This inspection was carried out on 26 July 2017 and was unannounced. Woodheath Care Home is registered to provide nursing and personal care for a maximum of 61 people. The home has two units one is a nursing unit called Cherry House and the other is a specialist dementia unit for 19 people called Apple House. The home is in Upton, Wirral and is close to local amenities.

The home is required to have 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. The manager had been registered with CQC since June 2017 and was in attendance at the time of the inspection.

We spoke with the registered manager and they were open and honest and told us that they were committed to delivering a quality service. People we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives also told us they felt people were safe.

People who lived at the home were protected from the risk of abuse because staff had undertaken safeguarding training, to recognise and respond to potential signs of abuse. Staff had a good understanding of what safeguarding meant and how to report it. The home had policies and procedures in place to guide staff.

The Mental Capacity Act 2005 and the associated Deprivation of Liberties Safeguards legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We found that in applying for these safeguards, people’s’ legal right to consent to and be involved in any decision making had been respected.

Staff were recruited safely and registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council. We saw evidence that staff had been supervised regularly. Regular staff meetings were held as well as relatives’ meetings. Relatives we spoke with said that communication with the home was good.

Each person living in the home had a plan of care and risk assessments in place. These were specific to them and were regularly reviewed. Care plans showed that people's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary.

The staff knew the people they were supporting and the care they needed. We observed staff to be kind, patient and respectful. People told us that staff ensured their dignity was protected and people were called by their preferred names.

The home had quality assurance processes including audits and satisfaction questionnaires. People’s care records were maintained to a good standard.

We saw records to show that infection control standards in the home were monitored and managed appropriately. The home was clean, safe and well maintained. The provider had an infection control policy to minimise the spread of infection and all staff had attended infection control training.

People who lived at the home and relatives we spoke with said they would know how to make a complaint. None of them had any complaints. The complaints procedure was clearly visible at the entrance of each unit.

We carried out an unannounced focused inspection of this service on 29th October 2015 and 6th November 2015. At that inspection a breach of legal requirements was found. This was because people who used services were not protected against the risks when receiving care or treatment. The provider had not assessed the risks to the health and safety of service users of receiving the care and treatment and did not do all that is reasonably practicable to mitigate any such risks. These were breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We issued the provider with a warning notice in relation to the breaches. A warning notice is an enforcement action used by the Care Quality Commission to direct a provider to improve their service to meet requirements of a specific regulation within a set time period. We gave the provider until the 01 March 2016 to meet their legal requirements in relation to assessment and mitigation of risk.

We undertook a focused inspection on the 30 March 2016 to check that they had met the requirements of the warning notice and their plan in order to meet the legal requirements in relation to the breaches described above. This report only covers our findings in relation to

these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Woodheath Care Home’ on our website at www.cqc.org.uk’

Woodheath Care Home is registered to provide nursing and personal care for a maximum of 59 people. This consists of two units, these are Apple House which is provides residential care and has capacity for nineteen people and Cherry House which is nursing care and has capacity for 42 people, five of these beds are for Intermediate Medical Care.

The home had a manager in place who was in attendance during our inspection but is not yet registered. 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 saw improvements had been made to care plans and risk assessments, medication processes and quality assurance processes.

This inspection was carried out on 26 July 2017 and was unannounced. Woodheath Care Home is registered to provide nursing and personal care for a maximum of 61 people. The home has two units one is a nursing unit called Cherry House and the other is a specialist dementia unit for 19 people called Apple House. The home is in Upton, Wirral and is close to local amenities.

The home is required to have 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. The manager had been registered with CQC since June 2017 and was in attendance at the time of the inspection.

We spoke with the registered manager and they were open and honest and told us that they were committed to delivering a quality service. People we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives also told us they felt people were safe.

People who lived at the home were protected from the risk of abuse because staff had undertaken safeguarding training, to recognise and respond to potential signs of abuse. Staff had a good understanding of what safeguarding meant and how to report it. The home had policies and procedures in place to guide staff.

The Mental Capacity Act 2005 and the associated Deprivation of Liberties Safeguards legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We found that in applying for these safeguards, people’s’ legal right to consent to and be involved in any decision making had been respected.

Staff were recruited safely and registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council. We saw evidence that staff had been supervised regularly. Regular staff meetings were held as well as relatives’ meetings. Relatives we spoke with said that communication with the home was good.

Each person living in the home had a plan of care and risk assessments in place. These were specific to them and were regularly reviewed. Care plans showed that people's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary.

The staff knew the people they were supporting and the care they needed. We observed staff to be kind, patient and respectful. People told us that staff ensured their dignity was protected and people were called by their preferred names.

The home had quality assurance processes including audits and satisfaction questionnaires. People’s care records were maintained to a good standard.

We saw records to show that infection control standards in the home were monitored and managed appropriately. The home was clean, safe and well maintained. The provider had an infection control policy to minimise the spread of infection and all staff had attended infection control training.

People who lived at the home and relatives we spoke with said they would know how to make a complaint. None of them had any complaints. The complaints procedure was clearly visible at the entrance of each unit.

Two inspectors carried out this inspection. The focus of the inspection was to answer 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.

Is the service safe?

We looked at the way the service protected people from abuse. We spoke with six members of staff about their understanding of safeguarding. We found that while staff understood the principles of safeguarding, responses on how this would be handled differed. Staff told us that they had received training in safeguarding awareness and this was confirmed through the viewing of training records. Staff understood the idea of whistleblowing with some being clear about where they could raise concerns about care practice if needed. Other people were not sure about how they could raise concerns to external agencies.

We were informed by the provider and by the manager that none of the staff working in the home, including the manager, handled any money belonging to people who lived at the home.

We walked all around both of the buildings and found that in general the premises were adequately maintained and improvements to the environment had continued. We identified some issues that required improvement we discussed these with the manager. The manager was able to show us certificates to verify that testing and servicing of all utilities and equipment including gas, electrical circuits, fire equipment, hoists, and the passenger lift were up to date.

We spoke to staff about training and they confirmed that they had completed mandatory health and safety training as well as training linked to the needs of people who used the service.

Is the service effective?

People we spoke with told us:

“The food is good, the girls are good and the nurses are good, what more could I want?”

“They can’t do enough for you here, they are really good, all of them.”

“We have nothing to worry about here.”

“We get well looked after.”

The care staff we spoke with were able to demonstrate their knowledge of people’s individual needs. Equipment was provided to meet people’s needs including profiling beds, different types of pressure relieving mattresses, moving and handling equipment and mobility aids.

Care plans recorded an assessment of the person's needs before they went to the home and after they had arrived. Each person had plans for how their care should be provided, and risk assessments for any identified risks to their health, safety or well-being. There was also evidence of input from the person's GP and other health care professionals including the falls team, district nurses, psychiatric nurses and continence service. Care staff completed charts to record people’s food and fluid intake, repositioning, and personal care.

Is the service caring?

All of the people we spoke with praised the staff and described them as kind and caring. They told us:

“They are all very good girls.”

“All of the staff are nice, they are gentle people.”

We observed that staff had a good rapport with the people who lived at the home and treated them with respect when providing care, for example when using moving and handling equipment.

Is the service responsive?

One of the people we spoke with had a relative visiting. They told us that any concerns they had raised had been dealt with to their satisfaction.

We looked at the way the provider supported staff to perform their respective roles. We found that while supervision had been undertaken, the records did not appear to have any records of the views of the person being supervised. We looked at minutes of staff meetings. These were held regularly and this was confirmed by the staff team. Minutes appeared to have little recorded involvement of the staff team.

The manager told us that residents /relatives meetings took place every six months and she had met with the families of more than half of the people who lived at the home during June 2014. A satisfaction survey was sent out every three months and we were able to look at forms that had been completed in April 2014. People had generally expressed satisfaction with the service provided. We did not see any evidence that the views of professional visitors to the home had been sought.

Is the service well led?

The directors visited at least monthly and carried out quality assurance checks.

The manager had considerable previous experience and been in post for two years. We looked at the staff rotas which showed that the home had a full complement of registered nurses including a deputy manager, and there was a minimum of one nurse on duty at all times. Team leaders and senior care assistants led the staff team on the dementia care unit.

An audit folder recorded monthly audits of care plans, accidents, medicines, pressure sores and infections. A detailed complaints procedure was displayed in the home and this gave information about who people could contact if they wished to make a complaint or raise a concern.

When we visited Woodheath on 24 September 2013 we found that robust recruitment procedures were not always followed. On 30 December 2013, we looked at the personnel records of staff who had been employed since our last visit to the service. We saw that all of the required checks had been carried out to ensure that people who lived at the home were protected.

When we visited Woodheath on 24 September 2013, we were concerned that only four regular nurses were employed to cover day and night duties. On 30 December we found that the deputy manager and three other nurses were employed on day duty. This meant that there were always two nurses on duty in a morning and the deputy manager told us that this had made a significant difference in making sure that care records were kept up to date and that people's nursing needs were met.

When we visited Woodheath on 24 September 2013 we found that the home's complaints procedure did not give enough information to people and we were not able to see how many complaints had been received or how complaints had been responded to. Since then, the manager had updated the complaints procedure and a complaints register had been put in place; however records lacked detail to show how issues arising from complaints had been addressed.

Staff were supportive to the people who lived at the home and protected their dignity. People were offered a choice of meals. People told us “staff are more like daughters, friends”, “I’d recommend it [the home] if people needed a home”, “staff don’t stop you doing anything”. Staff had a good rapport with the people who lived at the home and were able to demonstrate their knowledge of people’s individual needs.

Practical moving and handling training was being provided for all staff to ensure that they knew how to transfer people safely. We observed that Care plans contained brief biographic details, assessments of people's care needs, plans for how their care should be provided, and risk assessments for any identified risks to their health, safety or well-being. There was also evidence of input from the person's GP and other health care professionals as needed.

New staff had completed application forms in full and Disclosure and Barring disclosures were in place, however an employer reference was not always in place and records did not show that nurses’ registrations were always checked.

There were enough staff on duty to meet people’s needs, however we were concerned that only four regular nurses were employed to cover day and night duties.

A new complaints procedure written by the manager after our visit gave people details of how to make a complaint. Complaints records did not show how many complaints had been received or how they had been addressed.

We did not visit the home on this occasion, however a review of the information held by CQC provided evidence that people’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services because the provider worked in co-operation with others.

When we visited Woodheath on 7 and 8 November 2012 we found that there was little personal information recorded about some of the people who lived at the home and we did not see evidence that people, or their families, had been consulted or involved in writing the plans for their care. People were not aware of any meetings being held for residents or their friends and relatives. Relatives told us that the staff were often rushed and there were times when people's needs had not been met.

When we visited on 27 February 2013 some people told us that they had been part of care plan reviews. Care plans were being rewritten and approximately half were completed. Two observations carried out by an inspector found that staff treated people with respect, for example people were asked what they wanted to have for lunch and where they preferred to sit. Staff explained what they were doing when using a hoist. We considered that the staffing levels were sufficient to meet the needs of the number and dependency levels of the people who were living there at the time. Staff were following a programme of training and individual staff supervision meetings had started.

Staff meetings had been held and a meeting for residents and their families. The manager had developed monitoring and auditing systems and had used various methods of finding out people’s views of the service.

As part of the review of this service we were accompanied on the inspection visit by an expert by experience. An expert by experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service.

People spoken with during our visit to the service told us they were happy with the care and support offered. Both people who used the service and members’ of the staff team spoken with felt Woodheath was a ‘happy home where you can have a good laugh’.

Records and discussions with the Registered Manager indicated peoples’ likes and dislikes were taken into account when care and support was being planned.

We were told that a small number of people liked to spend most of their time in their bedrooms and have their meals brought to them. One person spoken said confirmed this was their choice and said they did not fell isolated as staff ‘dropped in’ for a chat and to see how they were.

During our visit we observed members of the staff team responding quickly to people who were experiencing difficulties. The support provided was sensitive and encouraged them to carry on with the task they had been trying to complete.

Overall people told us they were happy with the activities offered and felt the home was open to suggestions about new ones.

We observed that people who used the service received care and support in a timely manner that met their needs.

We observed the lunch time meal being served we noted for those people who needed support to eat they had to wait. This meant that on occasions people may have had cold meals. However we observed that care workers supported people to eat their meals in a respectful and sensitive manner.

Wirral local authority contracts and commissioning team told us they had no current concerns about the care and support being offered to people who lived at Woodheath.

We carried out this responsive review due to concerns raised with us by a relative of a person using the service about the quality and safety of nursing care support being provided at Woodheath. In particular the nursing care being provided to those people requiring end of life care including pain management.

Overall the people we spoke with were satisfied with the care and support offered to them. However some people made comments that indicated they were not fully involved in their care. Some comments made were;

"Staff are okay, some are really nice, other don't care quiet as much".

"It’s a lovely friendly place".

“I enjoy the quizzes and days out".

"None from the home came to see me before I came here".

"I've not been asked to read a care plan".

“The girls are lovely”.

“All the staff are very approachable”.

“I get looked after well here”.

“I have not been asked what my needs are, but they are really nice girls and I'm sure all I'd have to do is ask".

Wirral Local Involvement Networks (LINks) carried out a visit in March 2011 and raised no issues of concern.

Relatives told us they were happy with the care and support being offered to their parent and felt the staff team kept them well informed.

We observed some care workers offering people in the lounge areas respectful and sensitive support.

We observed nursing and care workers not offering verbal or physical reassurance to a person who was distressed.

We spoke to people living in the home who told us they got their medications regularly. Those who could request medications such as painkillers told us that if they asked for them they were made available.

People spoken with during our visit offered the following comments:

'I can ask for my medicines'.

'No, no one said that I could do my own tablets I thought they had to do it'.

People were able to choose their daily routine, for example what time they liked to get up and go to bed, where to spend their time during the day. We did not find information to show that people, or their families, had been consulted or involved in writing or reviewing plans for their care. At the time we visited, satisfaction surveys were being sent out to people living at the home and their families to get their views of the service.

Two people told us that they did not always receive the support they needed at mealtimes and we observed that people did not always receive their medication on time. The care plans for people living in the main house had not been well maintained which meant that staff did not have information about the care people should receive. Improvements were needed to the ordering, storage, administration and recording of medicines.

There were not always enough qualified, skilled and experienced staff to meet people’s needs and not all staff had received the training and support they needed to deliver care and treatment safely and to an appropriate standard.

The new manager had been reviewing all areas of the service and introducing auditing systems. She had identified improvements needed to the environment and redecorating was going on when we visited. During our visit we identified some health and safety issues that were brought to the attention of the manager.