This comprehensive inspection visit took place on the 20 November 2018 and was unannounced.

Woodford House is a care home. People in care homes receive accommodation and 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. Woodford House is registered to accommodate 40 people in one adapted building. At the time of our inspection 39 people were living in the home. The home accommodates people in one building and support is provided on two floors. There are two communal lounges, a dining area and a garden that people can access. Some of the people living at Woodford House are living with dementia.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive safe care. Risks to people were considered and reviewed when needed. There were enough staff available to offer support to people when they needed it. Medicines were managed in a safe way. There were safeguarding procedures in place and these were followed when needed. Infection control procedures were in place and followed. There were systems in place to ensure lessons were learnt when things went wrong.

People continued to receive effective care. Staff continued to receive training that helped them to support people effectively. When needed, people received support from healthcare professionals or were referred accordingly. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice. People received consistent care and enjoyed the choice of meals they were offered.

People continued to be supported in a caring way by staff they were happy with. People were encouraged to be independent and maintain relationships that were important to them. People's privacy and dignity was promoted and people continued to be offered choices.

People continued to receive responsive care. Staff knew people well and their care was reviewed and relevant to their needs. People had the opportunity to participate in activities they enjoyed. People's cultural and communication needs were considered. When people neared the end of their lives plans for this were in place and followed. Complaint procedures were in place and followed when needed.

The service remained well led. Quality assurance systems were in place to identify where improvements could be made and when needed these changes were made. The provider notified us of significant events that occurred within the home. Feedback was sought from people and their relatives and this was used to bring about changes.

We inspected this service on 5 April 2016. This inspection was unannounced. Our last inspection took place in September 2014 and we found no concerns with the area we looked at.

The service was registered to provide nursing and personal care for up to 40 people. At the time of our inspection 37 people were using the service.

There was a registered manager in post. 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 felt safe and staff knew how to recognise and report potential abuse. We found that individual’s risks were managed in a safe way. When people needed specialist equipment it was provided for them. The systems to manage medicines were safe and kept people protected from the risks associated to them.

People were treated in a caring way by staff who knew them well. Staff received an induction and training that helped them to support people. People were encouraged to make choices about their day and remain independent.

People told us they enjoyed the food and there were choices available. When people needed access to health professionals this was provided for them people and relatives were involved with reviewing their care and felt updated. We found there were enough staff to meet people’s needs.

When people were unable to consent mental capacity assessments had been completed. The provider had considered when people were being restricted and Deprivation of Liberty Safeguarding (DoLS) authorisations were in place. Staff knew about this and how to support people.

Quality monitor checks were completed by the provider and this information was used to make improvements. Feedback from people and relatives was used to make changes within the service. Staff felt listened to and assured any concerns they had would be dealt with.

This inspection was completed by one inspector. On the day of our inspection we found 37 people lived at Woodford House. Due to their complex needs or health conditions, we were not able to speak with people who used the service. We observed their experiences of care to inform our inspection. We spoke with six relatives of people who used the service, the registered manager, the general manager, the nurse manager and five care staff.

Below is a summary of what we found. The summary describes what relatives told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Relatives told us they felt their family members were safe. One relative told us, "My family member is safe here." Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy. Where safeguarding alerts had been made, the provider had investigated and responded appropriately.

We found people and their relatives were involved in the planning of care. Where people did not have the capacity to consent, the provider had acted within the requirements of the law. This meant people's rights were protected.

Staff knew about risk management plans and we saw that they supported people in line with those plans. This meant people were cared for in a way that protected them from harm.

The provider had robust recruitment procedures in place to ensure staff were of good character and had the skills and knowledge to support people in a safe way.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found applications had been submitted to the local authority. We found proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People’s care needs were assessed. All of the relatives we spoke with told us they were involved in their family member's care planning and annual reviews of care. We saw that care plans were regularly updated.

Is the service caring?

People were supported by staff that were kind and caring. We saw that staff gave people encouragement and respected their privacy and dignity. One relative told us, "The staff are good, kind and caring."

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to engage in a range of different activities each day.

Relatives and staff were asked their views about the service and the provider acted on comments and suggestions that they made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively. Records seen by us indicated that shortfalls in the service were addressed.

Staff were clear about their roles and responsibilities and knew about improvements that had been identified by managers.

We carried out this visit to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff did not know we were coming.

During the inspection we spoke with four staff and three relatives. One relative told us: “I can’t fault them here – they work really hard”. Another relative said: “They (the staff) are really good here”.

Records outlining the delivery of care were inconsistent. We found the care records lacked important information and clarity. This meant care, treatment and support may not be delivered in a consistent way.

We saw that people received a choice of well-presented and nutritionally balanced food.

We saw that the management and administration of people's medicines was undertaken safely which meant that people received their medicines as prescribed.

We checked that equipment within the service was safe and available for use. We found that equipment was well maintained and appropriate for its intended use.

Staff we spoke with told us they liked working at the home and felt they were supported to carry out their role effectively.

There were 40 people living in the service on the day of our visit. No one knew we would be visiting. We spoke with people who lived at the service, five members of staff, four visiting relatives, the deputy manager and the manager.

We used a number of different methods to help us understand the experiences of people living at the service. These included observation, speaking with staff and looking at records. We spent time in the dining room and main lounge. We observed the care that people received. We saw good interactions between the staff and people who live at the service and we saw that people were given choices.

We saw that people were offered a choice of what they wanted for drinks, breakfast and lunch. Relatives told us that they felt well supported by the staff at the service.

We saw that people were well dressed in individual styles.

People told us and we saw that where needed health professionals were involved in their care. We saw that staff followed their advice to ensure the health and welfare of the people living there.

Staff said they were well supported and had the training they needed so they could support the people living there.

Regular audits had been undertaken. The auditing of the service helped to ensure that the service was well run and met the needs of the people living there.