The inspection was carried out on 26 November 2018 and was unannounced.

Woodcote Hall is registered to provide accommodation with personal care for up to a maximum of 56 people. There were 51 people living at the home at the time of our inspection, some of whom were living with dementia. There was a registered manager in post who was present during 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.

At our last inspection we found that improvements were required. At this inspection we have found that the provider has made considerable progress but that there were still areas they needed to address in order to be rated as good overall. Following this inspection, the home continues to be rated as requires improvement.

People were supported to make decisions for themselves and where necessary best interest meetings were held however the staff were not able to locate all associated paperwork in a timely manner.

People were supported to have their personal care needs met however they did not always receive sufficient stimulation throughout the day.

People received sufficient food and drink however the meal time experience could be improved to ensure people were always given choice.

The environment had been improved and refurbishment was taking place however there was still an unpleasant odour that fluctuated during the day.

People's received their medicine from staff who had been assessed as competent to manage medicines safely.

The provider had systems in place to monitor the quality and safety of the services and was working through actions identified from the previous inspection and other audits completed in the home.

People were protected from harm or abuse by staff who knew how to recognise and report concerns. Staff were aware of the risks associated with people's needs and how to minimise these risks.

The management analysed the information to identify any trends and action required to prevent reoccurrence. The provider had safe recruitment procedures in which ensured that prospective new staff were suitable to work with people living at the home.

People were supported by sufficient numbers of staff who had the skills and knowledge to meet their individual needs. Staff received training relevant to their roles and felt supported by the registered manager.

People were supported by staff who were caring and kind. People were supported by staff who knew them well and who had access to up to date information about their needs.

People and their families were encouraged to give feedback on the quality of the service and to make suggestions for improvement. The provider had a clear complaints process and addressed concerns in a timely manner, sharing information with the local authority as necessary.

The inspection was carried out on 19 April 2017 and was unannounced.

Woodcote Hall is registered to provide accommodation with personal care for up to a maximum of 56 people. There were 50 people living at the home at the time of our inspection, some of whom were living with dementia.

There was a registered manager in post who was present during 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.

At our last inspection we found that people’s medicines were not managed safely. At this inspection we found that the provider had made significant improvements and were no longer in breach of the regulations. People received their medicines as prescribed and accurate records were maintained. Only staff who had been assessed as competent to manage medicines safely were able to administer medicines.

People’s rights were not always protected because the provider had not ensured decisions made on their behalf were in their best interests.

The provider had systems in place to monitor the quality and safety of the services. However, these had not identified all the shortfalls we had found.

The provider had not considered good practice guidance to help develop an environment that supported the independence and emotional well-being of people living with dementia.

People did not always receive care and treatment that was responsive to their needs and wishes. Staff were task led and had limited time to engage people in things they enjoyed doing.

People were protected from harm or abuse by staff who knew how to recognise and report concerns. Staff were aware of the risks associated with people’s needs and how to minimise these risks. Staff demonstrated they would take appropriate action in the event of any accidents or incidents. The management analysed the information to identify any trends and action required to prevent reoccurrence. The provider had safe recruitment procedures which ensured that prospective new staff were suitable to work with people living at the home.

People’s nutritional needs were routinely assessed monitored and reviewed. There was a choice of foods and people received the support they needed to eat and drink enough.

People were supported by staff who had the skills and knowledge to meet their individual needs. Staff received training relevant to their roles and felt well supported by the registered manager.

People were supported by staff who were caring and kind. People were supported by staff who knew them well and who had access to up to date information about their needs.

People and their families were encouraged to give feedback on the quality of the service and to make suggestions for improvement. The provider had a clear complaints process and people felt confident and able to raise any concerns with staff or management.

You can see what action we told the provider to take at the end of the full report

This inspection was unannounced and took place on 14 June 2016. At the last inspection in August 2015, we found the provider was meeting the regulations in all of the areas we reviewed; however improvements were required in some areas. At this inspection we found some improvements had been made, however the provider was not meeting the expected standards of care in relation to the safe handling of people’s medicines.

Woodcote Hall is registered to provide accommodation and personal care for up to 56 older people including people with dementia. On the day of the inspection there were 49 people living at the home. There was 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 2008 and associated Regulations about how the service is run.

We found that medicines were not always managed safely. People were not always supported by sufficient numbers of staff. People told us they felt safe and staff were aware of their responsibilities to keep people safe from harm. Risks to people had been assessed and were managed effectively.

People were supported by staff who had received training to ensure they had the skills and knowledge to be effective in their role. People were asked for their consent before support was provided. The registered manager had assessed people’s capacity and acted appropriately to ensure people’s rights were protected. People enjoyed the food and were supported to access appropriate healthcare services when required.

People felt staff were caring and treated them with kindness. Staff knew people well and understood their life histories as well as their needs. People and their relatives felt involved in decisions about their care and support and staff acted in a way that upheld people’s dignity and privacy.

People and their relatives were involved in the planning and reviewing of their care. A range of activities were available for people to participate in, although the registered manager recognised that improvement were needed in this area. People knew how to complain if they were unhappy about any aspect of their care and support and there was a system in place to manage complaints.

People, relatives and staff told us they felt the home was well managed. The registered manager had made a number of improvements since the last inspection. The registered manager was open to receiving feedback and was looking at ways to increase feedback from people and staff. There were systems in place to monitor the quality of care being provided and the registered manager felt supported by the provider to develop and improve the service.

During this inspection we found 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 the report.

This inspection was unannounced and took place on 12 August 2015. At the last inspection on 8 and 9 December 2014 breaches of legal requirements were found and the provider was not meeting the expected standards of care in relation to ensuring people’s care was planned and delivered to meet their individual needs. The provider was not managing people’s skin conditions effectively and did not have sufficient numbers of staff on duty. We also found that the provider had not ensured that there were effective systems to assess and monitor the quality of service provided to people. The provider took some action and applied to change their registration. They ceased to provide nursing care at the home and focussed on providing residential care only. They also wrote to us to tell us what they would do to meet the legal requirements.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements as there had been three breaches at the last inspection. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Woodcote Hall on our website at www.cqc.org.uk. At this inspection we found improvements had been made.

Woodcote Hall provides accommodation and personal care for up to 56 older people with a range of needs. There were 26 people living in the home when we visited. There was no registered manager in post. The provider had appointed an acting manager who had been in post two weeks prior to 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.

Everyone we spoke with told us there were enough staff on duty.

People’s prescribed creams were managed in a safe way by staff who were skilled to do so. The provider had commenced checking staff competencies in respect of medication management and we judged that people were now receiving their prescribed creams safely.

People were provided with a choice of meals and were supported to eat and drink sufficient amounts in line with their healthcare needs.

Staff communicated well with people and treated people with respect and kindness. People told us they could make their own decisions about their everyday lifestyle. People’s needs were responded to in a timely manner and people were not kept waiting for care and support they needed.

The provider had taken steps to commence assessing what was needed at the home to improve the service people received. A new acting manager had been appointed and had begun to take action where improvements were identified. We saw that some improvements had been made in records relating to people’s care and support needs with direction provided to ensure appropriate levels of care was provided . This improvement had been commented on positively by people using the service.

Two inspectors carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

Safeguarding procedures had been improved so that they protected people from the potential risk of harm. Managers had reported allegations of abuse into the safe guarding of vulnerable adults procedures appropriately.

Systems to monitor the quality of the service were not effective. Medication storage systems were not being monitored well. This meant that some medications might not work properly because they were not being stored appropriately.

Most people told us they felt safe. We saw that people were free to go about their daily routine. One person told us, “The care is really good”.

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 had been trained to understand when an application should be made and how to submit one.

Is the service effective?

Most, but not all, of the people who lived in the home told us they were happy with the care they received. They made comments such as, “Staff very good” and “I only have to press the buzzer and they come” and “As soon as I buzz, they’re there”.

Many of the care records had been reviewed since our last inspection. These generally confirmed people’s needs and preferences had been recorded and care and support had been provided in accordance with their wishes. However, we did find examples of records that contradicted what staff told us or showed that they had not been followed correctly.

People and their relatives were involved in the assessment of their needs. However, one person’s relatives told us they had advised the staff how their relative liked to be cared for but this advice had not been followed.

We found that there were plans in place for staff to receive the support and training that enabled them to meet the needs of the people living in the home. This program had been started but had not been completed at the time of this inspection.

Is the service caring?

People were cared for and supported by staff who showed a clear understanding of their needs. We saw that staff showed patience and gave encouragement when they supported people. Some people told us this was not always how they were treated. For example one person told us that they were rushed by some of the staff.

At lunch time we saw that staff assisted people with their meals in a friendly and caring manner. This made the mealtime a pleasant and relaxed experience for them.

Is the service responsive?

We saw that the care files indicated that people’s care had been reviewed recently. However, we found that some issues had not been fully checked. An example of this was the food preferences for one person whose dietary needs were important to them both culturally and medically. Another example involved the monitoring of someone’s bowels and the need to seek medical attention at a certain point.

Is the service well led?

A new manager had recently been appointed and was in the process of applying to be registered with us. Improvements had been made in a number of areas. Staff told us they were very supportive of the new manager and were confident that the improvements would continue. One person said, “Things are starting to change - improving”.

We identified further improvements as being necessary. The reviewing process carried out by the provider to ensure that any necessary changes were identified was not fully effective.

We found the service had good systems in place that ensured the safe management of medicines. We found good medicine administration and disposal records meant that we were able to see that people who used the service were having their medicines administered as prescribed. We found that medicines were being stored safely and the service had good systems in place to monitor the management of these medicines. This meant that people who used the service were protected against the risks associated with medicines.

We used a number of different methods to help us understand the experiences of people using the service because the people using the service had complex needs which meant they were not able to tell us their experiences.

We found that the poor arrangements for the record keeping and the administration of medicines could affect the health and welfare of people using the service.

We undertook this inspection to follow up concerns that we had been made aware of from other visiting professionals with regard to people’s care and welfare, infection control at the service and medication management.

Everyone we spoke with told us they were satisfied with their care. Care plans were well written, clear and contained detailed information about people’s individual needs. This meant staff understood how people preferred their care to be delivered.

People told us that they enjoyed the meals at the home and there was a choice at mealtimes.

On a tour of the home we saw that the environment was clean and tidy.

We found shortfalls in poor record keeping and the administration of medicines that could affect the health and welfare of people living in the home.

The home had developed an action plan in relation to the recent concerns raised. We could see progress had been made in addressing issues. The area manager, who was present during our inspection, acknowledged that there were still areas to be addressed. They continued to support the manager and staff to address the outstanding issues.

People told us they were happy living at Woodcote Hall. One person said, “I think it’s great here, I’m looked after very well”. Another person who was staying at the home for a short period of time said it was a nice place to stay and everything was “very good”. Overall people commented positively about their experiences.

People were involved in making decisions about their care and support.

Staff met people’s care and support needs in ways that they preferred. People were treated with dignity and respect. People were moved using suitable equipment and requests were responded to in a timely manner. Some people told us that they occasionally had to wait for assistance.

Assessments and plans were available but some information was missing and care staff said they did not have time to read them.

People enjoyed a range of activities both within the home and outside to places of interest.

Everyone told us that they enjoyed the meals on offer. There was a choice and drinks were served throughout the day. People did not always know that they could request drinks and snacks when they wanted.

People were protected because staff were overall confident to recognise and report abuse.

People were supported by staff that had numerous training opportunities. Some staff felt that the quality of the training could be improved.

The home ensured that people's views were considered and listened to and the complaints procedure was given to people on admission.

This inspection took place over two days on 8 and 9 December 2014. The inspection was unannounced. At our last inspection in August 2014, the home was meeting all but one of the regulations inspected. We saw improvements had been made with regard to this.

Woodcote Hall provides accommodation, nursing and personal care for up to 56 older people with a range of needs. There were 38 people living in the home at the time of the inspection. There was no 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.

We found some beaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We also found a breach in Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Everyone we spoke with told us more staff were needed. People considered the service was not always responsive to their individual needs due to staffing levels. We observed there was a lack of regular supervision for people seated in the communal areas of the home and for the people who remained in their own rooms. There were delays in staff responding to call bells. This meant that people were kept waiting for their care needs to be met.

People did not always receive the care they needed to minimise the risk of skin damage. They were not being mobilised when they needed to be and their dressings were not being changed at the assessed frequency. This meant they were at risk of harm.

Staff had received training to keep people safe and knew their responsibility to protect people from harm or potential abuse. However, the staff did not always demonstrate this in the care and support they provided to people.

We saw the service worked with healthcare professionals to make sure there was continuity of care to meeting people’s needs. Most people received their medicines as prescribed with the exception of some creams.

We observed some people engaged for short periods in one-to-one activities with the activities organiser. However, most people seated in communal areas and in their own rooms lacked any social interaction.

Since our last inspection people had experienced further changes in the staffing and management arrangements of the home. This impacted on the quality of the service and the consistency of care that people had received.