use the service were seen to be happy and enjoying interaction with the activities coordinator who was working that day.

During this inspection we did not ask people's views on the service.The purpose of this visit was to check that improvements had been made against the concerns identified at the previous inspection. We were satisfied with people's views on the service that we received at last inspection.

We assessed information from sample service user surveys that were submitted by the provider and we talked to service users and their family members during the site visit.

People told us that generally they were very satisfied with the care and treatment provided at The Woodlands Residential Home. They told us they were treated with dignity and respect and they were involved in decisions surrounding their care and social activities.

They also told us that they were satisfied with the cleanliness of the home, that their nutritional needs were met and that the staff and management were kind and caring and looked after their needs. They felt there was sufficient staff on duty at all times although on occasions they could be very busy.

Family members interviewed also expressed satisfaction at the care given to their relatives.

The Woodlands Residential Home provides personal care and accommodation for up to 14 people. Nursing care is not provided. The home is situated in Meols, Wirral. There is a small car park and garden available at the rear of the property. Bedrooms are single occupancy and are provided on two floors. A passenger lift enables access to bedrooms located on upper floors for people with mobility issues. On the ground floor, there is a communal lounge and a dining room for people to use.

The home has a registered manager. 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.’

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014. These breaches related to the provision of safe and appropriate care, medication management, ensuring people’s nutritional needs were met and the management of the service. You can see what action we told the provider to take at the back of the full version of the report.

We reviewed four care records. Some risks associated with people’s care were assessed but we found that risks in relation to skin integrity, behavioural needs and some physical health conditions were not properly assessed and managed. This meant staff had no clear guidance on how to manage these conditions to prevent further decline. This placed people at risk of receiving inappropriate and unsafe care. Where people had mental health issues, their care plans lacked adequate information on how these issues impacted on their day to day lives and decision making.

People’s nutritional needs and risks had been assessed but there were no appropriate nutritional care plans in place to advise staff how to promote people’s nutritional intake. Where people had special dietary requirements or where at risk of malnutrition, care plans lacked any guidance on how staff should monitor and manage people’s special dietary needs. This meant there was a risk people’s nutritional needs would not be met.

Some people required assistance to eat their meals. We found that the majority of staff did so in a patient, sensitive manner by gently encouraging the person to eat whilst sat next to them. One staff member however although patient, did not support the person to eat in a way that promoted their dignity or safety.

We found that care plans contained person centred information about the person and their life prior to coming to the home. Care plans however were not holistic, did not reflect the totality of people’s needs and care and some of the information was inaccurate. This made the delivery of good person centred care difficult as up to date information about the ‘whole’ person was not available to staff. We also saw that where person centred guidance had been given, it was not always followed by staff to ensure people received the care they needed.

We noted some elements of good leadership in the service. People told us they were happy with the care they received and said they were well looked after. We saw that people had prompt access to any medical or other health related support as and when required. Staff were confident in their job role, worked well together as a team and the manager was a positive role model for staff on how to provide kind and compassionate care. The way the provider and manager monitored the quality and safety of the service required improvement.

The audits in place to assess, monitor and mitigate any risks to people’s health, safety and welfare were ineffective and inadequate. Care plan audits failed to identify any of issues with the planning and delivery of care that we found during the inspection. Premises related audits were poor as it was impossible to tell what parts of the home had been monitored for quality and safety purposes. Medication audits checked the quantity of medication in stock against medication administration records but where discrepancies were identified there was no evidence that they had been investigated and resolved. Audits of people’s personal spending monies, held by the provider were ineffective as they did not verify that the balance of money each person had left was correct. This lack of effective audits demonstrated that the service was not consistently well led.

People we spoke with were happy at the home and spoke highly of the staff and manager. They told us staff were kind and respectful and ensured that they were well looked after.

We observed the serving of lunch in the dining room. Not many people attended the dining room to eat but we saw that people were given suitable menu choices and portion sizes were sufficient. Meals were served promptly and pleasantly by staff.

We noted that people looked well dressed and content. Staff supported people in a patient, unhurried manner and people looked relaxed and comfortable in the company of staff. Staff we spoke with had an understanding of people’s needs, preferences and life prior to coming into the home. We saw that staff used this knowledge to communicate with, and relate to the people they cared for. We saw that people who lived with dementia responded positively to staff who interacted with them in this way. This showed that there were some elements of good person centred practice in operation at the home.

We observed the home’s morning medication round. We saw that staff had been trained in how to administer medication and that they did so safely. Record keeping in relation to ‘carried over’ medication and the ordering of repeat medication required improvement.

Staff were recruited safely and received regular training and support in the workplace. We found that the number of staff on duty was sufficient to meet people’s needs. People told us they felt safe at the home and had no worries or concerns. Staff had received safeguarding training and demonstrated an understanding of safeguarding when asked. We saw that safeguarding incidents were appropriately investigated and reported.

There was a complaints procedure in place and the manager had responded appropriately to complaints made. Information for people at the home in relation to their service however was not readily available in the form of a service user guide.

Equipment was properly serviced and maintained. The premises, although shabby in parts, was safe. The provider told us they had a yearly refurbishment plan in place and we saw some evidence of this. The call bell system at the home required review to ensure that staff were able to quickly identify the location of the call.

People’s views on the quality of the service had been sought in October 2015 with positive results.