This inspection took place on the 7 and 8 August 2017. The inspection was unannounced on day one and announced on day two. Woodbury House is a care home which is registered to provide care with nursing for up to 45 people, including people who live with dementia. At the time of our visit 37 people were using the services.

The home is a large detached Victorian building in a country location, not far from the shops and amenities of Wokingham, Reading and Camberley. People had their own bedrooms and use of communal areas that included enclosed private gardens. The people living in the home needed residential or nursing care and support from staff at all times and had a range of care needs. These included dementia care and palliative care.

The service has 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.

People received safe care. There were sufficient numbers of staff to keep people safe and meet their needs. However, we found that staff deployment at lunchtime on the memory unit had not provided the assurance that people were being checked and supported effectively regardless of staff numbers being of a good ratio. We had discussed this with the registered manager who had taken immediate and appropriate action to improve.

We have made a recommendation about the assessment of staff numbers to meet people’s individual needs within the environment they live.

Staff were knowledgeable about how to keep people safe from harm. Risks to people's safety were assessed and plans were in place to manage and reduce risks. There had been a high turnover of staff in the 12 months prior to our visit. Staff were recruited safely using robust procedures. Medicines were managed safely by staff who had received appropriate training and had their skills monitored. The home had been refurbished. The kitchen and laundry were being reviewed for refurbishment and consideration of changing door closures to soft-closures.

People received effective care. Staff were trained and competent to carry out their roles effectively. Training updates were scheduled to cover staff induction and refresher training, which included dementia awareness, equality, diversity, and personal care. They were supported in their job roles through one to one meetings, appraisals and team meetings. People were supported to eat a choice of freshly prepared meals. They were supported with special diets if required and when necessary their dietary intake was monitored. Frequent snacks and drinks were available.

People were supported to maintain their health and wellbeing. Advice was sought from healthcare professionals when necessary. People were supported by staff to have maximum choice and control of their lives in the least restrictive way possible. The policies and systems in the service supported this practice.

The service was caring. Staff were kind, considerate and compassionate in the way they delivered support to people. They encouraged people to be as independent as they possibly could be. They addressed people in the way they liked and spoke respectfully to and about people.

The service was responsive. People's relatives and visitors were welcomed into the home and activities were designed to consider people’s individual interests. One to one sessions were a regular feature for people who were at risk of being isolated. People received person centred care that focussed on their individual needs and recognised their preferred routines. People and their relatives were comfortable to raise concerns and speak with the registered manager and staff team if they wished.

The service was well-led. There were systems in place to assess, monitor and analyse the se