The inspection took place on the 16 May 2017 and was unannounced.

Woodside Hall Nursing Home is a care home with nursing located in Hailsham. It is registered to support a maximum of 53 people. The service provides personal care and support to people with nursing needs and increasing physical frailty, such as Parkinson’s disease, multiple sclerosis and strokes. We were told that some people were also now living with a mild dementia type illness. There were 43 people living at Woodside Hall Nursing Home during our inspection.

At the last inspection, the service was rated: good. At this inspection we found the service remained good and met all relevant fundamental standards.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. These records helped staff to deliver care that met people’s individual needs.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures ensured staff were of suitable character to carry out their roles. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

Staff knew how to recognise the signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks of falls for people.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People were supported to have choice and their independence was promoted by staff who understood people's individual needs. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they had a good understanding of the legal requirements of the Act and the implications for their practice.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutritional and hydration needs. The main meal service was staggered which ensured that people received the assistance they required. The dining experience was a social and enjoyable experience for people.

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People were promptly referred to health care professionals when needed. The activities provided were varied and met people's social needs.

The provider and the management team were open and transparent in their approach. They placed emphasis on continuous improvement of the service. There was a robust system of monitoring checks and audits to identify any improvements that needed to be made. The registered manager acted on the results of these checks to improve the quality of the service and care.

Further information is in the detailed findings below.

The inspection took place on the 25 March 2015 and was unannounced.

Woodside Hall Nursing Home is a care home with nursing located in Hailsham. It is registered to support a maximum of 59 people. The service provides personal care and support to people with nursing needs and increasing physical frailty, such as Parkinson’s disease, multiple sclerosis and strokes. We were told that some people were also now living with a mild dementia type illness. There were 51 people living at Woodside Hall Nursing Home during our inspection.

At the last inspection in July 2014, we identified concerns in relation to care records and audits, dignity and privacy, gaining consent, which were breaches of Regulation 10, 17, 18 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. An action plan was received from the provider and at this comprehensive inspection we found that the required improvements had been made by the provider.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made.

People were safe. Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. People’s medicines were stored safely and in line with legal regulations. People received their medicines on time and from a registered nurse.

Risk assessments for health care needs such as mobility, skin integrity, nutrition and had been undertaken to ensure that people received safe care.

The delivery of care was based on people’s preferences. Care plans contained sufficient information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. Information was available on people’s preferences and choices.

Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and they had a good understanding of the legal requirements of the Act and the implications for their practice.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutritional and hydration needs. The main meal service was staggered which ensured that people received the assistance they required. The dining experience was a social and enjoyable experience for people.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People that chose to were seen in communal areas for meal times, activities and at other various times were seen to enjoy the atmosphere and stimulation.

Staff told us the people were important and they took their responsibility of caring very seriously. They had developed a culture within the service of a desire for all staff at all levels to continually improve. Areas of concern had been identified and changes made so that quality of care was not compromised.

Feedback was regularly sought from people, relatives and staff. Staff meetings were being held on a regular basis which enabled staff to be involved in decisions relating to the home. Resident meetings were held and people were also encouraged to share their views on a daily basis.

Incidents and accidents were recorded and acted upon which had then prevented a reoccurrence.

People were protected, as far as possible, by a comprehensive recruitment system.

Staff told us the home was well managed and robust communication systems were in place. These included handover sessions between each shift, regular supervision and appraisals, staff meetings, and plenty of opportunity to request advice, support, or express views or concerns. Their comments included “Really good, we work as a team, really supportive team.”

Quality assurance systems were in place to identify, assess and manage risks to the health, safety and welfare of the people. Care plan audits were robust and identified issues which were promptly amended. For example, one audit identified a person’s risk assessment for skin integrity (had not been updated and skin damage not identified in a timely manner). An action plan was implemented and a review of the person’s care plan found the actions had been met.

We spoke to 12 people during our inspection visit, this included three visitors. We also used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people who used the service. People we were able to speak with who lived in the service told us they liked living at Woodside Hall. We were told, "Excellent, sometimes I grumble but the staff are very good," "Caring and kind staff," and "I know I'm safe, staff look after us very well." We also spoke with relatives/visitors. One visitor told us, "Wonderful place, the staff are very committed."

People were enabled to express their views and were involved in making decisions about their care and treatment. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare. We saw documentation that the provider responded appropriately to any allegation of abuse. The home was clean and hygienic with systems in place to prevent cross infection. There were enough qualified, skilled and experienced staff to meet people’s needs. We saw that complaints were taken seriously and there was an effective complaints system available.

We spoke to people using the services but their feedback did not relate to this standard.

People told us that their privacy and dignity was respected and that they were able to raise any issues about the care directly with the staff.

All people spoken with expressed their satisfaction with the food provided, “really tasty good cooking, apart from sometimes the meat is tough” and “good and we get to choose”.

People told us that they liked their rooms and that they were cleaned regularly, “I have some pictures on the wall”.

We were told "I really like living here", "They try very hard, there is a lot of us to look after"

"I would like to be involved more, I sometimes think I am just a number".

We were also told "I am looked after very well. "

We were told "Food is very good" "Plenty of choice, always tasty, good food" "A wide

variety, Can not complain".

We were told "More staff please" "Never have to wait, always plenty of staff"

We were told "I really like living here", "They try very hard, there is a lot of us to look after"

"I would like to be involved more, I sometimes think I am just a number".

We were also told "I am looked after very well. "

We were told "Food is very good" "Plenty of choice, always tasty, good food" "A wide

variety, Can not complain".

We were told "More staff please" "Never have to wait, always plenty of staff"

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Woodside Hall Nursing Home is a care home for up to 59 people. It provides care and support to older people with nursing care needs, dementia or physical disability. At the time of our inspection there were 53 people living at the home. People we spoke with had mixed experiences about the home and the care provided. One person told us, “Yes, I’m very happy, the staff are very nice and helpful, I like the informality, they are so kind.” One person told us, “Staff don’t have time to sit and talk with us.”

A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The director provided day to day leadership. The clinical lead was responsible for meeting all clinical needs and provided support and guidance to the registered nurses. The clinical lead was in the process of submitting an application to the CQC.

Staff treated people with kindness and compassion. However, we observed a few interactions where people’s dignity was compromised. These were brought to the attention of the director and clinical lead to address with care staff. We found the provider needed to make improvements in this area.

Mental capacity assessments were not always completed in line with legal requirements. For example, assessments of capacity did not record how the decision was reached. We found the provider needed to make improvements in this area.

Many people had bed rails in place. Where a person could not consent to the bed rails, we could not see that a mental capacity assessment had taken place. Documentation did not record whether the bed rails were in place in people’s best interest to promote their safety. We have asked the provided to make improvements in this area.

Staffing levels were insufficient. Call bells were not always answered promptly, often people were waiting over 15 minutes. One person told us, “I press it but they don’t come quickly.” Throughout the inspection, we heard call bells continually ringing.

People’s medication was stored safely and in line with legal regulations. For people prescribed creams, staff did not consistently record when creams were applied. The provider has been asked to make improvements in this area.

The delivery of care and treatment was recorded and each person had an individual care plan which detailed the support required to maintain their health and wellbeing. For example, these included management of diabetes and moving and transferring.

The provider regularly sought feedback from people, relatives and staff. Audits of the feedback obtained did not record what action had been taken to make improvements. The provider has been asked to make improvements in this area.

Incident and accidents were consistently recorded, however, they were not reviewed on a regular basis to monitor for any emerging trends or patterns. The provider has been asked to make improvement in this area.

People were encouraged to do activities that were meaningful to them. They were dressed in accordance with their lifestyle choice. One person told us, “I’m wearing my favourite outfit today.” People were wearing their glasses and hearing aids. They were encouraged to bring furniture and items of importance into the home with them. An activities coordinator was in post and we observed a wide range of activities. People were seen playing games of cards and enjoying the commonwealth games on TV. We saw that people had formed a rapport with staff and with other people who lived at the home. People were seen sitting together enjoying afternoon tea in the sunshine.

We found a number of breaches 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 have shared our findings with the local authority.