The inspection of Woodland Villa Care Home (“Woodland Villa”) took place on the 19 and 21 September 2018 and was unannounced. At our last inspection in July 2017 we rated the service as Requires Improvement overall and in the individual domains of ‘safe’, ‘effective’ and ‘well-led’. There was a breach of Regulation 12 due to concerns in respect of how people’s risks were assessed, medicines were not always safely managed and good infection control practices were not always followed. We asked the provider to tell us how they were going to put this right and they submitted an action plan.

This was a comprehensive inspection during which we also reviewed that the concerns from the last inspection. We found all the concerns have been addressed and we found no concerns during this inspection. We have therefore rated the service as Good overall and in all areas.

Woodland Villa 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 Villa can provide care for up to 53 people. At the time of this inspection, 47 people were living at the service.

Woodland Villa is on the edge of the city centre of Plymouth, Devon. They provider nursing and residential care to older people who may have a physical disability. There are good public transport links for people to use to the city centre.

A registered manager was employed to oversee the running of the service. 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. They were supported by a matron, deputy manager, administrator and the provider was often at the service to oversee the service and the building.

People continued to receive care from staff who were knowledgeable and had the skills required to support them. Staff were competent and trained well. People had the support needed to help them have maximum choice and control of their lives in the least restrictive way possible. Policies and systems in the service supported good practice. People's wellbeing and healthcare needs were monitored by the staff and people accessed healthcare professionals when required. People’s medicines were managed safely.

People were free to be themselves at Woodland Villa. All identities, faiths and cultures were accepted and celebrated. This extended to staff, people’s communities and their loved ones. Woodland Villa staff assured people were accepted for who they are and every means was put in place to enable people to live full and happy lives while residing there. Every effort was then made to enable good communication whether this was respecting people’s first languages or providing other means, tailored to the person’s needs.

People, their relatives and visitors spoke highly of how kind and caring the staff were. We observed staff being patient, responsive and kind. There was a calm atmosphere in the service. People's privacy was respected. People, where possible, or their representatives, were involved in decisions about the care and support people received. People were supported emotionally and involved in deciding how they wanted their treatment needs to be met.

Care plans were personalised and care and support was responsive to people's individual needs. Each person could make choices about their day to day lives. Any concerns or complaints were quickly acted on and investigated. People were supported to take part in a range of activities according to their individual interests. People’s faith and cultural needs were respected and met.

The service was well led. People and staff told us the registered manager, pro

The inspection took place on the 25 and 26 July 2017 and was unannounced. At our last inspection in August 2015 we rated the service as Good. On this inspection we found concerns in respect of how the service was safe, effective and well-led. We have rated the service Requires Improvement.

Woodland Villa Care Home (known as “Woodland Villa”) is registered for 53 older people; when we inspected 46 people were living there. The service provides both nursing and residential only

A registered manager was employed to oversee the management of the service. 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.

People’s medicines were not managed always safely. People’s medicine administration records (MARs) were not always being maintained in line with current guidance. Although staff observed people had taken their medicine before moving on, they signed people’s MARs before the person had taken the medicine. There was not a robust process to ensure that only medicines that were needed each month were ordered and the stock of medicines was not being rotated. People who administered some of their medicines were not being risk assessed in line with current guidance. Medicines were not always stored safely and not always kept at the right temperature. People had medicines in their room that should have been locked away and other medicines had been brought into the home that staff were unaware of.

The home was clean and free from adverse odours. People told us they were happy with the cleanliness of their rooms and the service in general. However, people were not being protected by good infection control practices in all areas. We found the medicines room, emergency equipment and kitchen were not well maintained. We have advised the local environmental health inspectors know about the kitchen. The provider and registered manager addressed these concerns straight away.

People had their need for sufficient to eat and drink in a personalised manner. However, staff were also then not always ensuring the relevant risk assessment was updated or discussions with the person, family and relevant health professional were recorded. This meant not all records were complete in respect of people’s nutrition and hydration needs.

Risk assessments were in place to support people to live safely at the service. However, people had been identified in the care records as having issues swallowing their food, drinks and medicines but a risk assessment had not been drawn up to manage the current risk. The registered manager started putting a risk assessment in place to address this.

We spoke with the registered manager and provider about the concerns we had found in respect of the service being safe and effective and why this was not identified by the range of audits active in the service. We were told that staff had the responsibility of checking the medicines and cleanliness of the kitchen, for example. However, this had not maintained the standards we found at the last inspection.

Woodland Villa ensured all people regardless of their racial, religious and sexual identity were welcomed. All cultures, faiths and sexuality were welcomed and celebrated. People told us they were safe and happy living at Woodland Villa and were looked after by staff who were kind and treated them with respect, compassion and understanding. All staff expressed a commitment to values of providing only good care and to continue to improve the service.

People were in control of their care. People’s care plans were written with them, were person centred and reflected how people wanted their care delivered. Activities were provided to keep people physically and cognitively stimulated. People’s

When the Care Quality Commission inspects health and social care services the inspector works to answer five key questions; is the service safe, effective, caring, responsive and well-led?

In March 2014, the Care Quality Commission issued a compliance action to the registered persons regarding the storage of records. We were concerned records were not stored securely and it was subsequently possible for people to read these who were not authorised to do so.

The Care Quality Commission also received concerns in April and May 2014 regarding staffing levels.

This inspection was completed to check suitable action had been taken to improve procedures regarding the storage of records. We also wanted to check people were well cared for, and there were enough staff to meet their needs.

Subsequently at this responsive inspection we wanted to answer the question whether the service was safe.

Below is a summary of what we found.

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

Is the service safe?

Yes, on the day of the inspection we judged the service was safe.

We checked staffing levels at the home, and assessed whether these were appropriate to meet the needs of people who used the service. We were able to speak with 20 people who lived at the home. The majority of people were happy with the care they received, said there was sufficient staff to assist them and staff would respond to their needs promptly. For example, we received the following comments: “they are very caring, they really are….nothing is too much trouble”, “I am very well looked after, the staff are very kind…the food is excellent…I am very fortunate to have got in here”, “there are enough staff” and “there is no problem”. However some people did raise some concerns such as “there is not always enough staff, “they can be short staffed sometimes” and “sometimes there is a delay when I press the buzzer”. Although overall we judged staffing levels were adequate it is important the provider continues to ensure staffing levels are sufficient to meet people’s needs and to deploy them within the home appropriately so people can receive prompt support.

We judged suitable action had occurred to ensure records were stored confidentially. The record system was well organised and tidy. Records were accessible to staff. The records we inspected were also comprehensive and up to date.

We met and spoke with five people who used the service and three relatives of those who used the service. We also looked at the care records of four people who resided at Woodland Villa.

We observed staff working with people and spoke to four members of staff. We saw that staff spoke to people in a way that supported choice and preference, demonstrated a good understanding of people's individual needs and respected people’s privacy. Comments included; “The staff are very good, couldn’t be better.”, “You can’t fault the staff here” and “The staff are nice and treat me kindly.”

We saw that people’s personal support plans described their needs and how those needs were met. Risk assessments were individualised and detailed and multi-agency professionals had been promptly sourced to enhance individual wellbeing.

We observed that the equipment at the home was properly maintained, available and suitable for its purpose.

We saw evidence that Woodland Villa had sufficient staff with the right knowledge, skills and experience to support people who used the service.

We found that Woodland Villa had a clear complaints procedure that was followed in practice. The complaints procedure was well publicised and the home displayed an open culture that ensured any comment or complaint was listened to.

We found that the care records of people that used the service were not held securely and therefore confidentiality could not guarantee to be maintained.

We visited Woodland Villa because we had received information of concern. These concerns related to the number of staff on duty to manage people who required assistance with moving and handling. These concerns related to the care of people who lived on the residential side of the home, not the nursing side.

We spoke to fourteen people who used the service, three staff members, one volunteer and two visiting relatives. We also observed staff interaction with people as they went about their everyday duties. We talked with the staff and the registered manager.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people’s choices during drinks being served. We saw people’s privacy and dignity being respected at all times. We spoke to staff about the people who required assistance with moving and handling. We met individuals and observed the staff working with them, particularly when preparing to move people to the lunch table for their dinner.

There were enough staff on duty to meet people's needs with additional staff available from the nursing side of the home when required. Staff had received training in manual handling to enable them to carry out their roles competently and ongoing training was available. The home had provided suitable lifting equipment to keep people comfortable while they were being moved.

We met people who use services, relatives, talked with the staff and checked records. We looked at the care records of five people; we met them, looked at records and asked staff about their care. The registered manager also provided information.

Not all care plans were completed or updated and did not reflect people’s health and social care needs. This meant that people’s care needs may not have been met.

One person living in the home, who was a previous care home owner said, “Wouldn’t be here if it wasn’t good!”

We saw that staff did not always treat people with respect. For example, staff did not always knock on people’s bedroom doors before entering.

Comments from people who lived in the care home included, "Very impressed by the care" and, “All staff are brilliant".

People told us that if they had any concerns that they would speak to staff or the management and felt confident that appropriate action would be taken.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences.

We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful. They took time to work at people's own pace.

We observed people being supported to make decisions about their lives and be as independent as possible.

During our visit we saw sufficient staff on duty to meet the needs of people living in the home.

The inspection took place on the 7 and 10 July 2015 and was unannounced. We last inspected the service on the 5 September 2014 and found no concerns.

Woodland Villa Care Home provides accommodation for people who require personal care and nursing for up to 53 older people and who may have a physical disability. On the day we visited there were 49 people residing at the service.

There was a registered manager in place. 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.

People told us they were safe and happy at Woodland Villa Care Home and were looked after by staff who were dedicated to their roles and treated them with kindness and respect. Staff knew how to keep people safe from harm and abuse. People’s differences were celebrated and people were protected from harassment in relation to their identity.

Staff were recruited safely and underwent training to ensure they were able to carry out their role effectively. Staff were trained to meet people’s specific needs. Staff promoted people’s rights to be involved in planning and consenting to their care. Where people were not able to consent to their care, staff followed the Mental Capacity Act 2005. This meant people’s human rights were upheld.

People felt in control of their care. People’s medicines were administered safely and they had their nutritional and health needs met. People could see other health professionals as required. People had risk assessments in place so they could live safely at the service. These were clearly linked to people’s care plans and staff training to ensure care met people’s individual needs. People’s care plans were written with them, were person centred and reflected how people wanted their care delivered. Staff were praised by other professionals due to their commitment to support people to remain independent and improve while in their care. People’s end of life needs were planned with them. People were supported to end their life with dignity.

Activities were provided to keep people physically and mentally stimulated. People’s faith and cultural needs were met.

There were clear systems of governance and leadership in place. The provider and registered manager ensured there were systems in place to measure the quality of the service. People, relatives and staff were involved in giving feedback on the service. Everyone felt they were listened to and any contribution they made was taken seriously. Regular audits checked to make sure aspects of the service were running well. Where issues were noted, action was taken to put this right.