This inspection took place on 10 August 2017 and was unannounced. This meant the staff and the provider did not know we would be visiting.

The home had a registered manager in place. A registered manager is a person who has registered with 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.

Woodside Resource Centre (The Willows) was last inspected by CQC on 31 May 2016, 7 and 9 June 2016 and was rated Requires Improvement overall and in three areas; Safe, Responsive and Well-led. We informed the provider they were in breach of two regulations; good governance and staffing.

Whilst completing this visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had ensured improvements were made in these areas and this had led the home to meeting the above regulations.

Woodside Resource Centre is registered to provide personal care and nursing for up to 60 older people and people with a dementia type illness. On the day of our inspection there were 53 people using the service. Accommodation is provided across one level within three units; Presley, Monroe and Sinatra. Facilities included several lounges and dining rooms, communal bathrooms, shower rooms and toilets, hairdressing room and a communal garden with Gazebo. The general reception was large and spacious with a comfortable seated area.

We saw that entry to the premises was controlled by key-pad entry and all visitors were required to sign in. This meant the provider had appropriate security measures in place to ensure the safety of the people who used the service.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and was suitably designed for people with dementia type conditions.

People who used the service and their relatives were complimentary about the standard of care at Woodside Resource Centre. We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people using the service.

Training records were up to date and staff received supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The service was working within the principles of the Mental Capacity Act 2005 and any conditions on authorisations to deprive a person of their liberty were being met. All the care records we looked at contained evidence of consent.

People were protected against the risks associated with the unsafe use and management of medicines.

People had access to food and drink throughout the day and we saw staff supporting people at meal times when required.

People had access to a range of activities in the home and within the local community.

All the care records we looked at showed people’s needs were assessed. Care plans and risk assessments were in place where required and daily records were up to date. Care plans were written in a person centred way and they were reviewed regularly.

Staff used a range of assessment tools and kept clear records about how care was to be delivered and people who used the service had access to healthcare services and received ongoing healthcare support.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider had a robust quality assurance system in place and gathered informatio

This inspection was carried out on 31 May, 7 June and 9 June 2016. Each day of inspection was unannounced which meant the registered provider and staff did not know we would be visiting the service. We carried out an out of hour’s inspection on 7 June because we wanted to check staffing levels to make sure they were safe.

Woodside resource centre is registered to provide personal care for up to 60 people who live with dementia or require nursing care. The service was located in a residential area close to local amenities. At the time of our inspection there were 54 people using the service and 73 staff employed.

The registered manager had been in post for many years. 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 gaps in care records, emergency evacuation records, fire safety records and staff supervision and induction records.

Care plans were reflective of people’s individual needs, wishes and preferences and had been reviewed regularly.

People told us they knew how to make a complaint. Information was on display at the service.

Safeguarding alerts had been made when needed. Staff understood the procedures they needed to follow should they suspect abuse could be taking place. All staff spoken with told us they would not hesitate to whistle blow [tell someone].

Risk assessments for people’s individual needs and for the day to day running of the service were in place. Both had been regularly reviewed.

Certificates required to maintain the health and safety of the building were up to date.

There was no staff presence at times on the dementia unit. Some people were at risk of falls and we saw that incidents between people occurred during this time.

We heard mixed responses about staffing levels on the nursing unit. We observed times when staff were stretched and people needed to wait for care and support because staff were busy.

People had access to prescribed medicines. Medicines rounds were regularly interrupted at night on the nursing unit. Topical cream records were not up to date; however the service had started to take action to address this at the end of our inspection.

Staff told us they felt supported during their induction. Staff supervision, appraisals and training were up to date or had been planned in. However we noted gaps in supervision records.

People spoke positively about the food they received. Staff supported people to receive appropriate hydration and nutrition and took action when people became at risk of dehydration or malnutrition.

People had regular access to health and social care professionals. Any recommendations and contacts with people had been updated in people’s care records.

People told us they enjoyed living at the service and felt cared for by staff. They told us staff knew their needs well.

People told us their privacy and dignity was maintained. They told us staff spoke with them in private about their care.

The service supported people to maintain relationships with their family and friends.

Staff provided explanations when needed and gave people the time they needed to make a decision. The service supported people to access an advocate if they needed to.

A registered manager was in place and understood the requirements expected of them. Staff spoke positively about the registered manager and felt able to approach them when needed.

All the staff we spoke with told us the service had improved since our last inspection. They said they were happy and enjoyed working at the service.

All incidents occurring at the service had been fully investigated and outcomes recorded. The Care Quality Commission (CQC) and the local authority had been notified when required to do so.

Accident

One inspector carried out this follow-up inspection. At the time of our inspection 35 people were cared for in The Willows unit of Woodside Resource Centre.

We carried out this inspection to check that improvements had been made in respect of shortfalls in supporting workers and maintaining records identified on our previous visits on 19 May 2014 and 21 May 2014.

During our inspection on 8 February 2015, we spent time speaking with six care staff, two nurses and the registered manager. We spent time in the communal areas of the home observing how staff interacted with each other and with people who lived there and their visitors. We reviewed records and quality documentation that was appropriate to the focus of this inspection. If you want to see the evidence that supports our summary please read the full report.

We visited the home during the evening, as a part of an out of hours pilot. During the visit, we spoke with eight people who used the service. We asked people about the choices on offer; what the care was like and what people thought about the staff. We also followed up the action the provider had taken to improve access to the care records held on computer.

All of the people we spoke with told us that they really liked the home; thought the staff were excellent at their jobs and felt their care needs were met. They said, “The staff are wonderful” and “They are really nice set of people.” The people on the residential unit told us that their choices were respected. A large number of people experienced difficulty communicating their views so we spent time observing practice. We found that the care staff across both the day and night shift supported people in a sensitive manner.

We saw that staff involved people in discussions and always sought their views. In the evening we found that people retired to bed by 10.30pm. People told us that ths was in order to watch television or read a book in their room or because they were tired. The majority of staff had a very good understanding of people’s care needs, however we found that the night staff were unaware of people’s life histories. Not having this awareness meant they could not use various recommended dementia care strategies for supporting people when delivering the care.

At the last inspection we found that the home was not meeting people’s needs. We issued four compliance actions in respect of respecting people, care and welfare of people who used the service; ensuring people’s nutritional needs were met and staff training. Whilst inspecting the service we followed up these concerns to ensure the provider had taken the appropriate action to make improvements in staff practice.

Most people who lived at the home had marked problems with their memory and found it difficult to think about recent events or at times to have a conversation. Two people were able to talk to us specifically about the home and said ‘’It is nice here, they are a good bunch.’’ We spoke with three relatives and they told us that they found the service was now meeting people’s care needs. They told us that they really liked the home and thought the staff were good at their jobs. People said ‘‘I find that the staff are very good and easy to approach’’, ‘‘The staff keep a discreet eye on people and seem very attentive’’ and “They let me know about any changes.’’

Throughout the visit we used a specific way of observing care to help to understand their experience of the service. We used a tool called the short observational framework for inspection (SOFI).This involved spending a substantial part of the visit observing groups of people to see how they occupied their time; appeared to feel; and how staff engaged with them. From our observations we found that practices had improved substantially since our last inspection. The staff worked in ways that supported the people. All the care team treated individuals with respect and humanity as well as empathy. We saw that throughout our visit all the staff involved people in discussions about their care and general conversations. We found that the staff team were now working in line with expected practice for working with people who experienced problems with their memory.

Some people using the service were able to tell us about their experiences and we also spoke with visitors to the service and other health professionals. Some of their comments included; "I can make choices I choose to go to bed at around 10pm" , "We have resident meetings here", "Dad has a care plan we have seen it and we attend reviews. If his medicines change they always contact us."

Other people that use the service at Woodside Resource Centre were not able to tell us about their experiences due to their clinical condition. To help us to understand the experiences these people had, we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

The inspection team who carried out this inspection consisted of one inspector and an expert by experience. During the inspection, we spoke with seven people, two relatives, the regional manager, the home manager, deputy manager and eight staff. We looked at five sets of care records and six staff files. The home had three different units for residential care, dementia care and nursing care. We visited each of them and observed care practices .

The service had a registered manager in post. The manager of the home had been in post since January 2014 and was working to increase staff morale and to create a more positive environment for staff and for people living at the home. Some staff spoke positively of the support which they received from their manager.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

During the inspection, the team worked together to answer five key questions which are outlined below.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure living in the home. People living at the home were knowledgeable about the action they needed to take during an emergency evacuation. Not all staff spoken with were knowledgeable of the procedures they needed to follow.

The staff we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We inspected the staff rotas and dependency tool which showed that there were sufficient staff on duty to meet people’s needs throughout the day. However we saw that staff were very busy throughout the day. Staff, relatives and people living at the home expressed concerns about staffing levels on the nursing unit.

We found gaps in the recording of information in people’s records, activity schedules, staff rotas, audits and training records. We found some records were unavailable during inspection. Records did not contain all the information required by the Health and Social Care Act. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because records were incomplete. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Only half of the staff team had been trained to understand where an application should be made, and how to submit one.

Is the service effective?

People had personalised care plans which was set out in their care needs. We could not see if people had been fully involved in the assessment of their health and care needs and if they had contributed to developing their care plans.

There were gaps in the information provided in some people’s care records and the frequency of which assessments were carried out. During our inspection we saw very little therapeutic activities taking place.

Staff responded quickly when people’s needs changed. People had regular access to a range of health care professionals, some of which visited the home. People told us staff escorted them to healthcare appointments if needed.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people when they regularly worked on the same unit. However this was not always the case when staff were moved onto a the nursing unit.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff were aware of people’s preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Records showed that the home responded quickly when people became unwell. There was good evidence of multi-agency working.

People we spoke with knew how to make a complaint.

Is the service well-led?

Staff were clear about their roles and responsibilities. They understood the values of the home.

Staff training, appraisals and supervision were not up to date. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The home had a system to assure the quality of service they provided. Some audits were carried out and the regional manager regularly visited the home. People who lived at the home had completed a customer satisfaction survey.

What people said

Some people who were able to express their views told us they were satisfied with the care and support they received. One person stated, “The care is smashing.” One relative we spoke with told us, “It’s lovely in here and the staff are really nice.”

However not everyone we spoke with felt they were well looked after. One person we spoke to thought that the staff didn't undertsand their care needs. We spoke to the manager about this. Another person told us, "There isn’t enough staff to do what I want do. The staff leave me sat in a chair.”

Most of the staff we spoke with during the inspection told us they had concerns about the number of staff on the nursing unit. One member of staff told us, “An extra member of staff is needed. There is an accident waiting to happen.” Another member of staff told us, “How can we deliver good care if there are not enough staff.” People we spoke with also expressed concerns and told us, “If there was more staff I might even be able to go out” and “It would be lovely if staff had time to sit and chat.”