This inspection took place on 12 and 15 June 2017 and was unannounced. Woodside House is a nursing home that can accommodate up to 56 people. At the time of this inspection 55 people were living in the home, all of whom required nursing care. The home is on one level with 31 beds dedicated to support people living with dementia. This area of the home is called Memory Lane. The remainder of the home comprised of Willow Lane and Sycamore Lane. Some people living in these areas may also be living with dementia.

There was no 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. The manager in post told us that they were applying to register with us. They had previously been the deputy manager in the home and we have referred to them as the manager throughout this report.

Our previous inspection in September 2016 had identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to safe care and treatment and the management arrangements of the home. This June 2017 inspection found that improvements had been made and consequently the provider was no longer in breach of these regulations.

The service was staffed in accordance with the provider’s staffing assessment tool. Feedback we received indicated that this may not have always been sufficient, particularly in relation to the amount of engagement staff were able to have with people. We have recommended that the provider review their staffing and staff deployment arrangements from the day to day perspective of people using the service.

Risks to people’s welfare were identified, planned for and mitigated as far as was possible. Suitable staff recruitment arrangements were in place. People received their medicines as prescribed for them. Staff understood their obligations to help keep people safe and to report any concerns that might arise so that suitable action could be taken.

Staff received suitable training and support to help ensure that people’s needs were met effectively. People enjoyed the food and where people required specialist diets or assistance to eat their meals, this was received. The provider needed to ensure that people always had drinks available to them. Some people had raised this as an issue with us. The service acted in accordance with the requirements of the Mental Capacity Act 2005 and staff knew about their responsibility to support people to make their own decisions as far as possible.

The staff were caring, warm and promoted people’s dignity. People and their relatives were consulted in relation to the care that was planned and their views were acted upon.

The service responded to people’s needs. People’s care plans were detailed and person-centred.

The service was well managed and robust arrangements were in place to assess and monitor the quality of the service provision.

The inspection took place on 7 and 13 September 2016 and was unannounced.

Woodside House provides accommodation and care to a maximum of 56 people. The majority of people receiving care and support are older people and some people using the service may be living with dementia. The service is registered to support people both with their personal care and nursing care if they need this. At the time of our inspection, there were 53 people living in the home. People who are living with dementia are largely supported within the Memory Lane unit of the home.

There was a registered manager in post who was present for the second of our inspection visits. 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.

The service needed to make improvements to people's safety. There was inconsistent information about how drinks needed to be thickened to minimise the risks of choking for specific individuals and in one case the required thickener had not been used at all when a person was given a drink, presenting a serious concern for a person's safety. We ensured that action was taken immediately to rectify this and so that the registered persons could ensure the person was not exposed to serious and avoidable harm.

People were also exposed to risks from inappropriate storage of some toiletry products, creams and thickeners. This presented concerns that the products could cause harm by being swallowed, used inappropriately or contaminated. Staff used some products well beyond their expiry dates, presenting a risk they would not be safe and effective to use. Staff were using some creams and thickener, labelled as issued for others and which could therefore present confusion about the correct usage and management. Systems for assessing, monitoring and improving the service and for mitigating risks had not identified the concerns we found. Between our inspection visits, the registered persons told us they had taken action to improve. However, we were concerned that we have raised such issues in previous inspections and but again found similar failings. We could not therefore be confident in improvements would be sustained.

Staff understood the importance of reporting any concerns that people may be at risk of harm or abuse. They were recruited in a way which ensured proper checks were made, so contributing to protecting people from the risk of harm. There were enough staff on duty who were competent to meet people's needs safely, but they were not always well organised in the way that they supported people. This included during lunch time. Although people had a choice of enough to eat and drink, the mealtime lacked a calm, pleasant and conducive atmosphere for people to enjoy their meals. Some people did not receive consistent and sustained support from one staff member sitting with them throughout their meal to offer support and encouragement.

Staff understood the importance of seeking consent from people to deliver their care. They recognised how their individual approach could help people feel comfortable with receiving care and secure their cooperation. They were aware of the importance of acting in people's best interests where people were not able to give specific consent. People could be supported by their family members who knew them well, to make decisions and choices about their care if they found this difficult.

Where people's freedom may be restricted because of their lack of awareness of personal safety, the registered manager sought appropriate authorisation. This contributed to protecting people's rights and freedoms.

People had access to support and advice from health professionals to promote their physical and mental wellbeing. For example, sta

We carried out an unannounced comprehensive inspection of this service on 7 July 2015. A breach of legal requirements in relation to the management of people’s medicines was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We undertook this unannounced focused inspection on 27 October 2015 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this requirement. The area we looked at was under the relevant key questions of; is the service safe? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Woodside House on our website at www.cqc.org.uk.

Woodside House is a service that provides accommodation and care to older people, people living with dementia, people with physical disabilities and younger adults. It is registered to care for up to 56 people.

This service requires a registered manager to be in place. A registered manager is a person who has registered with the Care Quality Commission (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. There is not a registered manager in place at Woodside House but an application has been received from the provider to register a new manager at this service.

We found that some improvements had been made and that therefore, the provider was no longer in breach of the regulation in relation to the management of people’s medicines. Records indicated that people received their medicines when they needed them. They were given to people by staff who were competent and who followed good practice and national guidance.

People’s oral medicines were stored securely for their safety. However, medicines for external use such as creams that were kept in people’s rooms were not secure. This meant there was a risk that some people who may not understand what the medicine was for, could use them inappropriately which could cause them harm. Therefore, further improvements are required within this area.

The inspection took place on 7 July 2015 and was unannounced.

Woodside House is a nursing home that provides accommodation and nursing care to older people, people living with dementia, people with physical disabilities and younger adults. It is registered to care for up to 56 people. On the day of our inspection, there were 46 people living at Woodside House.

This service requires 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. The registered manager left Woodside House on 3 July 2015. The deputy manager was performing the role of acting manager until a new permanent manager had been recruited. We saw that the provider was in the process of employing a new manager.

At the last inspection on 12 November 2014, we asked the provider to make improvements in relation to the care and welfare of people, consent, monitoring the quality of the service and the accuracy of records. The provider sent us an action plan to say that they would be meeting the relevant legal requirements by 31 March 2015. We saw that this action had been completed. However, during this inspection, we found that people’s medicines were not always stored securely or managed safely.

Risks to people’s safety had been assessed and actions taken to protect people from the risk of harm. The provider also had systems in place to reduce the risk of people experiencing abuse. When concerns were raised, the provider had investigated these thoroughly and action had been taken to protect people when necessary.

Staff were well trained and there were enough of them with the right skills and abilities to provide people with the care and assistance they needed. They knew the people they cared for well and treated them with kindness, compassion, dignity and respect.

Staff asked people for their consent before giving them care and the provider was meeting their legal obligations in respect of providing care to people who could not consent to decisions themselves.

People had access to plenty of food and drink. People who were at risk of not eating and drinking were monitored closely and offered fluids and food on a regular basis. People saw healthcare professionals for specialist advice when they needed to help them maintain their health.

People had access to activities that interested them and helped them follow their interests and hobbies. They also had a secure garden they could access when they wanted to.

People and relatives were listened to and their opinions were respected. Any concerns or complaints they had were fully recorded and investigated by the provider.

The service had an open culture where people and staff could raise concerns without fear of recrimination. People and their relatives were encouraged to give suggestions on how to improve the care they received and these were acted upon. The quality of the service was regularly monitored and the provider learnt from accidents and incidents in an attempt to reduce them from happening again.

This inspection was unannounced.

Woodside House is a nursing home that provides accommodation and nursing care to older people, people living with dementia, people with physical disabilities and younger adults. It is registered to care for up to 56 people. On the day of our inspection, there were 50 people living at Woodside House.

There was a registered manager working 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 and associated Regulations about how the service is run.

All of the people we spoke with were happy living at Woodside House. They told us that they felt safe, were well cared for and that the staff were respectful, kind and compassionate.

We saw that staff treated people with respect and that they promoted their dignity and independence. Staff had the knowledge to protect people from the risk of experiencing abuse and there were enough of them working on each shift to keep people safe. People’s medicines were managed safely and the premises that people lived in and the equipment they used were well maintained and safe.

People had access to activities that they enjoyed to enable them to follow their own individual interests and they had choice about their daily routine. People told us that they enjoyed the food and we saw staff prompting and assisting people to eat and drink during the day of the inspection. Relationships that were important to people such as with friends and family were encouraged. People’s cultural needs were respected and they were supported to follow these. The service contacted specialist healthcare professionals for advice in a timely manner when they were concerned about people’s health.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the service was meeting the requirements of DoLS. However, the provider had not always recorded that they had discussed important decisions about people’s care and treatment with the person, those closest to them and if applicable outside healthcare professionals. Therefore, it was unclear whether the decisions that had been made about the person’s care and treatment was in their best interests. This was not following the requirements of the MCA 2005 and therefore we could not be sure that people’s rights were always protected.

Some people’s records contained inaccurate or conflicting information and the provider’s systems for assessing and monitoring the quality of the service were not always effective which could lead to people receiving unsafe or inappropriate care. Also, risks to people’s health had not always been assessed and in some cases had not been managed effectively. Specialist healthcare professional’s advice had not always been followed. This put people at risk of receiving poor care.

This meant that there were some of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and you can see what action we told the provider to take at the back of the full version of the report.

People told us they liked living at Woodside House. One person said, “I’m very content. I have my own room and it is nice and very homely. I have some of my own things in there”. Another person told us, “It’s nice here. The food is good and there are two choices every day. There’s plenty of it and you can have more if you want”. Another person speaking about their room said, “My room is nice and I chose the colour”.

People who were able told us they were involved in planning their care and had signed their care plan to show they agreed with the support they were to receive. We saw that relatives acted on behalf of those people who were not able to give consent. The care plans were up to date and reviewed every month. Risk assessments were kept under review and care plans were in place to reduce risks to people.

The service had robust procedures in place for managing the storage, administration and recording of medicines. People had their own medicines stored in a locked cupboard in their room and any controlled drugs were stored securely in the medication room.

Staff files showed that effective recruitment practices were in place that protected people living at the home. Staff spoken with were knowledgeable about individual needs and how people should be cared for and supported.

The service had a complaints procedure in place that was displayed in the entrance hall. Complaints records showed that the service responded appropriately and in a timely way to expressions of concern.

We noted throughout the home there were plenty of opportunities for people to be engaged in activities of their choice or for them to be alone if they so wished. People who lived in this home looked clean and tidy and this preserved their dignity. There was a calm atmosphere. We saw plenty of smiles and interactions with staff that were clearly being enjoyed.

People who lived in this home had personalised care plans that held information that was relevant to the person. They were easy to look through and the information found had been reviewed and updated where necessary.

The staff who worked in this home had been trained in the safeguarding of adults and understood the procedures to follow if they suspected abuse may be happening. People in the home were protected from abuse by procedures put in place by the provider.

Relevant training and support for all staff had been offered to ensure staff members had the skills and ability to carry out their job correctly.

Meetings, audits and quality questionnaires were used as part of the monitoring system when checking the quality of the care provided. We were told, "This is the best home. We tried two others and they were no-where near as good as this home."

People told us that they liked living at this home. They were able to spend their day where they wished and were able to take part in activities if they wanted to. One person told us about how he enjoys gardening and did the planting in the atrium area of the home. People told us they could have visitors when they wished and one person liked to entertain his wife in the atrium, where they could enjoy drinks and cakes that were available at all times.