We inspected Woodlands on 21 November 2018 and 7 January 2019. The first day of the inspection was unannounced. When we last inspected the service on 29 December 2016 and 12 January 2017 we found the provider was meeting the legal requirements in the areas that we looked at and rated the service as good with an outstanding rating in caring. At this inspection we found that the service had improved further and was outstanding overall.

Woodlands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Woodlands provide care, support and accommodation for up to 14 people who have a brain injury. The aim of the service is to support people to regain their social, cognitive, and independence skills and to develop people's confidence to enable them to return to independent living. At the time of the inspection there were 13 people who used the service.

A registered manager was in place. A registered manager is a person who has registered with the 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.

The service provided outstanding care, emotional support and rehabilitation to people following their brain injury. The registered manager and staff were exceptionally caring and encouraged people to do well in achieving their goals. Staff demonstrated a real empathy for the people they cared for. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life, this was reflected in the care and support that people received.

There was a strong recognition that people were individuals and the care and support provided ensured their needs were met and resulted in positive and improved outcomes for people. People received a service that was extremely responsive and based upon a person-centred approach and best practice. They had achieved exceptional results with people’s rehabilitation and improved people's emotional and psychological wellbeing.

The registered manager and staff worked extremely hard to find ways to ensure people were engaged and stimulated. Activities were meaningful and people had regular holidays. People were provided with choice and opportunities dependent on their needs or interest. There was a dedicated activities room with people’s art work proudly displayed.

The registered manager and staff worked in a way that put the needs of people first. Care plans were extremely informative and reflected people’s likes and dislikes in detail. The registered manager and staff knew every person they cared for in depth, what was important to them and the best way to provide care to them.

The registered manager displayed exceptional leadership qualities, drive and enthusiasm. They empowered staff to provide care that was tailored to individual's needs. Staff were highly motivated by the registered manager and showed pride in their work and the support they gave to people.

Without exception people, their relatives and professionals told us they experienced compassionate care from staff. This ensured the service was run in the best interest of people who used the service.

A comprehensive programme of audits and checks was in place to monitor all aspects of the service, including care delivery, accidents and incidents, health and safety, infection prevention and control and medicines. Audits resulted in clear action plans to address shortfalls or areas of improvement.

We observed care delivered in a way that truly reflected the provider's values of empowering people, sharing and engaging together, listening, honesty, outstanding leadership and support. T

We inspected Woodlands on 29 December 2016 and 12 January 2017. The first day of the inspection was unannounced, which meant the staff and registered provider did not know that we would be visiting. We informed the registered provider of the second day of our inspection.

When we last inspected the service in January 2015 we found that the registered provider was meeting the legal requirements in the areas that we looked at.

The home had 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.

Woodlands provide care, support and accommodation for up to 14 people who have an acquired brain injury. The aim of the service is to support people to regain their social, cognitive, and independence skills and to develop people’s confidence to enable them to return to independent living. The service has ten en-suite bedrooms and an attached self-contained flat with private lounge and cooking facilities. To the rear of the property there are a further three flats. People who use the service have the opportunity to progress from one of the rooms in the main part of the service to one of the flats, as their skills improve. At the time of the inspection there were 10 people who used the service.

The registered provider is also registered to provide personal care to people in their homes, however at the time of the inspection there wasn’t anyone who used this service.

The service provided outstanding care to people. Staff were exceptionally caring and inspired people to do well in achieving their goals. People were cared for by staff who knew them well and understood how to support them and maximise their potential. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life, this was reflected in the care and support that people received. We saw that staff treated people with dignity and respect.

Staff understood people's different ways of communicating and how to make people feel valued. The home had a strong, person centred culture and staff went that extra mile for the people and families they supported.

People were protected by the services' approach to safeguarding and whistle blowing. People who used the service told us they felt safe and could tell staff if they were unhappy. People who used the service told us that staff treated them well and they were happy with the care and service they received. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management acted appropriately to any concerns brought to their attention.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as health, behaviour that challenged, falls and going out independently. This enabled staff to have the guidance they needed to help people to remain safe.

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capac

The inspection visit took place on the 19th January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on 10th October 2013 and found the service was not in breach of any regulations at that time.

Woodlands provide care and accommodation for 11 people who have needs in relation to an acquired brain injury. The aim of the service is to provide support and aid development and rehabilitation to enable people to return to independent living. Accommodation is provided over two floors. Bedrooms have an en-suite toilet, wash basin and a shower. On the ground floor there is a communal lounge, kitchen/dining room, an activities lounge and a gym. The home is close to shops, pubs and public transport.

There is 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 at Woodlands. We discussed safeguarding with staff and all were knowledgeable about the procedures to follow if they suspected abuse. Staff were clear that their role was to protect people and knew how to report abuse including the actions to take to raise this with external agencies.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager had the appropriate knowledge to know how to apply the MCA and when an application should be made and how to submit one. This meant people were safeguarded.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who had an acquired brain injury and behaviour that may challenge. We found that the staff had the skills and knowledge to provide support to the people who lived at the home. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that six staff routinely provided support to 11 people.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development. We also saw a regular programme of staff meetings where issues were shared and raised.

The service encouraged people to maintain their independence. People were supported to be involved in the local community as much as possible. People were supported to independently use public transport and in accessing regular facilities such as the local G.P, shops and leisure facilities as well as to use the facilities in the service such as the kitchen for cooking meals. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people, who were able to were encouraged and supported to go out independently and others routinely went out with staff. People told us that they made their own choices and decisions and these were respected.

There was a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that the registered manager would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

People told us they were involved in planning their meals and were encouraged to help prepare food with staff support if they wished. We saw people had nutritional assessments in place and people with specific dietary needs were supported. Specialist advice was sought quickly where necessary. We observed the lunchtime meal and saw people had a wide variety of choice and were encouraged to take healthy options by staff.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans. The people we spoke with discussed their support plans and how they had worked with staff to develop and review them.

We reviewed the systems for the management of medicines and found that people received their medicines safely and there were clear guidelines in place for staff to follow.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home and there was plenty of personal protective equipment to reduce the risk of cross infection. We saw that audits of infection control practices were completed.

We saw that the manager utilised a range of quality audits and used them to critically review the service. They also sought the views of people using the service and their families on a regular basis and used any information to improve the service provided. This had led to the systems being effective and the service being well-led.