We undertook our comprehensive inspection of Woodthorne on 06 and 11 July 2018. The first day of the inspection was unannounced, the second announced. We previously inspected the service on 04 & 05 January 2017 and the rating after this inspection was ‘requires improvement’. There was also a breach of regulations in respect of the services governance. At this latest inspection we found the provider had improved the service sufficiently to address the breach of regulation, but there was still scope for improvement. We rated the service as ‘Requires Improvement’ at this inspection.

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

Woodthorne accommodates a maximum of 21 older people that may have dementia. People live in one building that was adapted to meet the needs of people living there. There were 18 people living at the home at the time of our inspection.

The provider is not required to have a registered manager for the home as they are a ‘sole provider’. They told us they had employed an acting manager but were still in day to day control in person or by phone. A ‘sole provider’ is a ‘registered person’. 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. They were present for most of our inspection.

People said they felt safe at Woodthorne although there were instances where the provider had not learnt from feedback given by healthcare professionals to ensure people’s safety was always promoted. We saw there was sufficient staff to ensure people received care in a timely manner, although visitors and staff felt more staff would be beneficial, to promote leisure activities for people for example. People were given their medicines in a safe way, but recording of these medicines was not always accurate, despite audits taking place. We found the home was clean and smelt fresh. There were appropriate checks on new staff to ensure they were safe to work with people.

People’s right to consent was sought by staff and any restrictions considered what people's 'best interests' were and what would offer the least restriction when considering their safety. People were confident staff were well trained. People could access external healthcare as they wished and needed. People liked the food they had access to and were offered regular and varied drinks which they enjoyed. Woodthorne was small, homely and appropriate for the needs of the people living there.

People were supported by staff who were kind and caring and they were treated with dignity and respect. People's independence was promoted by staff. People could make choices in respect of their daily living. People were supported to maintain links with their people important to them.

People could engage in some leisure activities, and access had improved, but there was scope for development of these to continue so there was daily access to pastimes people enjoyed. People, or their representatives were involved in their care planning. People’s needs, likes, dislikes and personal preferences were understood by staff.

People could raise complaints and these were responded to by the provider.

The provider had made improvements but there was still room to further improve systems to ensure any potential risks to people when identified were acted upon. The visibility of the provider, who was at the time of the inspection the manager could be promoted so people had a better idea of the management structure. People said there knew people in the management team they felt comfortable approaching though. The provider understood their legal responsibilities and used systems to keep them current with changes in the law.

This inspection was unannounced and took place on 4 and 5 January 2017.

Woodthorne Care Home provides accommodation and personal care for up to 21 older people and also provides a service for people living with dementia. On the day of our inspection there were 17 people living there.

At our last inspection on 4 November 2015, the provider was in breach of regulations 18 relating to staffing levels, 11 need for consent and 17 that relates to good governance.

The provider sent us an action plan that showed measures would be taken to comply with the regulations. At this inspection we saw that improvements had been made. However, there were areas that needed to be reviewed and improved to ensure people received a safe service.

The home had a registered manager who was also the registered provider. The registered manager was present on the second day of the inspection to receive feedback about the inspection. The deputy manager was in charge of the home in the absence of the registered manager. In the report we make reference to the deputy manager as 'the person in charge.' 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to ensure enough staff were on duty to meet people’s care and support needs. People were not appropriately supported to take their prescribed medicines and this placed their health at risk. People could not be confident that recruitment practices would ensure the suitability of staff who worked with them. People were not protected from the risk of further accidents because the provider had not taken action to avoid them happening again. People told us they felt safe living in the home and staff were aware of their responsibility to protect them from potential abuse.

People were supported by skilled staff who received one to one [supervision] sessions. People told us that staff always obtained their consent before providing them with care and support. People were assisted by staff to access relevant healthcare services when needed. People were provided with a choice of meals and had access to drinks at all times.

The provider’s governance remained ineffective and did not ensure people always received a good service. Systems were in place to encourage people to have a say in how the home was run. Staff felt supported by the managers to carry out their role.

People were involved in their care assessment. However, their interests and hobbies had not been explored by staff and people were not always provided with support to do things that interested them. People felt comfortable to share their concerns with staff and could be confident concerns would be listened to and acted on.

People received care and support from staff who were kind and compassionate. People’s involvement in planning their care ensured they received support the way they liked and their privacy and dignity was respected.

You can see what action we told the provider to take at the back of the full version of the report.

Our inspection was unannounced. On the day of our inspection18 people lived at Woodthorne Care Home.

This manager was not available at the time of our inspection as they were on leave. The deputy manager was the main person involved in our inspection.

During our inspection we spoke with five people who lived there, four relatives and five staff. All people and their relatives we spoke with were very complimentary about the overall service and the care that was provided. One person said, “It is a smashing place this, very good.” Another person told us, “I am very content here”. A relative said, “It is an excellent place. I know that they are safe and well cared for”. Another relative told us, “If in the future I needed to go into a care home I would have no concerns about coming in here”.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Staff knew about Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. However, the provider must look at the March 2014 Supreme Court ruling to see if they need to take any further action to ensure that people are not unlawfully deprived of their liberty.

We found that where staff had identified concerns regarding risks associated with people’s health and welfare they had been referred to appropriate agencies.

We identified that the equipment that was used was serviced regularly to ensure that it was safe.

Recruitment practice required some development to ensure that it is safe and effective and not placing the vulnerable people who lived there at risk of harm from potentially unsuitable staff being in contact with them.

People were not protected against the risks associated with medication because the staff were not following arrangements in place to manage medication safely.

We found that instructions that had been produced if an evacuation was required were not precise enough. They did not capture all risks that may present if an evacuation.

Is the service effective?

All people, relatives and staff we spoke with told us that people who lived there were safe and well cared for which gave assurance that an effective service was provided.

People had their needs assessed and staff knew how to support people in a caring and sensitive manner. The majority of care records showed how they wanted to be supported and people told us they could choose how this support was provided.

Staff received support from senior staff to ensure they carried out their role effectively. Staff we spoke with told us that they felt well supported.

People told us they could make choices about their food and drink. We saw people were provided with a choice of food and refreshments and given support to eat and drink where this was needed.

Arrangements were in place to request heath, social and medical support to help keep people well.

Is the service caring?

We found that care and support was provided with kindness and compassion. All people and relatives we spoke with were very positive about the staff. One person told us, “The staff are so kind”. A relative told us, “This is a very caring place. The staff care about the people here very much”.

The staff knew of people's care and support needs which ensured that individual personal care was provided in a way that people preferred.

Is the service responsive?

We found that meetings were held to enable people and relatives to raise any issues they wanted to. This showed that the provider was willing to listen to the views of the people who lived there.

When people became unwell the staff noticed this and secured appropriate medical input.

We found that the provider had taken note of our previous concerns and had learnt from past experiences. For example, some aspects of the recruitment process had improved which reduced the risk of unsuitable staff being employed.

We found that staff had implemented the heat wave policy as the weather was very warm. They offered and encouraged people to drink at least every hour and offered ice creams and ice lollies during the afternoon.

Is the service well led?

The owner/provider of Woodthorne is also the manager. The home is registered with us as is required by law.

The staff were confident they could raise any concern about poor practice at the home and it would be addressed to ensure people were protected from harm.

Staffing was generally organised to ensure people’s needs were met and support was available for activities.

Overall, we found that training was available for staff and most of the required training had been received.

We identified that staff did not always follow policies and instructions particularly concerning medication management. This placed the people who lived there at risk of ill health.

We inspected Woodthorne Care Home on a planned unannounced inspection which meant the service did not know we were coming. We were supported throughout the inspection by the deputy manager. The service does not currently have a registered manager. This will be addressed outside of the inspection process.

We spoke with people who used the service, their relative’s, staff and a visiting health professional on the day of our inspection. People told us they were happy with the quality of care being delivered at Woodthorne Care Home and they had consented to their care, treatment and support. A person who used the service told us: “We are well looked after here”.

We saw that the service was clean and had the necessary systems in place to prevent the spread of infection.

We found the service did not follow the correct procedures when recruiting new staff.

We saw that the service had a complaints procedure which was available for people who used the service or their representatives to raise any concerns.

At the time of our inspection 13 people were living in the home. We spoke with the majority of people that used the service who were able to tell us about their experiences. They told us that they were very satisfied with all aspects of life at Woodthorne. One person said "It's is lovely here. The staff are all very kind and the food is very good".

Some people were unable to speak with us, so we spent time in the communal area and observed the activity and interactions between people and staff. We saw that staff treated people with compassion and offered discreet assistance to those who required it.

We looked at the care records for three people to see how their care was provided and managed. We talked with staff who were aware of and able to discuss people's care needs. We saw some omissions of information. The deputy manager took immediate action to ensure the care records included details of people's care and support needs.

Staff told us their understanding of safeguarding vulnerable people and confirmed they had received training in this.

We observed that sufficient staff were on duty to meet people's needs in a timely manner. People told us that the staff were friendly, helpful and supportive. Visitors told us that the staff were kind and caring.

We saw the service had a system for monitoring the quality of the service provided. Some improvements would be beneficial to ensure omissions of information were identified in a more timely way.

This inspection took place on 3 and 4 November 2015 and was unannounced. At the last inspection on 25 July 2014, we asked the provider to take action to make improvements regarding the management of medicines and also assessing and monitoring the quality of the service provided to people, and this action has not been fully completed. At our inspection completed in November we found that further improvements were still required.

Woodthorne Care Home is a residential home that provides accommodation for up to 21 people who require personal care. At the time of the inspection there were 20 people living at the service. Most of the people who lived at the service are older people living with dementia. The service is required to have a registered manager in post and there was a registered manager at the time of the inspection. 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.

People told us that there were not sufficient numbers of care staff available to meet their needs. We saw that people did not always receive support when they needed it. People were not always protected from harm through recruitment practices that ensured appropriate staff were employed.

People told us that they were happy with how they received their medicines. We found that medicines administration and storage was not always safe. People were not always protected by robust infection control practices.

Risk assessments were in place but were not always updated or consistent in accurately reflecting people’s needs. Accidents and incidents were not consistently recorded.

People told us that they felt safe living at the service. Staff could recognise signs of abuse however they were not confident in whistle blowing procedures. People’s health and human rights were not always protected through the effective use of the Mental Capacity Act 2005.

Most people told us that staff had the right skills to support them effectively. People told us that they were happy with the food and drink that they received. People’s day to day healthcare needs were met.

People’s dignity was not always protected by staff. Most people’s independence was promoted with the use of mobility aids. People told us that they were able to make choices around the care they received. People told us that they felt staff were caring. People were supported to maintain relationships that were important to them.

People told us that there were leisure opportunities available to them but they felt more was needed. People told us that they were not fully involved in developing their care plans. People who had religious beliefs were supported to continue practising their religion.

People told us that they knew how to make a complaint if required. Complaints and feedback had not been recorded although people told us that their concerns had been responded to.

The provider did not have robust systems in place for identifying and managing risks to people and monitoring and improving the quality of service provided to people. People told us that they felt the service was well managed but they weren’t always sure of who the manager was.

Staff told us that the culture within the service was open and that they felt supported and involved by management.

We found that the provider was in breach of some regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.  You can see what action we told the provider to take at the back of the full version of the report.