This inspection took place on the 16 May 2018 and was unannounced. At the previous inspection of the service in February 2016 we rated them as Good and made one recommendation. This was because people were not always given a choice about whether or not their bedroom door was left open. During this inspection we found this issue had been addressed.

Woodland Nursing Home is a care home. People in care homes receive accommodation and nursing or 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. The service is registered to provide support with nursing and personal care to a maximum of 30 adults. At the time of inspection 23 people were using the service, many of whom were living with dementia. The service is built over four floors, with people living on the upper three floors.

The service had a registered manager in place. 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.

During this inspection we found two breaches of regulations. This was because quality assurance and monitoring systems were not always effective and the provider had failed to notify CQC about people who were subject to a Deprivation of Liberty Safeguard authorisation, even though they were legally obliged to do so. In addition, we have made four recommendations. These were related to fire safety, staffing levels, equality and diversity and the home's décor. We are still considering what our response will be to breaches of regulations.

People told us they felt safe using the service and systems were in place to help safeguard them from abuse. Risk assessments had been developed which set out how to meet people’s needs safely. Checks were carried out on prospective staff to help ensure they were suitable to work at the service. Medicines were managed safely and there were systems in place to reduce the risk of the spread of infection.

Pre-admission assessments were undertaken which looked at people’s care support needs. Staff were supported through regular training and supervision and new staff undertook an induction training programme on commencing work at the service. People told us they enjoyed the food and we saw they were offered choices about what they ate. People were able to access health care professionals and the service kept family members informed of any health issues.

People said they were treated in a kind and caring manner by staff. Care plans set out how to support people in a dignified manner. Staff had a good understand of how to promote people’s dignity, privacy and independence.

Care plans for people set out how to support them in a personalised manner relevant to the individual. Activities were offered and people told us they valued and enjoyed them. Systems were in place for dealing with complaints and people told us they knew how to make complaint if needed. Care plans included information about supporting people with end of life care.

Staff spoke positively about the registered manager and systems were in place for seeking the views of people who used the service and their relatives.

This unannounced inspection took place on 3 February 2016. The provider met all the regulations we inspected when we last visited the service on 28 August 2014.

Woodland Nursing Home is registered to accommodate up to 30 people who require nursing and residential care. At the time of the inspection, there were 27 people using the service and two people were admitted to a hospital.

The service had a registered manager. 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.

We found staff had the knowledge and experience to care for people who needed nursing care. People and relatives spoke positively about the staff by saying that they were kind and caring. We found staff had received training in adult safeguarding and were knew their duties to ensure people were protected from abuse.

We found that systems were in place to respond to people’s needs. Each person had a personalised care plan that was regularly reviewed and provided guidance for staff how to support them. This included referring people and helping them access to appropriate healthcare when needed. We recommended people’s risk assessments should include risks associated with keeping bedroom open or closed.

Staff told us they were supported by the registered manager. They told us they could approach the registered manager to ask for support and that they found her very helpful. We noted that staff had supervision with their line managers and had attended team meetings. Staff told us they had training opportunities and had attended various courses including the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty safeguards (DoLS). This showed that people were supported by staff that had been trained to provide quality care.

The registered manager undertook regular audits to check the quality and safety of the service. We found that the registered manager attended meetings with the other managers of care homes owned by the provider. We also noted monthly audits and reports were sent to the Head Office to enable the provider to advise and support the registered manger.

People and staff had the opportunity to influence the quality of service by sharing their views through informal feedback and survey questionnaires. We noted that the provider had a complaints procedure and people and their relatives were aware of how to make complaints if they were not satisfied with the service. This enabled the registered manager to review and develop the service.

A single inspector carried out this visit, during which, we gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see evidence supporting our summary please read our full report.

Is the service safe?

Risk assessments had been completed for each person using the service to identify potential risks such as falls or pressure sores. Staff we spoke with knew how to respond if a person using the service became unwell and we saw evidence they had received training to provide safe care. Accidents and incidents were reported and recorded. Appropriately trained staff were observed to safely administer and manage medicines. Medicines were stored and when no longer required disposed of safely. There were effective recruitment procedures in place and relevant checks were undertaken before staff were employed.

Is the service effective?

People’s health and care needs were assessed with their involvement where possible. Care plans had been developed and these reflected the level and type of support each person required to be safe and receive appropriate care to meet their needs and preferences. People’s mental capacity to make informed choices had been assessed and we saw relatives had been involved to ensure their best interests were considered. Relatives we spoke with felt people were safe and care was provided in accordance with people’s wishes.

Is the service caring?

We observed people using the service had their privacy and dignity respected and staff sought people’s agreement before providing care. We spoke with people and their relatives. Relatives told us they were always contacted if staff had a concern about a person using the service. One person using the service said, ‘’I’m very lucky really. They do everything for me. I have my own things in my own room and can go and rest when I wish.’’

People had been involved in the planning of their care and supported by their relatives to identify their preferences and what was important to them. People’s cultural needs had been respected by ensuring they were able to choose appropriate clothing and diet. Staff demonstrated a good understanding of each person’s needs and how to effectively communicate with them including being able to speak to people in their own language.

Is the service responsive?

There was a system in place to respond to and handle complaints. People were invited to be involved and make decisions about their activities but their wishes were respected when they did not wish to participate. There was evidence to show the service worked effectively with other health care professionals such as general practitioners to ensure people received care they had needed. We observed peoples wishes about aspects of their care and daily activities were respected and responded to appropriately.

Is the service well led?

The registered manager had completed audits of various aspects of the service to ensure the quality of service was maintained and improvements could be identified. There were satisfaction surveys undertaken to obtain feedback about the service and suggestions had been responded to appropriately. People using the service had also been supported by their families to participate in meetings to obtain their opinion of the service.

At the time of our inspection there were 24 people living at Woodland Nursing Home. Everyone using the service required nursing care and were living with dementia. We spoke with four people using the service, three relatives, and eight members of staff which included the manager, a nurse, carers, kitchen staff and the administrator. We looked at the comments book and the recent survey for people using the service and staff.

We saw that people were asked about their choices and staff sought their consent before providing support. The care plans showed that people's health and social care needs were identified and appropriate care was delivered to meet these needs.

All the people using the service and their relatives were happy with the care provided. One person said, “I couldn’t fault them in anyway, I think they are angels.” Another person told us, “the staff are brilliant. They always have a smile on their face.”

We found people received care and treatment in a clean environment. There were effective systems in place to reduce the risk of infection. Staff were able to describe the infection control policy to us and provided evidence to show that checks were carried out regularly.

Staff were qualified, skilled and had the relevant experienced to meet people’s needs. They all received appropriate support and training. However staff told us they often felt their job was task orientated and they would like to be able to spend more quality time with the residents.

There were quality monitoring processes in place. The people using the service and their representatives were asked for their opinion of the home through regular meetings and a yearly survey.

People told us what it was like to live at the home and described how they were treated by staff and involved in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Through the use of SOFI we were able to observe that people's experience of the service was a positive one. Staff support was provided in a way that protected people’s dignity and met their nutritional needs.

People who used the service made positive comments about the staff and told us that they were happy with the way they were looked after. They told us they were asked how they liked their care to be provided and that they were treated with dignity and respect. One person said, “I had my telephone installed since I have been in the home and that is six years now and I can communicate with my family and friends in private and staff respect my independence." Another said, “I enjoy taking part in the sing-along or just doing what I would choose to do." A third added, “I do not think I could be a in a better home. The staff are so nice.”