This inspection took place on 8 February 2018 and was unannounced.

When we completed our previous inspection on 24 January 2017 we found concerns relating to person centred care and staffing. We found treatment or care provided did not reflect people’s needs and people were not provided with stimulating activities. Staff were not provided with appropriate training, supervisions and appraisals, which meant they did not have the right skills and knowledge to meet people’s needs. At this time these topic areas were included under the key question of effective, responsive and well-led. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas are included under the key question of effective, responsive and well-led. Therefore, for this inspection, we have inspected these key questions and also the previous key questions of safe and caring to make sure all areas were inspected to validate the ratings.

The provider sent us an action plan in May 2017 and told us that they had addressed the shortfalls highlighted during our inspection in January 2017 and told us that they were no longer in breach with regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found during this inspection that the provider had taken appropriate actions and people’s health care and social care needs had been assessed and formed part of the person’s care plan. People who used the service were offered a variety of activities and the provider planned to provide activities during the evening and also at weekends. Staff had access to different training as part of their induction and regular refresher training was provided to ensure staff kept up their knowledge and skills of supporting people who used the service. Staff had also opportunities to meet the registered manager or their supervisor to discuss their development and performance, which they told us was valuable and helped them to understand people’s needs better.

Woodland Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Woodland Hall accommodates 72 people across three separate units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia.

A new manager started in June 2017 and registered with the Care Quality Commission (CQC) in December 2017. A registered manager is a person who has registered with the 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.

Staff at Woodland Hall told us that people’s safety and security was taken seriously. Staff told us that they would report any allegations of abuse and the service had demonstrated over the past twelve months that they notified the CQC of any allegations of abuse, which had been dealt with and responded to appropriately. Risk to people’s health and wellbeing in relation to carrying out treatment or care had been assessed and appropriate risk management plans were put into place to minimise such risks. People who used the service, relatives and staff told us that there were sufficient staff deployed to meet people’s needs. The service followed safe recruitment procedures and ensured that new prospective staff were assessed and vetted appropriately to ensure their suitability to work at Woodland Hall. People’s medicines were managed appropriately and safe medicines administration procedure ensured people could be confident to receive the correct medicines on time. Woodland Hall followed appropriate infection control procedures a

The inspection of Woodland Hall Avenue took place on the 24, 26, 27 and 31st January 2017. We did not announce we were inspecting the service on the 24 and 27 January 2017. We told the provider we were returning to the service on the 26 and 31 January 2017.

At our last inspection on 16 and 21 July 2015 the service was rated good overall.

Woodland Hall provides nursing care for up to 72 people who have a range of care and nursing needs associated with old age, including dementia. On the first day of the inspection there were 58 people using the service. The number of people varied slightly during the other days of the inspection.

The service does not have a registered manager. 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. At the time of the inspection the service was being managed by an operations manager who had support from other management staff in the running of the service. We were told that the provider was taking steps to recruit a manager who once appointed would register with us.

Systems and processes were in place to safeguard people. Staff knew how to recognise abuse and how to respond to concerns. People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm. Accidents and incidents were addressed appropriately.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The home had made necessary applications for DoLS and we saw evidence that authorisations had been granted.

People were treated with respect. We saw examples of staff engaging with people in a positive kindly manner. People were supported and encouraged to make choices in their day to day lives. Staff told us they enjoyed working in the home providing people with the support and care they needed.

People's social needs were not fully met. Not all areas of people’s care plans were person centred and people lacked the opportunity to take part in activities to promote their well-being and minimise social isolation. People told us there was not much to do. The service needed to improve in this area and was in breach of regulation.

Staff received some training to enable them to be skilled and competent to carry out their roles and responsibilities. However staff had not received training in meeting some aspects of people specific needs and care workers had not received regular one-to-one supervision to support them to carry out their roles and responsibilities. The service needed to improve in this area and was in breach of regulation.

People were supported to maintain good health. They had access to a wide range of appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. We found systems were in place to manage and administer medicines safely.

Staff were appropriately recruited. They underwent a range of pre-employment checks to ensure they were suitable for the role. Checks had also been undertaken to ensure that all the nurses who worked at the home had a current registration with the Nursing and Midwifery Council (NMC).

There were systems in place to regularly assess, monitor and improve the quality of the services provided for people. These included unannounced spot checks of the service carried out by management staff.

We have made a recommendation that the staffing needs of the service be reviewed as we fo

This unannounced inspection took place on the 16 and 21 July 2015. At the end of the first day of the inspection we told the provider when we would be returning to complete the inspection.

Woodland Hall provides accommodation and personal and nursing care for up to 72 people. Most people living in the home have dementia or mental health needs. At the time of this inspection five beds were being used by a local National Health Service [NHS] team for people needing a rehabilitation service. These beds were managed by Woodland Hall. The home is purpose built and located in north west London.

At our last inspection in 02 December 2013 the service was meeting the regulations we looked at.

At the time of this inspection a registered manager was employed at the service. 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.

The atmosphere of the home was relaxed and welcoming. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People were complimentary about the caring nature of staff. Staff understood people’s varied and sometimes complex needs and interacted with people in a courteous manner. People’s privacy and dignity was respected.

Arrangements were in place to keep people safe. Staff understood how to safeguard the people they supported, were familiar with people’s needs and their key risks. People’s care plans and risk assessments included the information staff needed to provide people with the care and support they needed.

Incidents and accidents were recorded, appropriately addressed and monitored to minimise the risk of recurrence.

Medicines were stored and administered to people safely. People were supported to maintain good health, which was monitored closely and referrals made to health professionals when required. People were satisfied with the food provided and had a choice of food and drink which met their dietary needs.

Staff received a range of relevant training and were supported to develop their skills and gain qualifications to be competent in meeting the needs of people they cared for. Staff told us they enjoyed working in the home and received the support they needed to carry out their roles and responsibilities. People were protected, as far as possible by a robust staff recruitment system.

Staff had an understanding of the procedures in place to protect people if due to their needs they were unable to consent and/or make one or more decisions about their care, treatment and other aspects of their lives. Staff knew about the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had the opportunity to participate in a range of activities of their choice, and were provided with the support they needed to maintain links with their family and friends. Views about the service was regularly sought from people, relatives and staff, and improvements made in response to this feedback.

There was an appropriate complaints procedure and people knew how to make a complaint. People were confident concerns and complaints raised by them would be appropriately addressed by the registered manager.

There was a clear management structure in the home. People told us the home was well managed and there were appropriate communication systems in place, including regular staff and resident/relatives meetings and other opportunities for people to obtain advice, support and to be involved in their and/or their relatives’ care.

There were effective systems in place to monitor the care and welfare of people and improve the quality of the service.