This inspection took place on 7 January 2019 and was unannounced. The previous inspection took place on 12 May 2016 and the service was rated Good.

Woodfield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were five people living at the service, although one person was on social leave for an extended period of time.

We have written this inspection report in a shorter format because our overall rating of the service as Good has not changed since our last inspection.

People told us the service felt like home and staff were kind to them. People told us they felt safe and the staff had received safeguarding adults training and understood how to protect people from harm. People told us there were enough staff to meet their needs.

Care records were up to date and there were risk assessments in place to provide information to staff in caring for people.

Medicines were safely stored and administered.

Staff had regular supervision and had completed training in key areas. Staff meetings took place and staff told us they could contribute ideas on how the service ran.

People were supported to have choice and control of their lives, although there was lack of clarity regarding one person’s liberty to leave the building unaccompanied. This aside staff supported people them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were systems in place to prevent the spread of infection. Accidents and incidents were logged and were reviewed; learning took place.

The registered manager was well regarded by health and social care professionals and audits took place in key areas, although audits had not identified duplicate and at times contradictory information in the care records.

We have made a recommendation in relation to getting feedback on the service from all interested parties.

This inspection took place on 12 May 2016 and was unannounced. The previous inspection took place on 3 March 2014 when the service met all the standards inspected.

There was 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.

Woodfield House is a care home that provides accommodation and support for up to five people with mental health needs. At the time of inspection there were five people resident at the service. The semi-detached house was situated in a wooded area. People had their own personalised bedrooms and access to communal areas such as a kitchen, lounge, dining area and garden.

People using the service told us the service was well run and they felt safe. They said staff were caring and staff we spoke with were enthusiastic about their work with people.

Staff had received safeguarding adults training and demonstrated a good understanding of how to protect people from harm. The service had risk assessed and put in place measures to protect people and to maintain a safe environment.

There were enough staff on duty to meet people’s needs and the service had safe recruitment processes in place.

The registered manager and deputy manager had a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated they understood people’s rights and asked people’s consent before offering support.

Staff had received training to equip them to meet people’s physical and mental health support needs. Staff supported people to access the appropriate medical services and were proactive in requesting medical interventions. People received routine health checks and their nutritional intake was monitored to ensure they maintained a healthy diet and ate healthily.

People had person centred care plans and staff motivated and supported people to identify and attend a variety of social activities. Several people had been successful in attending college courses that would assist them to develop work skills for their future independence. People had been involved in their care planning and there were regular reviews.

There was a complaints policy and procedure and people were encouraged to raise concerns.

The service undertook audits to ensure the quality of the service and had built strong working relationships with local professional bodies.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This inspection was carried out to assess what the provider had done in response to the action we had told them to take following our last inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines.

At our last inspection in March 2014, we found a number of issues with the way medicines were managed which meant that safe and effective arrangements were not in place to ensure that people were receiving their medicines as prescribed.

The provider wrote to us stating that they had taken action and had made the necessary improvements by 4 April 2014.

During this inspection we looked at recording and storage of medicines. We found that there were no omissions in records and our audits of stock evidenced the accuracy of the records.

People living in the home were at appointments or unable to speak to us on this occasion.

We saw in two people's care plans that self administration has been considered. It was risk assessed that it would be inappropriate for the person to self medicate, because of the persons medical condition.

We spoke with three people using the service as part of this inspection. They were all happy with the services provided, making comments such as “it’s like a palace” and “it’s alright, the best one I’ve been in.” We saw that people were treated respectfully and spoken to in an appropriate and warm manner. We found that people’s privacy, dignity and independence were respected.

People said that they received the care and support they needed. Comments included, “they are very good to me.” People said they liked the food provided, and that there were enough staff to assist them in the community when needed. We saw evidence of the service having a positive effect on people’s well-being. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider listened to people’s views, both informally and through regular surveys, and acted on them. We found that there were systems to regularly assess and monitor the quality of service that people received, and to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

However, we found that people were not always protected against the risks associated with unsafe use and management of medicines. This was because we identified that people did not always receive their medicines as prescribed and that records of administration were not accurately kept.

We carried out this unannounced inspection to check that the provider had complied with two warning notices and a compliance action made after the last inspection of the service in January 2013. At the last inspection we had found that records of people who use the service and staff employed in the service were inaccurate and could not always be located promptly. The provider did not have suitable arrangements in place to ensure that staff received appropriate training and support and there were insufficient staff present to meet people’s needs in an emergency.

During this inspection we found that improvements had been made. Most records we reviewed were accurate and these were readily available to staff when needed. Staff received appropriate training to enable them to deliver the care and support to people that they needed. People's medicines were being managed appropriately. There were enough staff available to meet people’s needs.

We spoke with four people who use the service and one relative. Most people were positive about their experiences in the home. For example, one person said, “I’ve been in other care homes but not as good as this one. It’s the best one”. They all considered there were enough staff. A person told us “the staff are around if you need them” and a relative agreed, “there are always lots of staff around, spending time with residents, talking, cooking and cleaning”. People told us new staff had joined the service recently.

We carried out this unannounced inspection to check if the provider had complied with four compliance actions issued at the last inspection of the service in June 2012. On that occasion we had found that records of people who use the service and staff employed in the service were inaccurate. The provider did not have suitable arrangements in place to ensure that staff received appropriate training and support. Suitable arrangements were not in place to safeguard people against abuse and up-to-date care plans and risk assessments were not in place for people who use the service.

On this inspection we found that people’s care plans and risk assessments had been updated. People who use the service told us they were satisfied with the care provided.

However, we found that accurate and appropriate records were not maintained in respect of people using the service, staff and the management of the regulated activity. Records could not be located promptly when required. Staff were not appropriately supported to enable them to deliver care and treatment safely and to an appropriate standard. There were insufficient staff to meet people's needs. There was a risk that if an emergency arose the lone staff member would be unable to maintain the safety of people using the service. We have taken action to address this.

We made two visits to the home on 22 June and 27 June 2012. We spoke with two of the five people who lived in the home. They were both happy living there. One person told us that staff were ‘nice’ and they enjoyed watching TV and listening to music.

However, care plans and risk assessments were either not in place or not up-to-date and there was a risk that people’s needs were not being met. Safeguarding concerns were not always recognised and there were not suitable arrangements in place to ensure that staff were appropriately trained and supported to care for people. Records, including those of people who used the service, were not always maintained accurately. As a result people were not always protected against the risks of unsafe or inappropriate care.

As part of this review, we spent time talking to people using the service and/or their representatives where necessary to gain their views of the service. Everyone commented positively about the standards of care and support they receive and had no complaints to make. One person rated the service as “four stars out of five”. When asked what they would do if they had a complaint, they told us that they would "go to the Manager and he helps me". People felt that they would be listened to if they were unhappy with the care and service.

We were told that people felt involved in the care planning process and that they had written aspects of their care plan. People also told us that they felt consulted with and involved in decision making regarding aspects of their individual care and the service in general including deciding on menus.

We were told us that staff ask them what they would like to eat and then they go out and buy the ingredients. People told us that there is "plenty of food" and "food is nice" and that they are encouraged to be part of food shopping.

People told us that they are supported to access their Community Psychiatric Nurse when they need to. We were also told of the high level of support that the Manager had offered a person to access dental services recently. People told us that they receive their medication on time and that they felt that there were no issues relating to the management of medication at the home.

People were satisfied with the standards of hygiene in the home. They commented that the home is always "clean and tidy" and "spotless". The following comments were made when we asked people about their home, "it’s a nice place" and "its not a home it’s a palace". Others told us "I like it 'cos its quiet" and "rooms are tidy" and "we have comfortable seating". A visitor told us that there is a “family feel” to the house and said that “from the minute I walked in, it felt really nice, lovely atmosphere.” People told us that they felt safe at the home an that it’s the right place for them.

People felt that there were enough staff on duty and commented that staff are "very helpful" and felt safe and able to talk to staff. A visitor commented that owners are “lovely people” and that “staff are very good”