About the service: Woodlands Care Centre is a care home that was providing personal and nursing care to 104 older people at the time of this inspection. The service is divided into five separate units, Dove, Byron, Tennyson, Coleridge and Wordsworth. Each unit consists of lounge areas, dining areas, bathrooms and single bedrooms with en-suite facilities.

People’s experience of using this service:

People felt safe at Woodlands Care Centre and received care from a staff team who were trained and confident to recognise and report any concerns. Potential risks to people were assessed and minimised and people were encouraged to retain their independence.

There were enough staff to ensure people’s needs were met safely in a way that suited them. Staff worked well together and with external care professionals to ensure people received the care and support they needed.

People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff respected people’s views and people were fully involved in making decisions about their care and support.

People had the choice to participate in a wide range of activities, both inside and outside the service. People were provided with a wide range of meals which they enjoyed. People were provided with the support they required to eat and drink. People lived in a service that was homely and well maintained. People and their dignity and privacy was respected.

People received care from staff who were kind and caring. Staff enjoyed working at the service and knew people well. There was a positive culture within Woodlands Care Centre and the registered manager and staff team were committed to providing a high-quality service for the people who lived there.

Rating at last inspection: Good (report published 10 October 2016)

Why we inspected: This was a planned inspection based on the previous rating

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Woodlands Care Centre is registered to provide the regulated activities of; accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 109 people. At the time of our inspection there were 104 people using the service. The home is divided into five separate units; Dove, Byron, Tennyson, Coleridge and Wordsworth catering to people's specialist needs. All bedrooms are for single occupancy and have ensuite facilities. There are communal areas in each unit, including lounge areas, bathrooms and dining areas. There is a communal garden area for people and their guests to use.

There was a registered manager in post. 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.

People told us that they felt safe living at the home. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any concerns. People received their medication as prescribed.

There were sufficient numbers of suitably qualified staff employed at the home. The provider’s recruitment process ensured that only staff who had been deemed suitable to work with people at the home were employed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager was knowledgeable about when a request for a DoLS application would be required. The registered manager told us that there were applications which had been submitted to the relevant local authorities and they were awaiting the outcome.

Staff respected and maintained people’s privacy. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. This meant that people’s dignity was respected and that their care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Care records were detailed and up to date so that staff were provided with guidelines to care for people in the right way.

People were supported to access a range of health care professionals. Examples included appointments with their GP and a chiropodist. Risk assessments were in place to ensure that people could be safely supported at all times.

People were provided with a varied menu and had a range of meals and healthy options to choose from. There was a sufficient quantity of food and drinks and snacks made available to people.

People’s care was provided by staff in a respectful, caring, kind and compassionate way. People’s hobbies and interests had been identified and staff supported people to take part in their chosen hobbies and or interests to prevent them from becoming socially isolated.

The home had a complaints procedure available for people and their relatives to use and staff were aware of the procedure. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

There was an open culture within the home and people were freely able to talk and raise any issues with the registered manager and staff team. People, staff and stakeholders were provided with several ways that they could comment on the quality of their care. This included regular contact with the provider, registered manager, staff and completing annual quality assurance surveys.

During our inspection on 02 July 2013 we spoke with ten people who lived in the home and seven relatives. People made positive comments about the way they were being cared for. One visiting relative told us, “My {relative} is getting the best attention”.

We found that care records were current and reflected the needs of people who lived in the home. Staff demonstrated a good understanding and knowledge of the care and support people required.

Safeguarding arrangements ensured that people were being protected and the homes willingness to report concerns had ensured that people were safe.

We found there were arrangements in place for adequate numbers of suitably trained staff employed. This had ensured people received suitable care and support.

We found that there was a system in place to check that people were satisfied with the service and there were various monitoring checks on a number of aspects of the service.

There was an effective system in place to deal with any complaints from people who lived in the home or their relatives.

As the main purpose of this inspection was to assess improvements made in relation to shortfalls identified during previous visits, we did not request information directly from people using the service on this occasion.

Overall we found that the provider had taken sufficient action to address the shortfalls in relation to medication recording and administration and was now compliant with Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, Management of Medicines.

Most people we spoke with told us they enjoyed living at Woodlands Care Centre; that staff treated them well and that they rarely waited a long time for assistance. One person commented, “Staff are wonderful on the whole”. Another reported, “It’s not like home, but it’s not a bad second”. Most people told us the food was good however one person, who required a vegan diet, stated that her meals were often oily and tasteless and that there was very little protein in them.

We received many positive comments from people’s relatives we spoke with. One relative reported, “The staff are excellent and do their job with professionalism and with love for people”. This relative was particularly impressed by the range of outings available for people and told us his father had visited the botanic gardens, Anglesey Abbey and the local pub this summer alone. This relative told us that seeing how staff managed to take his father out on trips had given him the confidence to try and take him out himself. Another relative reported, “Dad has aphasia and uses odd words for things, Rabina and Andy (two of the home’s nurses), have learnt dad’s language and can understand him better than anybody”.

A GP who knew the home well told us she had no concerns about the quality of care delivered to people there and described the staff as, “On the ball”.

One district nurse who visited the home’s residential unit described the staff as, “Knowledgeable and sensible” and told us she received appropriate referrals from them. However a number of health care professionals told us that sometimes there were staff shortages, and relatives told us there seemed to be less staff around at the week-end.

Despite these positive comments, however, we noted a number of significant shortfalls in the quality of care provided to people living at the home.

People we spoke with said they are able to do what they want, when they want to. They advised that staff members are always nice, accommodating, and polite and that they are treated with respect. People with dementia were engaged in activities and tasks with staff and participated in games and conversation. We were told how living at the home has allowed one person to visit community areas that they had previously stopped going to.

People told us they are cared for properly and staff members help them to access healthcare professionals. They said they don’t need to look at their care records as they receive the care they want and they don’t usually have to wait long for help.

People living at the home advised that they would be able to talk to staff members or the manager if they were not happy with something and that something would be done. There are 'residents meetings' where people can raise issues they want resolved and a newsletter saying what has been done about the issues raised at the meeting.

Most of the people we spoke with told us they liked living at the home and that staff were available when they needed them. One person commented, “Level of care here is very good and they really respond to reasonable requests.” Another person described the staff as “Nice and kind” and told us their key worker supported them well. Relatives, although generally happy with the quality of care their family member received, were critical of the high use of agency staff at the home and of some aspects of their family member’s personal care.

We raised numerous concerns about the service being provided, during our last inspection in July 2012. During this inspection in November 2012 there had been enough improvement for the home to be deemed compliant in five of the seven outcomes we assessed. However, the provider had failed to take action within many of the timescales that they themselves had set and many of the improvements only happened in the few days between our first and second site visits as part of this inspection. This showed that the provider was not fully committed to improving the service for people living at the home in a timely way.

We continued to have moderate concerns about medication recording and management at the home and have issued a warning notice as a result.