We inspected this home on 15 January 2018. At our last inspection we found the provider was not meeting all the regulations and we rated the home as Requires Improvements. We asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘is the service safe’ and ‘is the service welled’ to at least good. We found these improvements had been made.

Woodhall Park is set in its own grounds and the accommodation is presented over two floors. There are three lounges with views of the gardens and a large dining room where main meals are served. Bedrooms are situated on both the ground and first floor. There is outside seating to the front and in a small secure garden with raised planting beds off one of the lounges.

The service is run by two registered managers. 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 home offered a friendly atmosphere which people and relatives enjoyed, they were able to personalise their own living space. There were sufficient staff to support people’s needs who were aware of how to keep them safe from harm. Risks had been assessed and measures taken to reduce any risks. Medicine had been managed to meet peoples prescribed needs.

People are 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 support this practice. People’s wellbeing had been promoted through referrals to health care professionals. Any advice had been followed to promote good health. People enjoyed the meals and had a choice which reflected their preference and dietary needs. People were protected from having sore skin and their weights had been monitored to ensure they received the required nutritional support to maintain good health.

Staff had established positive relationships which enabled them to personalise the care they delivered. Care plans were person centred and identified people’s preferences and style of care they required to suit their individual needs. People and relatives all identified that staff were caring and kind. They offered respect and when they delivered care it was in a dignified way. When people were nearing the end of their life they received care to support their wishes.

The home had a complaints procedure; however the home had not received any complaints since our last inspection. People’s views had been considered and they had been involved in developing the care they received. Improvements had been planned to the home which would provide better facilities and consideration of people’s dignity when they received care.

Staff felt supported in their role and had received training and inductions to enhance their skills. When staff joined the home they were checked to ensure they were suitable to work with people. All those using the home felt it was well run. The registered managers completed regular audits to identify areas of improvements. When incidents occurred the learning had been shared to reduce the risk of it reoccurring. The registered managers understood their roles to meet their registration and had notified us of events. They had displayed the previous rating in the home and on the provider’s website.

This inspection visit was unannounced and took place on 8 November 2016. At our last inspection visit on 8 December 2015 we asked the provider to make improvements across all aspects of the service we inspected. The provider sent us an action plan which explained the actions they would take to make improvements. At this inspection, we found improvements to some areas; however some aspects still required improvement. The service was registered to provide accommodation for up to 41 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 41 people were using the service.

There were two registered managers in post to support the running of the home. 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.

At our last inspection on 8 December 2015 compliance actions were issued in relation to staffing, medicine management, the need for consent and areas of good governance. The provider sent us an action plan in January 2016 explaining the actions they would take to improve. At this inspection, we found improvements had been made regarding consent and medicines management. Some improvements had been made in relation to staffing, however further consideration was needed to ensure consistency. We found insufficient improvements had been made in relation to the auditing of the service and recognising how to drive improvements.

The managers had not always understood the requirements of their registration. This resulted in us not receiving notifications about events at the home. Audits to monitor and evaluate the service were not always completed to reflect on quality and drive improvements. Information was not always clearly recorded to ensure people’s needs would be met.

Staff felt supported and there was a warm friendly atmosphere. We saw people were supported for their needs, however there was not always a consistent level of staff. People felt safe, but not all the staff were able to provide us with the assurance they understood how to protect people from harm and the reporting process. There were no evacuation plans to provide guidance if the home needed to be evacuated.

People were able to make their preferences know, which had been documented in the care records. People were encouraged to be independent and make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns. People and relatives felt the environment was warm and friendly.

People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained. Support and compassion was provided when people neared the end of their life.

People’s capacity assessments had been completed and when required best interest decisions had been made with the relevant people to support. Some people were deprived of their liberty and the appropriate safeguards and authorisations had been sought from the local authority.

We saw people had a choice of food and were able to make decisions about the menu and the meal experience. When required support and advice around health and nutrition had been considered. Staff received training to enable them to support people and to support specific health needs. Support from health professionals was requested and available when needed.

Medicines were administered in line with people’s prescriptions and specific needs to support their health. Risk assessments had been completed and guidance provided. The provider ensured appropriate checks before people worked at the service.

We found breaches of the Health and Soc

This inspection was unannounced and took place on 8 December 2015. The service was registered to provide accommodation for up to 41 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 38 people were using the service.

At our last inspection in December 2013 compliance actions were issued in relation to the need for consent to care and treatment, and the management of medicines. The provider sent us a report in January 2014 explaining the actions they would take to improve. At this inspection, we found improvements had not been made since our last visit regarding consent to care and medicines management. We also found evidence of other regulatory breaches which related to staffing, the Deprivation of Liberty Safeguards (DoLS) and good governance.

The service did not have 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. The provider had recruited two people to manager the service who were jointly registering with us.

People told us there were not enough staff and we observed people’s needs were not always met due to the lack of staff availability. Risk assessments were not always up to date or used by staff to support people. We observed medicines were not stored correctly and there was no clear auditing of medicines or their administration.

Staff had been provided with training in a range of skills; however we observed some staff were not competent in the use of equipment. The staff and manager had limited knowledge about ensuring people were able to make decisions about their care and had not completed appropriate assessments to support people’s decision making in their best interest . This relates to the Mental Capacity Act 2005 and DoLS. The manager had not consistently completed audits in relation to the quality of care provided, to consider on going improvements to the service.

People told us the staff were kind, although not always responsive to their needs and preferences. There were limited activities within the home, which mainly related to group activities and not focused on people’s individual preferences.

People told us they enjoyed the food and they always had a choice from a menu. Special diets were catered for to ensure people’s nutritional needs were met. Referrals had been made to the appropriate health professionals to ensure people received the right support in maintaining their wellbeing.

People felt safe within the service and staff knew how to raise a concern and felt confident it would be responded to. The provider had a complaints policy, people and relatives felt able to raise any concerns and records confirmed previous complaints had been dealt with efficiently.

You can see what action we told the provider to take at the back of the full version of the report.

Several people told us they were not sure if they had ever been asked for their consent but said they had discussed their care at a review. We saw a consent document was not fully in use and had not been signed on any of the three records we looked at. This meant it was unclear whether or not the service was acting in accordance with the consent of service users.

We observed people's care and support during the visit and saw that they were well supported. People we spoke with told us they were satisfied with the care and support they received. One person told us “Everything is quite alright” and another said “The staff are ever so nice”. A relative told us they were pleased with the way the service had sorted out their family member’s medical problems and said “They always have time for you”. External professionals we spoke with told us they thought the service had improved its end of life care and that their advice was sought and acted on. One professional said “They are caring and conscientious”.

We saw there were missing signatures on people’s medication charts but that the medication had been taken from the dispensing package (blister pack). This meant that the recording of medicine administration was not accurate and it was unclear whether or not the person had taken their medication as prescribed.

We found there were sufficient staff on duty to meet people’s needs and the service dealt properly with any complaints or concerns brought to their attention.

People we spoke with expressed satisfaction with the service.They told us they liked the staff and that privacy and dignity was observed when personal care tasks were undertaken. They praised the staff describing them as caring and good. A relative told us "They try their best". All the people we spoke with stated the food was good and told us they enjoyed their meals. They were very complimentary describing the meals as first class, the tops and excellent.

Health professionals we spoke with praised the care. End of life care won specific praise from one professional who described it as excellent and another told us the service acted on advice and responded well to changes in people’s needs

People we spoke with confirmed that they felt safe using the service and the relatives we spoke with told us they had no worries about the way care was provided.

One person using the service told us that the service was “so nice, so friendly” and another said it was ‘the best without a doubt’ and that ‘all staff are nice and friendly’.

One relative told us that she was “absolutely satisfied with the care” that her mother received and another told us that they thought the service was “very good” and that health professionals were called in when necessary. They also said that the service made a “huge effort to know the individual”.

People told us they enjoyed their meals and one person told us that the food was “nicely cooked”.

Another told us trips out occurred and said “they hire a mini bus so they can take people in wheelchairs”.

One person described staff as “kind and helpful” and another told us staff “will do anything for you”.