About the service:

Woodland Park is a care home with nursing, providing support to up to 27 people. At the time of the inspection there were 25 people living at the service with two other people waiting to be admitted from hospital.

The home is set close to Babbacombe Downs, the sea and local shops and services.

People’s experience of using this service:

People and their relatives spoke highly of the service they received from Woodland Park. The service had strong person-centred values and placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences.

People received their medicines as prescribed. We have made a recommendation the service updates their medicines management policy to ensure it is in line with current good practice and make any changes needed as a result.

People were involved in the planning and delivery of their care and this was done in a way which encouraged their independence and choice. People’s care plans contained personalised information which detailed how they wanted and needed their support to be delivered. Staff knew people and their needs well, and could tell us how people liked to be supported.

Risks to people’s health, safety and wellbeing were assessed and acted upon including for the management of health conditions. People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

People were supported by kind and caring staff. We saw staff being engaged with people and there was a positive, happy atmosphere. Staff expressed concern and compassion towards the people they were supporting, and were. Staff were provided with the training, supervision and support they needed to ensure they had the needed skills to care for people well.

There was strong leadership at the service. People and staff spoke highly of the management team and there was a positive culture at the service with people and staff feeling their voices were listened to. Where people had raised concerns, for example about the food, we saw actions were in place to address them.

There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. Systems ensured learning from incidents and accidents, and the registered manager and staff updated their learning via attending local forums and using training resources available to them.

More information is in the full report

Rating at last inspection: This service was last inspected on 8 and 9 February 2018. It was rated as Requires Improvement at that time in the key questions for safe and well led, with an overall rating a Requires Improvement. We saw improvements had been made since the last inspection and have rated the service as good.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received we may inspect sooner.

This inspection took place on 8 and 9 February 2018 and the first day was unannounced. At our last inspection in August 2016 we found the provider was in breach of regulation because accurate, complete and contemporaneous records were not in place for each person living at the home. The home was rated as Requires Improvement at that time. Following this inspection the registered manager sent in an action plan stating what action would be taken to address the breach of the regulations. At this inspection we found sufficient action had not been taken in relation to the concerns identified at the previous inspection. We also identified new areas of concern.

Woodland Park is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Woodland Park provides 24 hour nursing care, personal care and intermediate care for up to 31 older people in one adapted building. There were 23 people living at the home at the time of our inspection.

There was a registered manager in post who worked across two registered services and spent half their time at each. 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.

Risk assessment tools were used to identify common risks such as those relating to falls, skin integrity and medication. People who were at risk of developing pressure ulcers had pressure relieving equipment in place such as pressure relieving air mattresses and cushions. However, some risks to people's health and wellbeing were not always identified in people's care plans, and risk management plans were not always in place to instruct staff on how they should care for people safely.

Some risk assessments and care plans contained detailed guidance; however, records did not always show that care had been delivered as it should. For example, where people required regular repositioning, records did not demonstrate this had taken place and quality assurance systems had not identified this.

The environment was not always safe. Three exit doors at the side and rear of the property were unlocked. One door did not have a lock and opened by turning the handle from both inside and outside of the property. The door was not alarmed. This meant anyone could gain access to the home and people’s bedrooms, unnoticed and unchallenged by staff. This put people’s safety, their belongings and the security of the building at risk.

An effective robust system was not in place to assess and monitor the quality of the service. Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements.

We heard bells ringing during the inspection and these were responded to effectively. We received mixed feedback from people and their relatives in relation to staffing levels. One person told us, “I think they’re understaffed. I’ve been here hearing people ring for a while.” Another person told us, “I use my bell when I need it, and they come.” Relatives we spoke with also felt that people waited a long time for attention. However, during the inspection we saw people's needs were usually met quickly.

We looked at how medicines were managed within the home and observed how medicines were administered. During the inspection we observed administration practice that was not considered best practice nor did it follow the provider’s own medicine policy. We made a recommendation to the provider about this.

Other aspects of medicine administration, documentation and storage were managed safely.

At the last inspection in August

Woodland Park is a large detached nursing home situated in Babbacombe, near Torquay in Devon. It is registered to provide personal and nursing care for up to 25 older people. An unannounced inspection took place on 12 and 16 August 2016. At the time of the inspection there were 19 people living at the service with a mixture of residential and nursing care needs.

We had previously inspected the service in May 2013 when we found the service was not meeting requirements in relation to records. When we checked in October 2013 we found the necessary improvements had been made and the service was compliant with all regulations. Prior to this inspection we had received information about a safeguarding matter that was being looked into by the local authority safeguarding team.

The service had a registered manager who worked across two registered services and spent half their time at each. 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.

Although staff were knowledgeable about people’s needs, we found people were at increased risk because staff did not have access to detailed, clear care plans about each individual’s care and treatment needs. Documentation about people’s care needs was fragmented. This made it difficult to see how risks were being managed as there was no clear pathway between the identification of risk through to the plan of care needed to manage the risk. Some people’s risk assessments and care plans did not contain accurate or up to date information or reflect the care they were receiving and there were gaps in some people’s records. For example, we found that records for the application of prescribed creams were not always being kept accurately. This meant the manager or nurses could not tell if people were receiving all of their prescribed medication correctly and people could be placed at risk of skin damage. However, we saw no evidence of skin damage this during the inspection.

The service had enough staff to support each person’s individual care needs. We saw staff sitting and talking to people and people being assisted unhurriedly. This indicated there were enough staff on duty to meet people’s needs.

People and their relatives told us staff were skilled to meet people’s needs and spoke positively about the care and support provided. One person told us “I’m very well looked after by the girls” One family member told us staff knew their relative’s care needs very well and commented “they are really on top of [name of relative’s] care. Staff here are wonderful really”. Staff were experienced and had the skills and knowledge to provide care for people living at the service. They undertook regular training relevant to the needs of the people they supported. Staff demonstrated awareness of safeguarding and understood their responsibility to report concerns. People were relaxed and comfortable with the staff supporting them. This indicated they felt safe.

Accidents and incidents were reported and measures were taken to reduce risks for people.

People were offered day to day choices and staff sought people’s consent for care and treatment. Mental capacity assessments were not always completed in line with the legal process set out in the Mental Capacity Act (MCA) 2005 Code of Practice. This meant people’s rights may not be fully protected.

The home arranged for people to see health care professionals according to their individual needs.

Staff worked closely with local healthcare professionals when necessary. A health professional said their experience was that staff sought advice appropriately and communicated well about people’s health needs.

The culture of the home was warm and friendly and people told us they felt s

At our inspection in May 2013 we found that the care plans did not accurately reflect the care being given to people who lived in the home. During this inspection we found the provider had made improvements to the care plans and records. This meant that people who lived in the home were protected from the risks of unsafe or inappropriate care and treatment.

We, the Care Quality Commission (CQC) visited this service on 26 June 2012. There were 19 people living at the home during out visit. We spoke with six of those people to obtain their views about this service. We also observed the experience of three people living at the home using an observation tool called the Short Observational Framework for Inspection (SOFI). We also spoke with a visitor to the home, the manager, a nurse, three care staff and two housekeeping staff. We visited all the communal areas of the home and some bedrooms. We have also included in this report comments received via our web form.

People told us they were involved in decisions about their care, and made choices about how they lived their daily lives. People said they were treated with respect, and we saw examples of this. We saw that staff provided personal care in private, offered people choices, were gentle and worked with people at a relaxed pace. There was one occasion when we saw that someone's privacy was not protected, and other occasions when staff could have been more in tune with this being the home of people who lived there. For example, a member of staff conducted a business call in the lounge when people living there were sitting and relaxing. A person who gave feedback through our anonymous web form facility said "every member of staff from the nursing and care staff to the cleaners, chefs and handyman treated the resident with empathy". This person also told us that care and nursing staff ensured that people were supported to continue with activities that were important to them such as listening to music.

People told us they felt able to express their views. One person said "if I want to say something, I just ring the bell and speak to one of the carers. They want to do their best for us". This reflected what other people told us. All the people we spoke with said they felt safe and well cared for.

People had care plans which included risk assessments. Some plans did contain a lot of detail. However, when we spoke with staff it was evident that their knowledge of people's needs and how those needs were to be met was very indepth and detailed. No one living at the home had a pressure sore, the incidence of falls was low and people were maintaining or gaining weight. This showed that there were good health promotion and preventative measures were in place. Records showed that appropriate referrals were made to health and social care professionals for specialist advice. We received a comment that a person receiving end of life care had the "best care possible", and was "comfortable, pain free and treated with love and dignity".

People told us they enjoyed living at Woodland Park. We observed that those people who could not speak with us had enjoyed social activities such as music to movement. One of the people who lived at the home had a dog, which we saw people positively interacting with and enjoying.

Some decisions had been made in people's best interests for safety reasons. Staff explained the reasons they had to do this, however they had not recorded these reasons or the people involved in the decision making. Records were not therefore completed in line with mental capacity act guidance as they should be.

We spoke with staff and they demonstrated a good knowledge and understanding of abuse and of their role in safeguarding people. Records showed they had received training and supervision in relation to this. Staff also received training including end of life care, health and safety, infection control and moving and handling. Records showed that staff were recruited in line with recruitment procedures. Staff told us they received induction training, although we found this was not always recorded.

The home had quality assurance procedures in place, although there were plans to further develop these. The manager had asked for feedback from healthcare professionals and relatives, and had received a low response. We saw records showing there was high satisfaction with the services provided and no suggestions for improvement. Relatives meetings had been stopped as they were not attended. People living at the home could not remember being asked for their opinion of the care they received. One person told us they would love to give this feedback, which would all be positive.

On the day of our inspection 24 people lived in the home. During our inspection, we spoke with four people who lived in the home, seven relatives/friends, two visiting healthcare professionals, and six staff.

People told us they were happy with the care they received. Comments included "the staff know how I like things to be done" and "I'm very happy here". Some people who lived in the home had dementia and when we spoke with them they were not always able to tell us about their experiences. During our visit we observed good interactions between care workers and people who lived in the home. We spoke with care workers who were able to tell us how they met people's care needs.

We found that care workers were receiving appropriate training and professional development so they could carry out their job role effectively. Care workers knew how to report concerns to ensure people were protected from the risk of harm.

The home had a comprehensive quality assurance system to assess and monitor the quality of the service. People told us "there’s nothing to complain about” and “I've no complaints".

Records were not always maintained to evidence what was happening in the home. Care plans did not contain up to date and accurate information.

We found that some items in the first aid boxes had passed their expiry date. The registered manager took action to remedy this.