This inspection took place on 5 and 6 September 2018. The first day was unannounced.

Woodstock Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Woodstock Care Home accommodates up to 28 people. Care is provided over one floor. There are communal areas that people can reside in along with space for dining. There is a pleasant garden area that people can access. At the time of our inspection visit, 26 people were living in the home most of whom were living with dementia.

A registered manager worked in the home. 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 of Woodstock Care Home in January 2016, we rated the quality of care as Good. At this inspection we have continued to rate the home overall as Good.

Why the service is rated Good:

People were supported and cared for by staff who were very kind and compassionate and who knew people very well. People were treated as individuals and with dignity and respect. They had choice and control over their care.

There were enough staff to meet people’s needs and to spend time with them to provide them with stimulation. A variety of activities were provided to enhance people’s wellbeing.

People received their medicines when they needed them and the home and equipment that people used was clean. Systems were in place to protect people from the risk of abuse and the staff were in the main, well trained and knowledgeable.

People’s consent had been sought in line with the relevant legislation and they were supported with kindness and compassion at the end of their lives. People received enough food and drink to meet their needs and had access to the relevant healthcare professionals when required.

Good leadership was in place. People, relatives and staff felt valued and there was an open culture where concerns could be raised without fear. These were listened to and dealt with in a timely manner.

Systems were in place to monitor the quality of care provided to people. The provider and registered manager strived to continuously improve the quality of care through several methods including the use of regular audits, the introduction of technology and the sharing of lessons learnt as a result of incidents, accidents or complaints.

Excellent links with the community had been formed for the benefit of people living in the home and plans were in place to develop these further.

However, during the inspection visit we did find that some areas required improvement within the key question of Is the service safe? This was because a risk to people’s safety in relation to the storage of toiletries and prescribed creams had not been adequately assessed and therefore managed appropriately and some staff used poor practice when supporting people to move. The registered manager agreed to act to reduce any immediate risks to people’s safety in relation to these areas.

We have made one recommendation which is for the registered manager and provider to become familiar with the Accessible Information Standard. This is a standard that is in place to improve how care services provide people with information where they require support with their communication needs.

This inspection was unannounced and took place on 12 January 2016.

Woodstock Care Home is a service that provides accommodation and personal care for up to 28 people. On the day of our inspection, there were 24 people living within the home, all of whom were living with dementia.

There was a registered manager employed at the home. 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 home is run.

People who lived at Woodstock Care Home felt safe and happy living there. Relatives were also happy with the standard of care that was being provided and everyone we spoke with recommended it as a place to live.

The equipment that people used had been well maintained and people received their medicines when they needed them. Risks to people’s safety had been assessed and actions taken to reduce any risks that had been identified.

People were given a choice about how they wanted to live their lives and their decisions and preferences were respected. They were asked for their consent by the staff and had access to plenty of food and drink to meet their individual needs. Advice from other healthcare professionals was sought and acted upon when any concerns about people’s health had been identified.

People were cared for by kind, caring and compassionate staff who listened to people, made them feel valued and treated them as individuals. There were enough well trained staff to provide people with the care they needed.

People and staff felt able to raise concerns without any fear of recrimination and they enjoyed working at Woodstock Care Home. The registered manager demonstrated good leadership and had promoted a culture where the person was seen as an individual.

Systems were in place to make sure that the care being provided was safe and of good quality. The registered manager was pro-active in trying to improve the quality of care that was being provided to the people who lived at Woodstock Care Home to enhance their wellbeing.

We examined the care records of three people, these showed us that people and their relatives and friends were supported to be involved in the care that they received. This and the other evidence seen showed us that people’s privacy, dignity and independence were respected in this service.

People’s care and welfare needs were recorded in detail and their care plans showed us that these needs were being met. This meant that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff spoken with told us that they were confident that they would recognise and know what action to take if they observed a potential abusive situation. This meant that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff outlined examples of the care and support that they provided for people using this service. This demonstrated to us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We saw examples of audits having been carried out by senior staff. We noted that where concerns had been identified actions to address these had been taken. This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

After the inspection of this service on 19 September 2012 we issued two warning notices to notify the provider that they were failing to comply with relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations.

On 06 December 2012 we visited the service to check that they had complied with the warning notices and other necessary actions. We found that they had.

We reviewed, in detail, the care plans of four of the people living at the home. We found that significant improvements had been made. All the care plans had been re-written and new assessments had been undertaken. We saw in all of the plans reviewed that, monthly monitoring of people’s needs had taken place. This included assessments for a person’s risk of developing a pressure sore, or suffering from a fall. Assessments also looked at people's mobility and manual handling needs. Care plans were now person centred and focused on people’s individual and assessed needs.

We observed people having their breakfast . We found that improvements had been made since our last inspection. For example, people were not left to wait for a long period of time to receive a drink and something to eat. We saw that a member of staff was present throughout the meal time to ensure that people’s needs were met.

We spoke to five members of staff who confirmed that improvements were being made and that they now felt more supported in undertaking their roles.

To help us understand people's experiences we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We observed breakfast time and found that people did not have their needs met. Upon our arrival to the dining room, we observed people wandering around confused about where their breakfast was. We overheard one person saying "We've not had anything since we woke up - not even a drink". Five people decided to wait in the dining room to receive their breakfast. We noted that people waited for 35 minutes to receive a drink and up to an hour for their breakfast. There were limited staff interactions and no explanation was made to people about how long their breakfast was going to be.

We observed people becoming frustrated and banging the tables and during the breakfast sitting observed two people becoming frustrated with another person sitting at their table. We overheard them threatening this person saying "do you want me to crush your face?" and "shut up or I'll chuck my tea over you". Although two staff members were present at the time of these incidents, they made no attempt to calm or resolve the situation.

Four out of eight people told us that they felt staff were excellent and responded to their needs the best they can, but that they understood that they, “Sometimes” had to wait for staff when they called them. One person told us: “Where are they (staff), there is no one around”. We observed two people wandering through corridors and when they did not meet any staff, they sat in the lounge. We observed that staff did not enter a lounge where eight people were sitting for 45 minutes.

Three people told us that food was good. One person told us that there was only one choice for the main meal, which we also noted from the menu, and this was confirmed by the cook and observed at lunch time.

We used the Short Observational Framework for Inspection (SOFI), because most people could not clearly express themselves. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We found that there were not enough staff for people to interact with and that five out of eight people were not engaged in any activity or interactions with staff.

We observed verbal conflict between two people, but there were no staff present to calm the situation and support and protect people.