This inspection took place on 21 and 22 May 2018. The first day of the inspection was unannounced. We previously inspected the service in April 2017 and found there to be one continued breach in legal regulation. We issued the provider with a requirement notice to ensure improvements were made.

People living at Woodfalls Care Home received accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Woodfalls Care Home is registered for up to 24 people to live at the service. Whilst registered for 24 people, only 23 can be accommodated. At the time of the inspection there were 18 people living at the home and one of these people was receiving treatment in hospital.

There was a manager in post. The manager was awaiting registration with CQC at the time of the inspection. 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 last inspection in April 2017, we found that medicines were not always managed safely and the service was unclean in places. We also identified that people’s care plans did not always contain enough information to ensure their needs were being met. At this inspection, some concerns from the previous inspection had been addressed. However, most shortfalls remained of concern. The manager was aware of some of the areas that required improvement and an action plan was in place to address these.

There were some improvements in the record keeping for daily medicine administration. However, records for medicines administered on an ‘as and when required’ (PRN) basis were not recorded safely. They did not provide an overview of how often people received the medicines. The protocols for administering PRN medicines were inconsistent and not always in place for some people. This left people at risk of not receiving medicines in accordance with the prescription directions.

The protocols for the administration of topical medicines, such as creams and lotions were not in place. This meant there was no guidance as to where specifically people required their prescription.

Areas of the home were unclean. We found a build-up of dust on ornaments and cobwebs that had clearly been in place for some time. The condition of the fixtures and fittings prevented thorough infection prevention control during cleaning. This meant there was increased risk of cross infection.

We saw that audits identified that parts of the building required redecoration and repair. However, this had been put on hold due to having empty rooms at the home.

People had pressure relieving equipment in place, such as air mattresses. Staff did not record information provided by the community nurse, to check mattresses remained at the correct setting. It was not possible for the service to know if the equipment was at its most effective setting.

Staff practice for recording fluid intake was inconsistent. They recorded fluid intake in different places and at times did not complete the records fully. There was no overview of people’s fluid intake where it had been assessed as a need to do this in monitoring their health.

There was no overview or monitoring of infections. Staff recalled from memory who had been diagnosed with an infection. There was no monitoring in place to identify the frequency or duration of infections.

Staff understood how the Mental Capacity Act 2005 (MCA) applied when people lacked capacity. When people had been assessed as having mental capacity to make decisions, staff told us they would still stop them from leaving the service if they wished. This practice would mean that staff detained people unlaw

We carried out this inspection over two days on 24 and 27 April 2017. The first day of the inspection was unannounced. Our last inspection to the service was on 16 and 17 November 2015. During the inspection in November 2015, three breaches of legal requirements were identified. We issued the provider with three requirement notices to ensure improvements were made.

At this inspection, there was a new registered manager in post. They started employment at the home in July 2016 but had been the registered manager previously in 2013. 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. The registered manager was not available on the first day of the inspection due to annual leave. They were available throughout the second day and discussions took place on the telephone after the inspection.

Woodfalls Care Home provides care and accommodation to up to 24 older people, some of whom are living with dementia. Whilst registered for 24 people only 23 can be accommodated. At the time of the inspection, there were 23 people living at the home.

Since their appointment, the registered manager had addressed certain aspects of the service and improvements had been made. However, some shortfalls which were identified at the last inspection remained outstanding. The registered manager was aware of the areas that still needed attention and a development plan was in place to address these.

On the first day of the inspection, there were not enough staff to support people effectively. Staff were busy and interactions with people were limited and task orientated. This improved on the second day of the inspection, particularly as the registered manager and deputy manager were on duty and assisted with care provision. A review of staffing levels had taken place and one to one staff support for some people had been introduced. This had enabled an improved service although there were some concerns about the number of staff available during the late afternoon and evening period.

Not all areas of the home were clean. There was dust and debris on surfaces and less visible areas such as the side of tables and walking frames. The registered manager agreed the level of cleanliness was not to their usual standard. They explained staff sickness had recently occurred and the ability to consistently provide cover, had impacted on this.

Guidance for staff had been developed in relation to people’s “as required” medicines. However, staff had not always signed the medicine administration record to show they had given people their medicines. This did not ensure the medicines were taken as prescribed or enable accurate monitoring of the medicine’s effectiveness.

A new electronic care planning system had been introduced and information about people’s care had been inputted into this. To ensure staff received key information, the system’s templated care plans had been used. This meant some information was generic rather than person specific. This did not clearly inform staff of people’s needs and the support they required. The registered manager was aware such information needed to be “tweaked” to make it person centred.

People benefitted from an established staff team who knew them well. There had been a review of staff training and a clear plan was in place to address any shortfalls. Greater focus had been given to face to face training rather than “on line” sessions. Staff felt well supported and had regular discussions with their supervisor. Appraisals, which reviewed staff’s performance, were being completed.

The registered manager regularly worked alongside staff and completed various care shifts. This enabled them to get to know people well and provide clear le

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. One relative of a person living at the home said of staff ‘there is nothing they could do better; they know the individuals here well’.

The provider had taken steps to provide care in an environment that was adequately maintained.

Staff received appropriate training and supervision. One member of staff said ‘we get lots of training, it’s very good’.

We saw that there was an effective complaints procedure. One relative said ‘I would feel able to speak to staff if I had a complaint. They are really approachable and not at all defensive. When I have brought up little things in the past they have been resolved immediately and absolutely to our satisfaction’.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We saw people with cognitive impairment had their mental capacity assessed to enable staff to provide the appropriate support to people to make decisions and agree to care. We observed staff discussed care options clearly, patiently and sensitively with people. People were given time to make decisions and agree to care.

Staff had received appropriate training to update their moving and handling knowledge and skills. Staff were able to apply this knowledge to practice.

People's records were stored securely. We saw people's records of care were reviewed and updated regularly and reflected person centred care.

People and their relatives said they were very pleased with the care and support provided. People told us that they were supported to make choices and their independence was respected. One person told us " I sometimes walk down to the shop with another lady here" Other comments included "We are well looked after" " You couldn't find a better care home"

People were involved in initial assessments before they moved into the home. People we spoke with told us they were asked about their preference for the gender of the staff providing their personal care.

People were offered a choice of what to eat and drink. People's nutrition and hydration was being assessed and appropriate support was given to those at risk of losing weight.

People were able to have their needs met because there were sufficient numbers of experienced and trained staff available when they needed them. People told us "the staff are very caring, they come quickly when you buzz" and "The staff are lovely"

People and their relatives were asked for their views about the service provided and the manager had an action plan based on their feedback.

We found that there were some risks to people because staff did not know about and follow correct procedures for helping people with their mobility needs. The home also did not have systems in place to document when decisions had been taken in people's best interests in accordance with the legal requirements of the Mental Capacity Act 2005.

We carried out this inspection over two days on 16 and 17 November 2015. The first day of the inspection was unannounced. Our last inspection to the service was on 15 December 2013. During the inspection in December 2013, no breaches of legal requirements were identified within the areas we looked at.

Woodfalls Care Home provides care and accommodation to up to 24 older people, some of whom have dementia. Whilst registered for 24 people only 23 can be accommodated. At the time of the inspection, there were 23 people living at the home.

There was a registered manager in post. The registered manager started employment at the home in March 2015. 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. The registered manager was present throughout the inspection.

Not all care plans were up to date and reflected people’s needs. The information did not inform staff of people’s preferences or the support they required. Staff checked people’s skin to ensure it was not sore but there was no information within people’s care plans about the prevention of pressure ulceration. There was limited detail about managing people’s continence and emotions such as agitation and resistance. The registered manager told us these shortfalls would be addressed once the new electronic care planning system had been implemented.

People medicines were administered safely in a person centred way. All medicines were stored securely and staff had appropriately signed the medicine administration record. However, protocols were not in place to inform staff of the administration of “as required” medicines. Records did not demonstrate staff had consistently applied people’s topical creams.

Some audits to monitor the quality of the service had been introduced. The registered manager was aware a more comprehensive approach was required and more audits in different areas were to be introduced. Some shortfalls, such as the inaccessibility of call bells were not being identified within the audits. Priority was being given to new furniture but not all issues identified were being addressed.

Additional staff training had been arranged since the registered manager’s appointment. The registered manager had clear expectations of the standards staff were to achieve. Courses had been scheduled for those staff not up to date with certain topics. Staff felt supported although there were some concerns around the pressure caused by a change in manager and a review of care practices. A formal staff supervision system had been introduced and was working well. Time was required to fully embed the system.

During the inspection, there were sufficient staff available to support people effectively. Staff spent time with people and were attentive to their needs. People were not rushed and not waiting for assistance. However, there were some views that more staff would be beneficial. Agency staff were being used to maintain staffing levels at times of staff sickness and annual leave. To ensure consistency, the same agency staff were being requested.

People and their relatives were very complimentary about the staff and the care provided. There were many positive interactions which indicated staff knew people well. Staff spoke with people in a friendly, respectful manner and promoted rights to privacy, dignity and choice. Staff showed a commitment to their work and were concerned about people’s wellbeing. There were positive comments about the food and people had enough to eat and drink. People were appropriately supported to see their GP or other health care professionals, as required.

People looked content, well supported and were relaxed around staff. Relatives had no concerns about their family member’s safety. They knew how to make a complaint and were confident any issues would be appropriately addressed. Staff were aware of their responsibilities to report any suspicion or allegation of abuse.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.