This inspection took place on 25 and 26 October 2017, the first day was unannounced. The service was last inspected in August 2015 when it was rated as Good overall. At the inspection in 2015 we recommended that the service kept staffing levels under review, the moving and transferring practice of staff was continually observed and reviewed and that social interaction should be improved. At the inspection in October 2017 we found improvements had been made and further improvements to social interaction was planned.

Woodland Court is registered to provide accommodation and personal care for up to 39 people who may also require nursing care. The service is located in a residential area of the seaside town of Torquay. On both days of the inspection there were 26 people living at the service.

A registered manager was employed at the service. 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 and their visitors told us they felt safe living at the service. One visitor told us they trusted the staff to care for their relative and didn’t feel the need to visit every day. Staff had a good knowledge of different types of abuse and had received training in keeping people safe. Safe staff recruitment procedures were in place. This ensured, as far as possible, that only suitable staff were employed at the home.

People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. One visitor told us “Can’t fault the place, nothing too much trouble.” Another relative told us “It’s like having a second family here. I will still come and visit when mum’s not here.”

Risks to people’s health, safety and well-being had been assessed and plans were in place to help minimise the risks. Risk assessments contained good details on how risks were managed. Some people were at risk of pressure area damage to their skin and there was equipment in place to minimise the risk of damage occurring.

There were sufficient numbers of staff to ensure people’s needs were met safely. A recent review of staffing levels had highlighted times when more staff were needed. A new rota was due to be implemented the week following the inspection with extra staff being on duty early mornings and evenings. Following the inspection we received confirmation the new rotas had started.

Medicines were stored securely in a locked cupboard and only registered nurses (RNs) administered medicines. Records were kept for medicines received and disposed of and regular audits were made.

Procedures were in place to protect people in the event of an emergency. Accidents and incidents were analysed to identify any trends and where issues were identified action was taken to minimise the risk of reoccurrence. Arrangements were in place to minimise the risk of cross infection. There were maintenance contracts in place for the servicing of equipment such as hoists and gas and electrical installations.

There was a comprehensive staff training programme in place. Where people had specific needs specialist training was arranged such as pressure area care, death and dying and caring for people living with dementia. There was an effective system in place to ensure staff were putting their learning into action and remained competent to do their job. Staff records showed they received regular supervision and yearly appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We heard staff asking people for their consent when carrying out care tasks and offering them choices. Staff had re

This inspection was carried out by one Adult Social Care inspector. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

On the day of the inspection the Registered Manager was not at the home. The provider’s representative was present throughout the inspection.

At our previous inspection on 18 February 2014 we found that improvements were needed to the quality assurance system and the way records were managed. At this inspection in August 2014 we looked to see if the improvements had been made.

Before this inspection we received some concerns about the way the home managed the end of life care for people who lived at the home. We looked at the care records for people who received end of life care and following our inspection we spoke to a visiting health care professional. We found that people received appropriate end of life care.

Some people living at the home were unable to tell us about their care. Therefore as well as speaking with people we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences of living at the home were. The SOFI tool allowed us to spend time watching what was going on in the home and helped us to record how people spent their time and whether they had positive experiences.

Is the service safe?

We found care and treatment had been planned and delivered in a way that was intended to ensure people's safety and welfare. For example, we saw a comprehensive assessment of people's needs and a range of risk assessments had been completed. We saw that where people had been assessed as being at risk from pressure sores, suitable equipment had been provided to minimise the risks.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards aim to ensure that people are protected from the risk of inappropriate restraint in any form. The provider’s representative told us no applications had needed to be submitted. We saw no evidence that anyone was being inappropriately restrained or detained. The provider’s representative told us that the Registered Manager had received training to enable them to understand when an application should be made, and how to submit one. The provider’s representative was aware of recent changes to the interpretation of the legislation.

We saw that medication was being stored safely. Medication was supplied to the home in a series of colour coded blister packs and stored in a locked trolley in a locked room. Medication was transported around the home safely by means of the locked trolley. We saw the medication storage areas were clean and free from a build-up of excess stock.

We saw that where reviews of care plans had taken place, updated information had not always been transferred to the current support plans. For example, we saw no updated support plan for a person who sometimes refused medication. This meant staff may not always have the most up to date information available to them. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. For example, we saw that where people had been assessed as needing help with personal care, there was some evidence in the daily records that this help had been given. We saw information recorded in one person’s care plan about how staff were to support them to use oxygen. This meant that people's needs were being met effectively.

We saw that care plans had been signed by the individual or their representative. This showed us that people were involved in planning their care.

We found that staff received appropriate training and professional development. For example, staff told us they had received training in safeguarding vulnerable people, food hygiene, diabetes, Mental Capacity Act 2005 and moving and handling. This meant that staff were suitably trained to be able to effectively meet people's needs.

We saw there was an effective system in operation which was designed to enable the provider to regularly assess and monitor the quality of the services provided. For example, we saw a ‘quality matrix’ that indicated what audits should be conducted and when. We saw that a series of audits were undertaken including, care plans, rooms and health and safety. However, the provider may wish to note it was not always possible to see where issues identified had been completed.

Is the service caring?

People living at the home spoke highly of the care received. One person told us the staff were “On the whole very good – some go that extra mile”, another person said “It has been a very positive experience, whatever time I have left, I want to spend here”.

We saw a variety of thank you cards that had been received by the home. Comments included “You all were without exception, all very kind and made my time with you very pleasant” and “Thank you for looking after X and helping us through some difficult times”.

We saw people being supported to take their medication. We saw that staff were patient and kind allowing people time to take their medication and ensuring it had been taken. We heard people being offered choices about what they wanted to drink. Any personal care that was needed was offered in a discreet way, ensuring people's privacy and dignity.

Is the service responsive?

We discussed people's care needs with staff. They told us about people's needs and how they liked their care to be delivered. Staff we spoke with were able to tell us what they did to support people and knew what to do for them if they needed any additional support. For example, one staff member told us how they supported an individual with changes in their mood.

We saw directions to staff on how to prevent one person’s eyes becoming infected. There was evidence in the person’s daily records that these directions had been followed.

We found that generally people’s personal records including medical records were accurate and fit for purpose. For example, everyone living at the home had a care plan that included a series of risk assessments.

Is the service well-led?

We spoke with two care staff and one registered nurse who told us they felt supported to ensure they were effective in their role. One told us we “can always go to the manager if we need anything”. We saw that risks relating to the health, welfare and safety of people who used the service and others who may be at risk had been identified. For example, we saw that the time and place of accidents had been recorded and action taken where needed.

The provider took note of reports prepared by the Commission following an inspection. We know this because some improvements had been made following our last inspection in February 2014.

We spoke to three people living in Woodland Court, and they told us that they liked living at Woodland Court and that they felt well looked after. We spoke to a family member who told us that the care staff were "very friendly" and that "nothing is too much trouble".

We spoke with four members of staff and watched them interacting with people who used the service and other healthcare professionals in the home. We saw that people living in the home were responded to quickly when they requested assistance, and the staff were polite in asking people to wait while they prioritised care needs for people who used the service.

We looked in three care plans and saw audit paperwork relating to risk assessing and found that there were regular reviews and systems in place to ensure staff knew about care specific care needs of individuals.

We found that some care plan documentation was not completed correctly and other records were not completed which were required.

People told us they thought the care they received was very good and that they were able to make choices as part of their daily lives. One person said “Its all good. The food is lovely, the staff are kind and I am well looked after. What more do you need?” A visitor said “They are so good here. They always call the doctor when (my relative) is unwell; they know them really well and they do everything for them. The care could not be better”.

We saw that people had a full access to health care services and had their care needs met.

People liked the staff that cared for them.

People using this service felt safe and were confident that staff had the skills needed to safeguard them and to meet their needs. Staff training, supervision and annual appraisals were linked to ensuring that staff had the skills to meet people’s needs.

Systems were in place to involve people in the service, and their suggestions were encouraged and acted upon. Systems for assessing quality and managing risk were in place.

The people living at Woodland Court informed us they were very happy with the service they received. Further information about people’s experiences in the home was given to us by visiting relatives and management of the home. We also spoke to other professionals about their views and experiences of this home.

During our visit we observed people enjoying themselves and interacting positively with the staff and manager supporting them.

Several people said they liked living in the home and enjoyed their regular visit by family members and the staff were very good.

We were told by a visiting Physiotherapist for several people living in the home that the home is “very good” and always carries out tasks and instructions they request.

The District Nurse had recently informed the management of the home that their care plans were excellent and very informative.

One regular visitor to the home said, “Everyone is nice, welcoming, friendly and cheerful” and went onto say, “Nothing is too much trouble and I eat here a lot and the food is very good”. Another visitor said they had done an “excellent job sorting out my relative’s medication”.

People living in the home told us, “Well satisfied and the best food I ever had”, another said, “ Couldn’t have better staff” and many of the other people living in the home agreeing that the staff were very good or excellent. One person said, “the staff get their moods”.

Woodland Court is registered to provide accommodation and personal or nursing care for up to 39 people. People living at the home had nursing needs one person was in the early stages of living with dementia. The home is part of the Woodland Healthcare Group.

This inspection took place on 18, 21 and 27 August 2015, when there were 22 people living at the home.

At our last visit in August 2014 we found that improvements were needed to the way records were maintained. At our visit in August 2015 we found improvements had been made.

There was a registered manager employed at the service. 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 is supported by a ‘clinical lead’, who is a registered nurse and oversees all nursing care provided by the home.

People and their relatives said they felt safe and secure at the home and they trusted the home to care for them. Safe staff recruitment procedures were in place. People were protected from the risks of abuse. Staff had received training in safeguarding people and were able to tell us about different types of abuse. Staff were aware of whistleblowing procedures and where to find relevant contact details for any external agencies they may need to contact.

Some people living at Woodland Court had nursing needs. For example, they could not walk and were at risk of developing pressure sores. People spoke highly of the care they received. They said “I love it… it’s just wonderful” and “I am very pleased…the staff are wonderful…you only have to ask for something and it comes……I’m so surprised by how good everything is, they all seem to have time for you”. Everyone spoken with said they would recommend the home. One person said “I’d give it 5 stars”. Another person said “I would definitely recommend it..they let me bring in anything I wanted”. One visitor told us “I come to see her every day and she’s happy all the time”.

Staff were responsive to people’s individual needs. For example one person could become distressed. We saw staff distracted them using items from a specially prepared ‘memory box’. People told us staff were responsive to their needs. They and their relatives have faith in Woodland Court to look after them and attend to their needs properly. One person said “I worried about going home from hospital as I need 24-hour care but it’s absolutely lovely. I made the right decision”.

Staff treated people with respect and kindness. For example, staff addressed people with their preferred name and spoke with respect.

Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their wishes. Care plans were reviewed regularly and staff told us they felt the care plans were very useful. They said that people’s needs were always changing and care plans ensured they kept up to date with the changes.

Risks to people were minimised. Risk assessments contained good details on how risks were managed. Moving and transferring and pressure area assessments were in place and had been updated when risks had changed. Records of medicines administered confirmed people had received their medicines as they had been prescribed by their doctor to promote good health.

People received effective care and support from staff who had the skills and knowledge to meet their needs. People were happy with the skills of the staff. One person told us “Some long-serving staff have retired or moved but they’ve been replaced by very helpful and well-trained staff”.

Some people and their relatives told us they felt there were not enough staff on duty. One person told us “There’s not enough staff, definitely not…they’re rushed off their feet…they could do with one more on each shift”. They went on to say that sometimes they had to wait quite a while for their call bell to be answered. However, other people told us they felt there were enough staff and did not have to wait long for their call bells to be answered. Throughout our inspection we heard call bells answered promptly and staff met people’s needs in a relaxed and unhurried manner. We discussed staffing levels with the registered manager. Although staffing numbers were above what had been determined by the staffing calculator they used, the registered manager told us that an extra member of staff was to be recruited for the morning shift.

Woodland Healthcare Group, Woodland Court’s owners had taken the decision to not have a nurse on duty in each of their care homes for nursing overnight. One nurse currently covers three homes. There were good procedures in place to ensure the nurse could be contacted should they be needed. There was an on call system, whereby if another nurse was needed they could be called. Night staff had received extra training to ensure people were kept safe at night.

Staff had received a variety of training including moving and transferring, safeguarding people, infection control and confidentiality. However, we saw two staff using poor moving and transferring techniques with one person. We spoke with the clinical lead about this who immediately spoke with staff and reminded them about the importance of always using the correct methods to help people move safely. Moving and transferring update training was due the week after our inspection and staff would be attending that.

Staff received supervision and an annual appraisal from the registered manager and clinical lead. They told us they used the sessions to ensure staff felt supported and as a check on their competence.

People were supported by staff who had a good understanding of the Mental Capacity Act 2005 (the MCA) and the associated Deprivation of Liberty Safeguards (Dols). This legislation is in place to ensure people’s legal right to make a decision is upheld and that their liberty is not restricted without proper authorisation.

People were supported to make decisions about day to day aspects of their life, such as what to eat, what to wear and where to spend their time. People were able to choose whether to remain in their rooms, join others in the lounge or walk about the home. People were asked for their consent before staff provided personal care. People told us staff always asked if it was alright to help them.

While we were at Woodland Court, there were no scheduled activities and no-one spending individual time with people. One person told us of a visit by an ‘animals lady’ and there were arrangement to meet people’s individual religious needs. For example, communion was regularly held at the home. One staff member was employed to provide activities for two sessions each week. However, people were at risk of social isolation as they spent most of their time in their rooms. Staff told us if they could improve one thing it would be to have more time to spend individually with people. One visitor told us they had been concerned that their relative was not able to get out much, but this had improved as they were now going out to a coffee morning each week.

People received a balanced diet with sufficient to eat and drink. People were offered plenty of snacks and drinks through the day. People spoke highly of the chef and the choices they are given for food. Many positive comments were received about diet and choices, including “The food is beautiful…I’m on a low fat diet so I have boiled potatoes now rather than chips and my health is improving”.

People were encouraged to maintain good health and had visits from healthcare services where required. Records showed people had seen their GPs and other health and social care professionals as needed. Relatives told us they felt people’s healthcare needs were met promptly and the staff quickly informed them of any changing needs. One person told us they had moved to Woodland Court with the expectation that they would live only a few weeks, but their health had improved. The registered manager confirmed this was the case and said “Staff simply took the time and had the patience to get them to eat”.

People’s needs were met in a suitably decorated and furnished environment. The registered manager told us there was a programme of refurbishment in place and plans to upgrade all the furnishings. We saw some rooms that had already benefitted from the refurbishment. There were no unpleasant smells in the home and it was very clean. There was signage around the home to aid people’s independence. For example, toilets and bathrooms were clearly signed.

There were ways for people to express their views about their care. Each person had their care needs reviewed on a regular basis which enabled them to make comments on the care they received and voice their opinions. One person told us they had told staff about a piece of oxygen equipment they used, this was put in their care plan so if they were unable to manage themselves, staff would be able to provide the help needed. Another person told us “They take my wishes into account, ask how I am and what I want. I have organised my care plans and signed them”.

There were large notices in the entrance and around the home inviting comments or concerns. Everyone we spoke with told us they were confident that if they did raise concerns they would be dealt with quickly by the registered manager.

One person had referred a complaint they had made about care received at Woodland Court to the Local Government Ombudsman (LGO) as they had not been satisfied with the way their concerns had been dealt with. The home has put plans in place to address the issues.

Relatives and friends were welcome at any time and were coming and going all the time during our inspection. They could have privacy in individual rooms or in the lounge.

People, staff and visitors felt the service was well led by an open and approachable manager. One visiting social care professional told us they had been impressed with the discussions they had had with the registered manager and said “They know what they are talking about!” The registered manager was described as ‘very efficient’. Everyone knew them and said they were available around the home.

There were systems in place to assess, monitor, and improve the quality and safety of care. The registered provider’s representative visited regularly and the registered manager provided them with a weekly report on the home. Information included when health and safety and mattress audits had been completed. Other regular audits included medicines, care plans and the environment. A recent environmental audit had identified five rooms had a bad odour. All carpets had since been cleaned.

We have made recommendations relating to staffing levels, staff training and activities. This was because we found that while the issues were being dealt with further improvements could be made.