Woodrow Retirement Home Limited is a residential care home for up to 18 older people with including people living with dementia. At the time of this inspection there were 17 people living there. A manager is registered for the service, and they are also the provider. 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

Staff were attentive, understanding and kind. People praised the caring manner of the staff. Comments included “Lovely caring bunch” and “I have always found them lovely. A member of staff told us “We do get very attached to people.” They also told us “We treat people like they are our own parents”. The staff team spoke with fondness of people who had received end of life care. A relative praised the care given to her mother and all the family at the end of her mother’s life, saying “They were lovely with me”. They went on to say “They kept her as comfortable as possible.”

People continued to live in an environment that was well maintained, comfortable, clean and safe. People were encouraged to bring items of furniture to personalise their rooms and make them feel homely. Equipment was regularly serviced and maintained. The provider had placed a high priority in ensuring the home met current safety standards to reduce the risk of fire.

People were supported by sufficient staff to meet their needs. People living in the home and relatives told us there were, “Plenty of staff, whatever the time of day.” The provider had taken care when recruiting staff to carry out checks to ensure they were entirely suitable for the job. People and relatives told us the staff were competent. Staff training records showed many of the staff held relevant qualifications and had received training and regular updates on a wide range of topics relevant to the needs of people living there. Staff were well supported and supervised. There was a stable staff team. A member of staff told us there was a happy atmosphere and it was a “Good place to work”.

Medicines were stored and administered safely. Records of medicines administered were well maintained. The provider and staff had worked closely with the local pharmacy and health professionals to ensure people’s medicines were safe and met their health needs.

People were offered a variety of meals and drinks to suit their preferences and dietary needs. People praised the food. Their comments included “The food is very good”. A relative told us “She eats very well. She enjoys lots of different foods.” The staff had information about each person’s dietary needs, and sought specialist input and guidance where necessary.

Each person was carefully assessed before they moved into the home. People and relatives were involved and consulted in drawing up and reviewing their care plans. There were systems in place to help them identify risks and risk assessments were regularly reviewed. Where care needs changed, care plans were updated to ensure staff had up-to-date information about each person’s needs. Staff were observant and noticed changes in people’s health. They sought medical advice and treatment promptly when needed. A health professional told us “They follow our advice.”

There was a strong emphasis on treating each person as a valued individual. All staff had received training on Equality and Diversity. The registered manager had sought information, support and training from local organisations and reputable internet resources on topics to help staff understand the effects of disabilities such as partial sight, and dementia to enable staff to offer positive

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? We had also received some concerns about how people’s care needs were met and how accidents and medicines were managed.

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.

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 an assessment of the person'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 risk.

People living at the home told us that staff were always polite and respectful. One person told us that staff “Always speak nicely to me”.

We saw the medication systems in use meant people had their medicines at the time they needed them and in a safe way. Staff told us about one person who had to have their medicine at a set time and following particular guidelines. We saw these instructions detailed on the MAR sheet and staff signatures confirmed the correct administration.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The Registered Manager had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We discussed people's care needs with staff and 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.

We found that staff received appropriate training and professional development. For example, staff told us and records confirmed that staff had received training in safeguarding vulnerable people, food hygiene, first aid, and moving and handling. A mixture of training methods was used. For example, DVDs, distance learning and ‘hands on’ training were all used to provide training.

Is the service caring?

People we spoke with told us that they were supported to make their own decisions and were able to make choices about how they spent their day. People living at the home told us that staff were always polite and respectful. One person told us that staff “Always speak nicely to me”.

Staff supported people to make choices and decisions about their daily lives. For example, people told us they were able to get up and go to bed when they chose. We saw some evidence on people’s care plans about how they liked their care to be delivered. People living at the home told us that staff always asked them what they wanted staff to do for them. One person said they (staff) “Always ask if I’m ready to do this or that”.

People living at the home spoke highly of the care received. One person told us “It’s very nice here – couldn’t better it”. Another person told us that staff “have to do everything for me, they are very nice”. Another person said “Staff are very nice and obliging – nothing is too much trouble”. Another told us that it was “Not at all institutional”.

Is the service responsive?

People we spoke with told us that they were supported to make their own decisions and were able to make choices about how they spent their day. People told us that they mainly liked to spend the day in their rooms.

We saw the main lounge for the home was being refurbished. This had been ongoing for some time. We saw evidence that meetings had been held with people to let them know the plans for the lounge. People told us they were looking forward to it being completed and felt it would be a pleasant place to sit.

Information about visits from and to health care professionals had been recorded in individual care plans, showing clear evidence that people were supported to maintain access to specialist medical services. For example, we saw that a GP had visited following concerns raised by staff about one person’s posture.

The Registered Provider told us that they generally had very few complaints raised and these were usually dealt with very quickly. We saw a leaflet on ‘How to make a comment, suggestion or express a concern’ was available in the hallway. The Registered Provider showed us one letter of complaint they had recently received. They told us that they had resolved the issue, but there was no evidence of this on the file.

Is the service well-led?

The Registered Provider had owned the home for some time, and there was a consistent staff team. Staff were aware of the needs of the people living at the home and were able to meet them.

We saw evidence that a training matrix was kept that identified which staff had received training in administering medicines. This was confirmed by training certificates and by the member of staff administering medicines. We also spoke with a new member of staff who told us that they would not be able to administer medicines until she had received the appropriate training.

We spoke with two care staff and the cook. They told us that they felt supported to do a good job. The Registered Provider took note of reports prepared by the Commission following an inspection. We know this because following our visit in July 2013 the Registered Provider made the required improvements in relation the administration of medicines.

We carried out this inspection in October 2013 to follow up on our July 2013 inspection. At our July inspection we had concerns about the management of medications at Woodrow Residential Home. On our October 2013 visit we found that the home had made improvements.

We spoke with the manager, a senior care worker and a care worker about the way medications were managed at the home. One member of staff told us “I go through the medication admin sheets religiously and there’s also a whiteboard to prompt us”.

We also spoke with the new pharmacy provider for the home. The home had changed pharmacist’s since our last inspection. The new pharmacist had worked with the home to make improvements.

We looked at relevant training records, medication care records and medication audits. We looked at security arrangements for medication and controlled drugs at the home.

We found that the provider had taken notice of the concerns raised in our July 2013 inspection and that improvements had been made.

Woodrow is a long established and family run home for older people. On this inspection we found that the dependency levels of the people living there had risen and some people had early memory loss. We found people were being well cared for, but that the home needed to make some changes to better reflect the change in needs of the people living there. We also identified concerns over the way that medication was being managed and stored.

People told us they were looked after well and were happy at the home. One person told us "I have lived here a very long time. The staff know me well, and they are very good. I was very poorly recently and I couldn't thank them enough for all the extra help they gave me. They really were wonderful." Another person we spoke with told us "I've no complaints. I don't think I could be better looked after anywhere else."

We found work had been carried out on the building to make it a more attractive and safe place to live. Additional work was still under way to provide a new lounge area and landscape the gardens.

We found that staffing levels were appropriate to meet the needs of people living at the home. The provider had assessed the quality of the services provided against guidance and instigated a more robust process for quality assurance, involving people who lived at the home.

We visited Woodrow to follow up on areas of concern identified at the last inspection in May 2012. At that time we identified concerns about the care plans, the upkeep of the building, staff training and support systems and quality assurance systems.

Following the visit the provider sent us action plans of the changes he had made. He also sent us photographs or other evidence of the work as it was progressed.

On this visit we found that the majority of the areas we had identified had been improved. There had been substantial work undertaken on the building, and new systems were in place for staff training and support. The dining room had been redecorated and refurbished, the hallway re-plastered and decorated, and 2 rooms refurbished, along with new wet rooms installed.

Further work was planned to provide a new lounge once planning permission was resolved. This had been delayed due to the building being in a conservation area. We saw evidence that progress was being made on this, and that people living at the home had been involved in making decisions around this room and it's future use.

The care plans had been improved and further work was planned on these to ensure they better reflected people's needs and any risks associated with people's care.

We visited Woodrow on the 3rd May 2012 as a part of our scheduled inspection programme. We spoke with six of the fifteen people receiving a service at the care home. All of the people we spoke to told us the care they received met their needs and wishes.

Each person had a plan of care, and we saw that these had been drawn up with the support of the individuals concerned, and signed by them wherever possible to confirm they were in agreement with the contents. Statements on confidentiality of information were contained within files.

One person told us "the care here has been really excellent. I can't fault it". Another person we spoke to told us "the best thing about this place is that there are no rules and regulations about what we do. They look after me extremely well".

People living at the home that we spoke to told us they were comfortable with the staff and management and had no concerns. People told us if they were worried about anything they would tell their families or staff at the home.

We saw staff communicating effectively with individuals receiving care. People were being spoken to respectfully.

People told us they had chosen the home by recommendation from people already there or who knew of the service.The senior staff told us the home was full with a waiting list of people wishing to move in.

Woodrow Retirement Home Limited is a long established service, registered to provide accommodation and care for up to 16 people. The home is not able to provide nursing care, provided by the community nursing service. People living at the home are older people, some of whom may have some early memory loss.

The home was last inspected in June 2014 when it was meeting the requirements at that time. The inspection took place on 25 September and 6 October 2015 and was unannounced. On the day of the inspection there were 15 people living at the home.

A manager is registered for the service and they are also the owner. 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 living at the home were older and many had mobility difficulties. On the first day we inspected we found there were some risks within the environment. For example, a door to the basement was not locked and people who were unsteady on their feet could have fallen down the steps. One person’s bedroom door was propped open with a chair. On the second day of our inspection the registered manager had taken steps to remedy these matters. Other risks within the environment were well managed. For example, radiators were covered to prevent burns and window openings were restricted to prevent people falling from a height.

The way the home was managed could be improved. There were no effective quality assurance systems to help improve the service. Although some audits were carried out such as medicines, the registered manager told us “It’s fair to say I have done little in the way of quality assurance lately.” There was no system in place to monitor accidents and incidents in order to reduce the risk of repeat occurrences. There was no formal system in place to obtain the views of people living at, working at or visiting the home. The home was an older building with some narrow corridors. The manager had not carried out any risk assessments to determine how this impacted on people and had therefore not put management plans in place. We have asked the manager to take advice on when to make a referral to a healthcare professional following a fall.

The registered manager was keen to develop and improve the service and had plans to further improve the environment, care records and social activity.

Work had been carried out recently to create a new lounge/dining area which was large, bright and nicely furnished. The atmosphere in the home was warm and welcoming. The interactions between people and staff were positive. We heard and saw people laughing and smiling and people looked comfortable and relaxed in their home. People and visitors told us they thought staff were very good and caring. People told us “I am lucky to be here. It’s just like a home from home they all so very good”. Relatives told us they were welcomed in the home and able to visit without any restrictions. The relatives of one person told us how the staff had helped them to celebrate their relative’s milestone birthday.

Everyone we spoke with said they were treated with respect and dignity. One person said staff were “Little troopers – do everything they can to make me happy” and another said “I always like to be called by my surname and all the staff respect that”.

People, relatives and health and social care professionals all spoke positively about the registered manager who took an active role within the running of the. Staff told us they were able to raise concerns and said any issues raised were dealt with straight away. Staff felt there was an open culture within the home, where anything could be discussed and they were able to make suggestions for improvement.

People had regular access to healthcare professionals such as GPs and community nurses.

Staff told us about things that people liked to do, such as crosswords and listening to classical music. Staff were also aware of people’s past lives and told us they chatted to people about this. However, people were at risk of becoming socially isolated as they spent much of their time alone in their rooms. Although, one person told us they were “Quite happy in my own company – can have what I want on the TV.” Staff told us the new lounge/dining area was rarely used. There were no items around the room that might encourage people to use the room such as books, magazines or jigsaw puzzles. We spoke with the registered manager about how enthusiastic one member of staff was about getting people to use the room and interact more. On the second day we inspected the registered manager had arranged for the staff member to work an extra two afternoons each week to provide extra social stimulation for people.

People’s personal 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. Pressure relieving equipment was used when needed. Procedures were in place to protect people in the event of an emergency. Staff had been trained in first aid and there were first aid boxes easily accessible around the home. People living at the home we spoke with said they felt safe and free from any harm. One person said “My room is nice and they always lock my patio door at night” and another said “I am always looked after by staff and they always pop into my room to make sure I am OK”.

People were kept safe as there was a policy which ensured all employees were subject to the necessary checks which determined that they were suitable to work with vulnerable people. People were protected from the risks of abuse. Staff knew how to recognise abuse and how to report any concerns. There were enough staff on duty to keep people safe. Staff told us that they felt there were enough staff to keep people safe, but they had little time to spend with people when they were not providing personal care. During the inspection staff were busy but people were not rushed and staff responded to call bells quickly.

People’s individual needs were assessed prior to admission and a more in depth care plan was developed as they settled into the home. Staff and people living at the home as well as visitors all felt people were supported by staff who knew them well and understood their needs and personal wishes. However, People’s care plans were not always updated when people’s needs changed which meant staff may not always have the most up to date information about them.

People received care and support from staff who had the skills and knowledge to meet their needs. Staff had received a variety of training including moving and transferring, first aid, food and nutrition and safeguarding people. Relatives told us “They look after [relative] and myself very well. It’s very good otherwise we would have taken [..] away a long time ago”. Another relative said “They have done a good job to keep [..] going”. They also said staff coped very well even when their relative was not being very nice to them.

Although not all staff had received formal training in the Mental Capacity Act 2005 (the MCA) and the associated Deprivation of Liberty Safeguards (DoLS) people were supported by staff who had a good understanding of the legislation. 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. Healthcare professionals, relatives and staff had been involved in determining that one person should be supported to receive medicines and with washing and bathing. People’s liberty was only restricted when there was no other means of keeping them safe. 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 asked for their consent before staff provided personal care. One staff member told us “I always ask the residents if and when they are ready to go to bed”.

People received enough to eat and drink. At lunchtime people generally ate in their bedrooms, only two people ate in the dining room. People eating in their bedrooms told us they preferred to stay in their rooms. A good choice of menu was available including vegetarian options and the cook was preparing a separate shepherd’s pie for one person who did not like onions.

Medicines were stored safely and securely. Staff who gave people their medicines had completed training. Records of medicines administered confirmed people had received their medicines as they had been prescribed by their doctor to promote good health. Regular audits of medicines ensured any errors would be picked up and action taken to prevent it happening again.

People were able to express their views. Occasional meetings were held to give People information and ask for their opinion. People told us the registered manager and staff were always asking them if everything was alright with them. Comments and concerns leaflets were displayed around the home that gave people information on how to raise concerns.

We have made recommendations about seeking advice from healthcare professionals and ensuring people’s assessed and changing needs continue to be met.

We found a 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.