The inspection took place on 18 July 2018 and was unannounced. The last inspection took place under the service’s previous registration and the service was rated good in all areas. Since then the service has re-registered under a new name.

Woodlands Atherton Dementia Care Home and Services is registered to provide residential care for up to 38 adults, but usually only accommodates 36 as there are two larger rooms which can be shared. On the day of the inspection there were 34 people residing in the home, one of whom was in hospital. In addition, there was one person undertaking an assessment day and another admission expected the following day. The home specialises in the care of adults with varying levels of dementia and complexity in needs.

The home is situated in a quiet residential area, located off the main Atherton to Bolton road. There is a large garden to the rear and car parking available at the front of the home. It is located close to local amenities.

There was 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.

People felt safe living at Woodlands. There was an appropriate safeguarding policy and all concerns were logged and responded to appropriately. Staff had regular safeguarding training and demonstrated a good understanding of safeguarding issues and reporting mechanisms.

The recruitment system was robust and staffing levels were sufficient to meet the needs of the people who used the service.

Individual and general risk assessments were in place and up to date. Health and safety training was undertaken by all staff and there was a monthly maintenance report and a number of monthly audits, for which most documentation was complete and up to date.

Medicines systems were robust. Infection control measures were in place and staff wore appropriate personal protective equipment, such as plastic gloves and aprons, when delivering personal care.

We looked at four care files, which included appropriate health and personal information. Staff had a thorough induction and training was on-going for all staff. Supervisions and appraisals were carried out regularly and there was an electronic system to monitor and alert managers to when supervisions were due.

Information, such as the service user guide and statement of purpose, could be produced in other languages or formats as required. A statement of purpose is a legally required document that includes a standard set of information about a provider’s service. There was a sign on the front door to say that information could be made accessible for everyone.

The environment was dementia friendly with appropriate signage. People said they enjoyed the food and the dining experience was positive, relaxed and enjoyable. The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People felt their privacy and dignity were respected. We observed care throughout the day and saw consistent, meaningful one to one interactions between staff and people who used the service. Independence was promoted and communication was good between the home staff and other professionals, agencies and families.

The service was committed to ensuring people were treated equally and paid attention to the diversity of the people who used the service. Documentation was securely stored and staff were aware of the confidentiality policy.

The care files included information about people’s choices, preferences and interests. Care plan reviews were completed regularly and people were involved as required.

Throughout the day we saw staff never missed an opportunity to engage in meaningful occupations and

The unannounced inspection took place on 12 July 2016. The last inspection was undertaken on 20 May 2014 and the service was meeting all requirements reviewed at that time.

Woodlands House is registered to provide residential care for up to 38 adults. The home specialises in the care of adults with varying levels of dementia and complexity in needs. The home is situated in a quiet residential area, located off the main Atherton to Bolton road. There is a large garden to the rear and car parking available at the front of the home. It is located close to local amenities.

There was a registered manager 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.

On the day of the inspection there were 35 people living at the home. There was one vacancy and one person currently in hospital.

The service had a robust recruitment system in place and staffing levels were sufficient to meet the needs of people who used the service.

There were appropriate individual and environmental risk assessments in place. Staff were aware of safeguarding procedures and confident to report any concerns.

There were systems in place to help ensure medicines were ordered, stored, administered and disposed of safely.

Regular quality audits were undertaken and issues identified and addressed by the service.

The induction programme was robust and included all mandatory training. Staff had regular supervision sessions and annual appraisals and further training and development was on-going.

Care plans included a range of health and personal information. They were person-centred and people’s preferences, likes and dislikes were documented.

People’s nutritional and hydration needs were catered for and the environment was suitable for people living with dementia.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who used the service were well presented and well cared for. Relatives and professional visitors told us staff were kind, respectful and caring.

The service ensured equality and diversity was respected. Privacy and dignity was also respected.

Residents’ meetings were held regularly to ascertain people’s views and opinions and information was produced in the form of the service user guide.

The service endeavoured to support people to stay at the home when they were nearing the end of their lives if this was their wish.

There was a range of activities on offer within the home and the service linked in with the wider community to help keep people integrated within society.

There was an appropriate complaints policy in place which was prominently displayed within the home.

The manager attended a number of local care home meetings to keep up to date with changes.

Regular team meetings took place and staff feedback was sought through regular questionnaires and listening groups.

During this inspection the Inspector gathered evidence to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During the inspection we looked at respect and involvement, care, partnership working, supporting workers and quality assurance.

This is a summary of what we found, using evidence obtained via observations, speaking with staff, speaking with people who used the service and their families, speaking with professional visitors to the service and looking at records:

Is the service caring?

We observed good interaction between staff and people who used the service. Staff were patient and respectful and took time to explain things and listen to people who used the service. People who used the service looked generally happy and well presented.

We saw evidence that people’s dignity and privacy was respected, by the way staff communicated with people and within the care records which documented individual needs. The care records included documentation of communication between the home and other agencies and services.

Efforts were made to ensure people had their say, for example, questionnaires were sent out to relatives to gain their views and the home was in the process of setting up listening groups to provide another opportunity for people to raise issues and make suggestions.

Activities were geared to people’s abilities and conditions, so there were a significant number of one to one interactions, or small group work, such as reading and discussing The Daily Sparkle, a reminiscence activity newspaper, and stimulating discussion . It was clear that much thought and training had gone into activities.

People at the home were all living with dementia, so it was difficult to obtain their views. However, we spoke with five people who were visiting relatives at the home. All the visitors with whom we spoke were positive about the home, the staff and the care offered.

Is the service responsive?

People’s individual care needs were assessed and care delivered in as personal and individual way as possible. The staff clearly knew the preferences and personalities of the people who used the service and responded to them appropriately.

One staff member was a dementia champion, ensuring they kept up to date with all dementia training and initiatives so that the service could respond to the particular needs of the people who used the service.

We saw evidence of the consideration of mental capacity and decisions being made in people’s best interests, with the input of relevant professionals, family and friends.

We spoke with two professional visitors to the service who told us the staff communicated well, referred appropriately and followed instructions and advice given by them.

Is the service safe?

Risk assessments, such as falls, nutrition and moving and handling were in place in the care records and were reviewed and updated regularly to ensure people’s needs were met safely.

Staff had undertaken a significant amount of training appropriate for their roles and their knowledge and skills were kept up to date by a regular programme of refresher and new training courses. Policies and procedures were regularly re-visited, usually following relevant training courses, to keep staff up to date with changes and updates.

There was an appropriate Deprivation of Liberty Safeguards (DoLS) authorisation in place for one person who used the service. This helped keep the person safe and secure within the home, with the least possible amount of restrictions applied. Staff were aware of the criteria for DoLS and of where to seek advice and guidance for this process.

A fire risk assessment was in place and all fire safety measures had been implemented to comply with the requirements of Greater Manchester Fire and Rescue Service.

All people who used the service had a Personal Evacuation Plan (PEEP) so that staff were aware of the level of support required by each person in the event of an emergency.

There was evidence that staff were well supported, communication was effective and training was relevant and on-going.

Is the service effective?

Staff with whom we spoke demonstrated a good understanding of their roles and responsibilities.

Care plans we looked at included clear information about people’s needs, wishes and preferences and we saw evidence that the care offered was in line with this information.

Feedback from the most recent relatives’ survey indicated a good level of satisfaction. Relatives were confident to offer suggestions for improvements and there was evidence that these were considered and responded to appropriately.

We spoke with five people who were visiting relatives at the home. All felt the care provided was effective and appropriate. Two of the visitors commented that their relatives’ well-being had improved significantly since moving into the home.

Is the service well-led?

The home had an appropriately registered manager in place at the home.

There were a significant number of audits and checks in place to help ensure consistent standards of care within the home.

We saw evidence of ongoing review of systems and constant change to ensure they were fit for purpose. For example, as there were often few responses to the satisfaction questionnaires, these had been changed recently to make them more user friendly and encourage more feedback.

Another new innovation was the electronic system which was in the process of being implemented at the home. This would help make the service more efficient in a number of ways, for example, accidents and incidents could be tracked and analysed more easily for patterns and trends so that these could be responded to. Monitoring information would be more useful and accurate as we were shown how the system could track progress and collate information. This showed a commitment to constant change to facilitate continual improvement to service delivery.

We sampled four care files and daily records of people who used the service. We found care plans had been implemented involving the person themselves when possible or with relatives or representatives.

For part of this inspection we were supported by an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of service. This person sat and spoke with a number of people who used the service at Woodlands House. Comments included: “If I hold my hand up they come straight away”, “These are good girls", "The staff are nice”, “This is a lovely place, quiet, no noise".

We found Woodlands House were meeting the nutritional needs of people who used the service. People were adequately protected from the risks of inadequate nutrition and dehydration.

We found staff files contained all the relevant information to demonstrate staff had been safely and effectively recruited and employed.

Woodlands House had appropriate systems in place for the management of medicines. Arrangements were in place for obtaining medicines routinely and out of hours. When we spoke with people who used the service we were told: "I get my tablets on time each day", "If I need anything, like a pain killer, I only have to ask" and "I have my medicine when I need it".

Care was provided in single rooms, some with en suite facilities. Bedrooms and communal areas were clean and well organised.

We had received information of concern about the care and welfare of people who lived at Woodlands House. We made the decision to carry out an unannounced inspection at the home as soon as possible.

The majority of the people who used the service had varying stages of dementia and mental health needs which meant they were not able to tell us their experiences, however we spoke with three people who used the service and one relative who was visiting at the time. We were told “My X has really settled here well. We had lots of information about the home and we feel that the staff are wonderful”. "I have always found my X to be clean and cared for".

We sampled four care files and found that they contained care plans that had been implemented to include personal likes and dislikes and these were updated each month or as care needs changed.

During the inspection we found care staff had guidance available to them on how to report any concerns about safeguarding vulnerable adults. Care staff knew how to raise any concerns.

We spoke with staff who raised no issues about the numbers of staff who worked in the home. We were told: "I haven't experienced under staffing at all and I feel that staffing levels are good".

During the inspection we observed that there was a senior manager on duty and four care workers. We had no concerns about the numbers of staff on duty.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of two people, who told us:

“My X has really settled here well. We had lots of information about the home and we feel that the staff are wonderful”.

“I have nothing but praise for the staff here, they do a great job: They always keep us up to date and we have never had any cause to worry at all”.

For part of this inspection we were supported by an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of service. This person talked with a number of people who use the service at Woodlands House. The Expert by Experience completed a report after the inspection and some of their comments and observations are included in this report.