This inspection took place over two days on 10 and 11 January 2017 and was unannounced. At our last inspection we found four breaches of regulations 11, 12, 16 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to assessing people’s capacity and decision making ability, emergency evacuation in case of fire, responding appropriately to complaints and staff not receiving regular supervision and appraisal. At this inspection we found that the provider had addressed these issues.

Woodbury Manor is a residential care home that provides care and support for 60 people aged over 65, some of whom have dementia. The home does not provide nursing care. It has three wings. Cedars, which provides care and support to 22 people living with advanced dementia. Maple and Woodbury provide care and support for people who are elderly frail and may have a diagnosis of early stage dementia. At the time of the inspection the service was supporting 51 people.

There was a registered manager in place who had been in post for 11 months. The registered manager was present throughout 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.

There were detailed risk assessments in place that provided staff with clear guidance on what the risks were to that individual and how identified risks could be mitigated. Risk assessments were tailored to each individual. Risk assessments were reviewed and updated regularly.

There was a system in place if people were at risk of developing pressure ulcers. All people living at the home were assessed each month and appropriate referrals made if there were any concerns.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

Care plans were person centred and reflected individual’s preferences. Care plans had been signed by people. Where people were unable to sign, they had been signed by relatives.

Medicines were well managed by the home. People received their medicines on time. Medicines storage was appropriate and secure and there were regular audits of medicines.

Accidents and incidents were documented and any follow up treatment was recorded.

People were supported to ensure that they had enough to eat and drink to meet their nutritional needs. Staff were aware of specialist diets and people’s needs relating to this.

The provider had ensured that all staff employed had received appropriate checks before commencing employment.

The provider encouraged learning and development. Training was updated regularly and monitored by the manager. Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care.

There were activities provided for people and people were involved in choosing what activities they wanted each month.

There was a complaints procedure in place which people and relatives had access to. Complaints were responded to and resolved in a timely manner.

People and their relatives felt that staff were kind and caring.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care. There was a complaints procedure as well as incident and accident reporting. Surveys were completed with people who used the service and their relatives. Where issues or concerns were identified, the manager used this

A single inspector carried out this visit. We gathered evidence that helped answer our five questions; Is the service caring, responsive, safe, effective and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people using the service, three visiting relatives and five staff supporting them and from looking at a selection of records.

Is the service safe?

Staff were recruited via a robust selection system ensuring staff had the skills required to keep people safe. The home was clean throughout and this was maintained by domestic staff, who were well-led by a supervisor.

Deprivation of Liberty Safeguards (DoLS) which applies to care homes were adhered to. On the day of our inspection we were advised the provider was in negotiations with the local authority to apply for DoLS applications for appropriate people who used the service. Staff had been trained to understand when an application should be made to deprive someone of their liberty.

Systems were in place, which ensured the home was continually reviewing safety measures. There were systems in place to make sure the manager and staff learned from events such as falls, accidents and incidents. This reduced the risk of harm to people and helped prevent such incidents in the future.

Is the service effective?

From our observations people were happy with the care which was being delivered and their needs were being met. One person told us, "The care here is excellent.” From speaking with staff and our own observations we found there was good understanding of people's care and support needs. Staff we spoke with were clear about how best to support people while maintaining their independence and dignity. Care plans we examined included assessments and reviews of people's health and care needs, as well as detailed information to ensure staff delivered care consistently to meet people's needs.

Is the service caring?

People were supported by sympathetic and patient staff, who displayed patience and gave encouragement when supporting people. Lunch was sociable and people told us they enjoyed the food served. One person told us, "the food here is good.” People were given time and supported to enjoy their meal.

Is the service responsive?

Relatives of people living at the home were updated monthly by care support staff with a review of their care plan. The home held residents' meetings and published a care home newsletter. The home had a transparent complaints policy and responded to concerns promptly. People we spoke with told us the manager was approachable and they would feel comfortable raising any concerns with her.

Is the service well-led?

The manager held regular staff meetings and used them to communicate issues related to the day to day running of the home. Staff we spoke with were clear about their roles and responsibilities and confirmed they had the opportunity to attend regular staff meetings. They said they felt supported by the manager. There were systems in place to ensure training was kept up to date for all staff.

At the last inspection on 8 February 2013 we found that some staff did not receive appropriate training to work with people who use the service. The provider had also failed to notify us of incidents of injuries and deaths in a timely fashion. The registered manager has since taken steps to address these areas of concern.

In relation to the care provided, one person told us "I just love getting up in the morning to be in here." Care plans were under review as the provider had introduced a new format to improve the quality of recording as recommended by the local authority. There were systems in place to ensure medicines were managed safely. The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. Records used within the service were appropriately maintained.

In relation to the care provided, one person told us "staff are brilliant with me." One persons' relative told us "the staff here are angels." We found that care plans and assessments of risks to people who use the service were regularly reviewed. Staff demonstrated the knowledge and skills needed to protect people from abuse. Arrangements were in place to ensure people were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. People felt safe with the staff that supported them. The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.

We found that some staff did not receive appropriate training to work with people who use the service. The provider had also failed to notify us of incidents of injuries and deaths in a timely fashion.

People and their relatives told us that staff involved them in decisions about care and treatment. One person said, "Staff do listen to me and do what I want." Another person explained that staff, "Told me about how they would care for me." People said that they received the care and support they needed. A person said, "Staff asked how I wanted things done." People spoken to confirmed that they trusted staff and felt safe. A person said, “I feel safe here.” They told us that staff knew how to support them. A person told us when asked about how staff treated them, "The staff are helpful." People told us and we observed that staff listened to them. Staff responded to any suggestions they made about the home.

This inspection took place over two days on 26 and 27 November 2015 and was unannounced. At our last inspection we found that the provider met all standards that we inspected.

Woodbury Manor is a care home that provides care and support for 60 people aged over 65, some of whom have dementia. The home does not provide nursing care. It has three wings. Cedars, which provides care and support to 22 people living with advanced dementia. Maple and Woodbury provide care and support for people who are elderly frail and may have a slight degree of dementia.

The home’s registered manager had left the week that we inspected. 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 operations manager and a head of care for Woodbury Manor were present throughout the inspection.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff were able to explain the principles of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). However, only one person had an MCA assessment in place. The provider had failed to ensure that people they had identified as potentially lacking capacity were appropriately assessed. There were 38 people who had been identified as requiring a DoLS but these had not been applied for.

There were weekly fire alarm checks. However, the provider had not put personal evacuation plans (PEEPS) for people who required specific help in case of a fire. This put people at risk.

There were person centred care plans that allowed staff to provide appropriate support to people. Care plans stated people’s likes and dislikes and contained detailed life histories.

Staff did not receive regular supervisions. Supervisions that we saw were brief and did not support staff to carry out their role effectively. There were no appraisals for staff for the past two years.

The provider did not record complaints effectively. There was no evidence that management used learning from complaints to drive quality of care.

People were supported to maintain a healthy lifestyle and had healthcare appointments that met their needs. These were recorded and monitored on a regular basis. Medicines were administered safely and on time. Staff had completed training in medicines and administration.

People told us that they felt safe within the home and well supported by staff. Where people were unable to talk to us, we carried out a Short Observational Framework for inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

People were supported to ensure that they had enough to eat and drink to meet their nutritional needs. Staff were aware of specialist diets and people’s needs.

The provider completed annual surveys with people and relatives. Action plans were created following surveys to help maintain and improve quality of care. 

The home had two activities coordinators and there was a full programme of activities both internally and externally to the home. People were consulted during regular residents meetings about what they wanted to do. People felt that their views were listened to and acted upon.

The home was clean and well decorated. The provider had ensured that décor and layout of the home supported and assisted people living with dementia.

We found that the service breached four regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. Where there were breaches of regulations, you can see what action we told the provider to take at the back of the full version of the report.