Woodside Nursing Home provides care and support for up to 49 older people. At the time of our inspection there were 38 people living at the service. The service is situated in a residential area of Bath. It is located over three floors with communal lounges, dining rooms and access to garden and woodland areas.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staffing levels were kept at the safe assessed level by the provider. However, feedback about staffing levels was mixed from people and staff. Recruitment procedures were followed to ensure staff suitable to the role were employed. Staff had effective induction, training and supervision.

People told us staff were kind, caring and respectful. Staff had developed positive relationships with people. People’s independence was encouraged and supported.

People had access to the outdoor garden and woodland area. People told us how they enjoyed this space and the views they had from communal areas of the service. The service was well signed. Furniture and décor had been thoughtfully considered so it was bright and homely whilst supporting people’s needs.

The service facilitated meaningful activities. Activities for people to get involved in on an individual or group basis were displayed within the service. These were also communicated to people and relatives in a monthly newsletter. Regular outings occurred.

Medicines were administered safely. Risk assessments identified risks to people and gave guidance about how people could be supported safely. People’s health needs were met. People enjoyed the food provided. People were supported appropriately with food and fluid requirements.

Infection control policies were followed and the service was clean, tidy and well maintained. Regular checks of fire safety equipment and procedures were completed.

Care plans were person centred and described people’s preferences and routines. People’s individual interests, cultural and spiritual requirements were catered for.

Staff felt supported by the provider. There was a positive atmosphere at the service. Systems were in place to monitor and review the quality of the service.

Further information is in the detailed findings below

The inspection took place on 9 and 12 May 2016 and was unannounced. The service was last inspected in December 2013. There were no breaches of the legal requirements at that time.

Woodside Nursing Home is registered to provide nursing care for up to 52 people. On the day of the visit, there were 51 people at the home.

There was a registered manager for the service who was currently on extended leave. An acting manager who worked for the provider was managing the service in their absence. 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 people we spoke with said they always felt safe and secure at the home. They told us that staff were kind and always respectful. When risks to people were identified suitable actions were put in place to minimise the risk of people being harmed when receiving care. The risks of abuse to people were minimised, as staff were competent in their understanding of abuse. The team were trained to know how to report concerns correctly.

People were supported with their needs by enough staff to provide individual care and to keep them safe. Staff were deployed thought the home in a way that meant peoples’ needs were met in a timely way.

People told us that they were happy with the food and told us they were offered choices at each mealtime. People were provided with a varied diet that suited their needs.

Woodside is located in a wood of extremely large trees. Many people told us how they liked the setting of the home and the views from their windows of the woods and wildlife that they saw. There was a purpose built specially adapted stairway into the grounds. This included a seating area at the end of it. People were able to sit there and enjoy the country views.

There was a programme of regular one to one and group activities taking place in the home. People told us they liked the entertainers who performed at the home on a regular basis.

Care plans guided staff so that they knew what actions to follow to meet people’s range of care and nursing needs. Staff knew what was written in each person’s care records. They knew how to provide care that was flexible to each individual and met their needs.

We saw that there were positive and caring relationships between people and the staff who supported them, this also included relatives and friends.

When they were able to, people were encouraged to be included in making decisions about how they were being cared for. There were effective systems in place that helped ensure staff obtained consent to care and treatment in line with legislation and guidance. When people did not have capacity to consent, their care needs were assessed in line with The Mental Capacity Act 2005. Staff had completed Mental Capacity Act training. They knew about consent, people’s rights to take risks and the how to act in someone’s best interests.

People were supported with their range of needs by staff who had been on regular training and were developed in their work. This helped them to improve and develop their skills and competencies. Nurses were able to go on regular training and updating of their skills. This was to help them know how to provide nursing care based on up to date practice.

People knew how to complaint and make their views known .The provider actively sought the views of people and their families. Suggestions were acted upon and changes were made to the services when needed.

The new acting manager spoke positively about the responsibilities of their role. Staff spoke positively of the management structure of the organisation they worked for. They said that senior managers and the acting manager provided strong and effective leadership. The staff team told u

There were 48 people living at the home when we visited. We spoke with people using the service, their visitors, a health professional, read people's care plans and supporting documentation, and observed how people were cared for in the communal areas of the home.

We saw that where people lacked capacity, relatives and family members had been consulted on admission about decisions related to people's care. Most care records contained regular follow up to confirm the person or their family had been consulted and updated, although this was not evidenced in all of the records we viewed.

We received positive comments from people using the service and from visitors to the home. One person said that "the staff are lovely, especially the boys" "I don't mind when they have to help me with washing and dressing because they are so careful" and "they are very good and care for us very well". Comments from families included "they always let us know if there are any changes" and "we feel very comfortable visiting".

We observed staff on each of the three floors interacting with people, speaking discreetly to them when asking if they required assistance, knocking on people's doors, and where appropriate, waiting to be invited in.

People using the service and their representatives were asked for views about their care and treatment and these views were acted on. Meetings were held on a regular basis and feedback was also sought in an annual resident survey.

We went back to Woodside Nursing Home to check on improvements at the service. In October 2012 we found the service non compliant with care and welfare of people due to inconsistencies in care plans; contradictions around people's mental capacity; and a lack of information about some medicines.

The provider had shared our report with people and their families and had meetings to discuss how they would address our concerns. They also sent us an action plan saying when they would complete their improvements. We visited Woodside Nursing Home again in March 2013 and found these areas had been addressed and the service was now compliant.

While we were there we met and talked with a number of people and visitors. We were told the care at the home "could not be faulted" and "the staff are very good." We observed care being delivered with kindness and warmth. Staff arranged and took part in activities and encouraged people to be active and independent. Staff knew people's needs, regularly assessed them, and ensured these needs were met.

We visited Woodside Nursing Home and were able to meet many of the people living at the home, and talked at some length with five people.

Woodside Nursing Home is a large purpose-built facility spread over three floors with parking at the front and grounds and gardens to the rear of the building. The provider has constructed a sweeping raised platform of wooden walkways suitable for wheelchairs which stretches from the terrace at the back of the house down to the edge of the grounds. There are a number of terraces, seating areas and viewing points. People who live at Woodside said that when the weather is good, they take regular walks or trips down these pathways with members of staff or their visitors, and enjoy the fresh air, eating outside, and views over Bath and the open countryside.

People also told us that they found members of staff "so kind" and "respectful" and "so helpful to me". We were told that the activities at the home are "very enjoyable" and "there is always something going on to fill the days". People told us that they recently visited local museums and during our visit there was a 'reminiscence session' where people were looking back at how they used to shop when they were young and how things have changed.

The home has a trained chef and people said the food was "always very fresh", "lovely", "just what I like" and "properly nutritious".

We met and talked with people living at Woodside Nursing Home and some of their families and friends. One person said there was "no question about that" when we asked if staff made sure they gained their consent for providing care and support. A visitor to the home said staff "seem to always ask before they do anything".

One person said "on the whole, staff are very kind". Other people we met said care was "very good" and said: "I've got no complaints". One person said "they can't do enough for us". A family member said: "I am very happy with the care" and "they always keep us informed about [the person's] care". One person said: "I do like living here" but said they did spend a lot of time sitting alone in their room watching television. They said this was mostly their choice, but there was also not much for them to join in with and the lounges were "very quiet and most people were asleep". A family member we met said "they do their best to keep folk entertained but it's often very quiet in here".

We observed people who were quiet or with limited or no independence having little interaction with staff. One person with almost no verbal communication was left sitting in a chair on a hoist sling for five hours with little attention or interaction from staff. Some of the care records were not an accurate reflection of people's care needs or how those needs were to be met safely. There was some evidence of people's dignity not being fully considered.