We inspected Woodlands Nursing Home on 12 September 2016. This was an unannounced inspection. The service is registered to provide accommodation and nursing care for up to 40 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 34 people living in the care home, including one person who was in hospital.

At our last inspection on 14 November 2014 the service was found to require improvement in all outcome areas and one breach of regulations was identified, regarding Deprivation of Liberty Safeguards (DoLS). Following that inspection we asked the provider to advise us how they would address the identified shortfalls. They subsequently sent us an action plan stating the improvements they intended to make and the date by which they would be completed. On this inspection we found the necessary improvements had been made and the service was no longer in breach.

A registered manager was in post and present on the day of the inspection. 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.

There were policies and procedures in place to assist staff on how keep people safe. There were generally sufficient staff on duty to meet people’s needs; however some inconsistencies were identified regarding staffing levels over the weekend. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their

This inspection took place on 14 November 2014 and was unannounced.

Woodlands Nursing Home is registered to provide accommodation, nursing and personal care for 40 older people. At the time of this inspection there were 36 people using the service, some of whom are living with dementia and physical disabilities. The service is located in Ripley in Derbyshire which has amenities and good transport links.

There was a registered manager at the service at the time of our inspection. 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.

Three people received their medication covertly. This means that in order for them to take their medication it needed to be hidden in food or drink. There were no mental capacity assessments or best interest decisions assessments in place, to confirm why these people did not have the capacity to make decisions about taking their medicines. This meant that the provider did not follow the required legal requirements. The registered manager told us that none of the people using the service were subject to a Deprivation of Liberty Safeguards (DoLS) and no application had been made. The registered manager at the service was aware of the recent Supreme Court ruling regarding DoLS and informed us that she was in the process of seeking further advice in this area.

We saw that that on some occasions the communal areas were left unattended. This demonstrated that the deployment of staff was not effective. Some relatives raised concerns about the staffing levels in particular on the unit supporting people with dementia.

We looked at the medicines administration records two people who used the service. Medicines were managed safely and kept securely. People who required medication on an ‘as and when’ basis (PRN) did not have clear PRN protocol’s. This meant that people may not receive their PRN medicines as prescribed.

There was a noticeable malodour on the unit supporting people with dementia, which did not ensure people lived in a well maintained environment.

People who used the service and their relatives told us they felt safe with the support they received from the staff at the service.

People told us that they liked the staff and that the support they received from staff was good. However, we saw that some people received lack of support during meal times.

Staff told us that the management team supported them and provided them with the relevant training to help them support the people at the service.

There were systems in place to monitor the quality of the service. People using the service views were obtained in the running of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with nine people who used the service and eight relatives.

People we spoke with who were able to express their views said they were happy with the care they received, and felt that their needs were being met. Comments from people included ‘’I am happy here and I like the staff; the staff respect my privacy and dignity; the staff are 1st class, they can’t do enough for you.’’

Relatives we spoke with told us they were generally happy with the care their family member received, and felt involved in decisions about their care and treatment.

Four relatives said that they felt that more staff were needed at times to meet people’s needs. The findings of our visit supported this. The provider was recruiting further staff to increase the staffing levels on days to meet people’s needs.

People liked the staff that supported them. They said that they felt listened to and able to raise any concerns with the staff. Systems were in place for handling complaints to ensure they were investigated and responded to properly.

The premises were clean, adequately maintained and safe. Further areas were being re-furbished to ensure the premises meet people’s needs.

Arrangements were in place to ensure that staff received appropriate training, supervision and appraisal to carry out their work properly.

We spoke with four people who use the service. They were all pleased with the decision that they live at Woodlands. They all agreed that their privacy was respected, with one person stating, “Staff always knock and ask if they can come in...I have a key and can lock my door…my bedroom is my home.”

The people we spoke with described good levels of contact with the local community. One person told us, “My good friend visits regularly and takes me out.” People told us they were involved in drawing up their care plans and risk assessments and they confirmed that staff encouraged them to be as independent as possible.

The people we spoke with said that staff respected their personal preferences such as when to rise in the morning and when to go to bed. One person told us, “Staff respect my wishes…I choose where I sit for meals.” People also felt that all their needs were met at Woodlands, with one person adding, “I ask and it’s done.”

People felt that a range of suitable activities were offered. One person told us they were interested in gardening and said, “Staff accompany me into the garden...[staff member] asks me my advice on gardening.” People told us that their clothes were well laundered and we were able to confirm this from their appearance. One person said the laundry service was, “excellent.”

The people we spoke with told us that they felt safe living at Woodlands. One person said, “Staff are caring…I’m able to talk to staff…I once told [the manager] about an agency staff who was abrupt with me…I don’t see that staff now.” All the people we spoke with confirmed that staff showed them respect and ensured their dignity was maintained.

People told us that staff were competent at their job and felt there were sufficient staff to meet their needs and were readily available. They said the quality of the service they received was very good. They told us about meetings held for the people who use the service and how their contributions had been acted upon. People confirmed they had been asked what they think of living at Woodlands – in questionnaires and to their face. One person told us, “I’m happy here and I do praise the staff – they’re excellent.”