What life is like for people using this service:

People felt safe because of the quality of the care and support they experienced. There were enough staff. Staff were attentive to their people's needs and staff responded quickly when they used their call-alarms. People knew how to raise any concerns about their safety.

The provider had safeguarding procedures and polices that staff were familiar with. Staff knew how to report concerns and were confident that any concerns they raised would be taken seriously by management.

An experienced team of staff supported people. Many of the staff had been at the service for as long as some of people the people who lived there. People felt safe because the staff knew their needs so well.

People had their medicines on time. Storage of medicines was safe.

The home was clean, tidy and fresh because staff followed good infection control procedures.

People had a choice of healthy meals and their dietary requirements were met. The staff were knowledgeable about people’s food preferences. People who required support with eating received that support. Staff made sure people saw their GPs and other healthcare professionals when they needed to.

People liked the way the home was decorated. People could bring their own furniture and furnishings. Their rooms were decorated to their taste. We saw that the home was well-maintained.

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

The staff treated people with kindness and respect. People had good relationships with the staff. They and relatives were involved in decisions about their care and support. Relatives could visit the home at any time.

People took part in activities. They joined in with games that promoted movement and exercise. We saw people reading, watching television and talking with other people and staff. People who wanted were supported to follow their faith needs.

The provider and registered manager ensured information was provided to people in a way they found accessible. People’s care plans included ‘communication passports’ which explained how they wanted staff to communicate with them.

If people had any complaints about the service they would tell the registered manager or staff. They were confident their concerns would be addressed.

The registered manager carried out audits to assess the quality of people’s experience of the service. People’s views of their experience of the service were sought and acted upon. People consistently said they were happy living at the home and felt well-cared for. The registered manager

carried out checks to ensure the premises were safe.

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.

About the service:

Woodthorpe Manor Nursing Home is a registered care service providing care for up to 30 older people. It is situated in a residential area of Woodthorpe, a suburb of Nottingham. On the day of our inspection visit there were 21 people using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at last inspection: Good (report published on 2 July 2016)

More Information is in the detailed findings below.

This inspection took place on 7 June 2016 and was unannounced.

Accommodation and nursing care for up to 30 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 22 people using the service at the time of our inspection.

A registered manager was in post and she was available during 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.

Staff knew how to identify and respond to potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices and safe medicines practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink and external professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People were treated with dignity and respect. People’s privacy was respected and staff encouraged people to be as independent as possible.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken. The registered manager was aware of their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

This inspection took place on 6 January 2015 and was unannounced.

At previous inspections on 16 and 18 December 2013 and 12 March 2014, we asked the provider to take action to make improvements to the areas of consent, care and welfare of people who use services, meeting nutritional needs, safety and suitability of premises, safety, availability and suitability of equipment, supporting workers and records. We received action plans in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in all the areas.

Accommodation for up to 30 people is provided in the home over two floors. The service is designed to meet the needs of older people.

There is a registered manager and she was available throughout 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 they felt safe. Systems were in place for staff to identify and manage risks and the premises and equipment were safely maintained. People had mixed views about staffing levels but we found that sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices. Safe medicines management procedures were followed.

A person told us that staff knew what they were doing and we found that staff received appropriate induction, supervision, appraisal and training. People told us staff asked their permission before providing care. However, we found that documentation was not fully completed to demonstrate that an assessment of people’s capacity to make decision had been correctly made. People were happy with the food provided at the home. The home involved outside professionals in people’s care as appropriate.

People told us they were treated with kindness, could express views about their care and were treated with dignity and respect. We observed interactions between staff and people living in the home and staff were kind and respectful to people when they supported them and people were involved in their care where appropriate.

Information was available to support staff to meet people’s needs. People who used the service told us they knew who to complain to if they needed to and we saw that complaints had been handled appropriately by the home.

People told us that there were meetings held where they could raise issues and we saw that the registered manager responded appropriately to them. Staff told us they would be confident raising any concerns with the management and that the registered manager would take action. There were systems in place to monitor and improve the quality of the service provided and these were effective.

We spoke with four people who were using the service and asked if they felt they were treated with dignity and respect. Each person told us they were treated with dignity and respect, one person said, “The staff are very nice, very good.” Another person said, “I feel encouraged to make my own decisions.”

We looked at five care plans, to see if the required improvements had been made. We saw that there had been some improvements to the amount of information available in care plans. Despite these improvements, we observed some practice which indicated care was not always delivered in line with people’s care plans.

We carried out a tour of the home looking at communal areas, bedrooms and bathrooms. The home appeared to be clean and we did not observe any unpleasant odours. People's medication was stored, administered and recorded appropriately.

We spoke with two care staff about the staffing levels in the home. Staff told us they thought there were sufficient numbers of staff on each shift to meet people’s needs. We were also told that staff were able to take holidays and their scheduled days off because there were enough staff employed to cover the rota.

There were effective quality monitoring systems in place. People using the service, their relatives and staff were asked for their views and these were acted upon.

We spoke with four people who used the service, looked at three people’s records, and spoke with one care worker, two nurses and the registered manager.

People we spoke with indicated they liked living at Woodthorpe Manor. Comments included: “it’s a nice home”, “they look after us well” and “they always ask you what you want and how you are…it makes it all worthwhile”. From brief observations we saw that people were spoken to with dignity and respect and staff were attentive to people’s needs. People looked well kempt and were smartly dressed.

We looked at the care plans and records of three people who used the service. We found people’s needs were assessed and care was planned and delivered in line with their individual plan.

Staff were aware of how to protect people from abuse and the appropriate procedures for reporting allegations of this nature. Staff had been appropriately screened to ensure they had the proper qualifications and were suitable to work with vulnerable people. Staff we spoke with demonstrated a good understanding of the needs of people who used the service.

Records were accurate and fit for purpose.

A person said, “The home tries to cater for the individual.” They also told us their privacy and dignity were respected. Another person said, “There are activities for me including dominoes and listening to the singer yesterday.” Another person said, “I feel fully involved in my care.”

A person said, “There are a range of activities if you want to get involved.” They also said, “Care is good.” Another person said, “Very good care.” Another person told us they would like more activities for people who are not mobile.

When we asked about the facilities in the home, a person said, “The chairs are comfortable.” Another person said, “Standard of premises are ok.” Another person said, “The environment is as well as it could be.”

We asked about the support people receive and one person said, “Carers are always busy so I sometimes have to wait for my care, to be moved upstairs to bed.” They also said, “I do have to wait at night for my buzzer at the side of my bed to be answered.” Another person said, “The nurses are very good and help when they can but staff do not always respond straightaway.” Another person said, “It is sometimes hard to get hold of staff.”

A person said, “If I have a complaint I can raise it at the regular meetings with the management.” Another person said, “I know how to make a complaint to the management during evening meetings.”

We spoke with five people using the service. One person said, “When receiving personal care, the staff talk to each other rather than to me. When I want something, I’m told I have to wait. They say, ‘There’s more people here than me who need help.’”

People had mixed views on whether staff asked permission when providing care but most people were positive regarding the care they received. One person said, “I’m happy here, the girls support me.”

People were generally positive about food and drink offered to them. One person said, “I’m not a big eater, but I’m not left satisfied at the end of the meal. I do get enough to drink.” Another person said, “The food is lovely, and I do feel full afterwards.” Another person said, “The food is lovely, and I have a drink.”

We found that people’s dignity was not always respected and they were not always involved in making decisions about their care and treatment. Where people did not have the capacity to consent, the provider could not provide sufficient evidence to demonstrate that they acted in accordance with legal requirements at all times.

People did not always experience care, treatment and support that met their needs and were not always supported to be able to eat and drink sufficient amounts to meet their needs.

We found that effective infection control practices were not always being followed. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found that people who use the service were not fully protected against the risks of unsafe or unsuitable premises. People were not fully protected from unsafe or unsuitable equipment.

There were not always enough qualified, skilled and experienced staff to meet people's needs. People were not cared for by staff who were fully supported to deliver care and treatment safely and to an appropriate standard. We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive and that people’s personal records including medical records were not always accurate and fit for purpose. Records were not always kept securely.