About the service: Woolston Mead is a residential care home that was providing personal and nursing care to 20 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

We received positive feedback about the quality of care people received and the overall management of the service.

People told us that they felt safe living at the service. Care records provided detailed information around people's individual risks in order for staff to keep them safe from avoidable harm. Person centred care was delivered, giving people choice over their daily routines in line with their preferences.

Staffing levels were appropriately managed and people received care from consistent, regular staff. Enough staff were employed each day to meet people's needs and keep them safe. People and their relatives told us that care was provided in a safe and timely manner.

Recruitment processes were robust. The necessary pre-employment checks were completed and people received care from staff who were suitable to work in adult social care environments.

People received their medicines when they needed them from trained and competent staff.

People's overall health and well-being was effectively assessed and managed. Referrals were made to external healthcare professionals accordingly.

People were offered a variety of meals and snacks each day to meet their dietary needs and preferences. People received support to eat their meals when required.

People were supported in a kind, caring and compassionate manner. Staff were familiar with the support needs of the people they were supporting.

The registered provider had a complaints policy in place. People and relatives knew how to make a complaint if they needed to. However, no complaints had been made.

People were encouraged to participate in a programme of activities. Some people received Holy Communion in the home each week. There were no restrictions for relatives and friends to visit. Visitors were made welcome.

The home was mostly clean and hygienic. Health and safety measures were in place to ensure people lived in a safe, well-maintained environment. A programme of redecoration and refurbishment was in place and underway.

Rating at last inspection: Requires Improvement (Report published 1 May 2018). At this inspection we found the overall rating had improved.

Why we inspected: This was a planned comprehensive inspection based on the ratings at the last inspection. It is CQC methodology to re-inspect Requires Improvement providers within a 12-month timescale.

Follow up: No concerns were raised within this inspection. We will therefore aim to re-inspect this service within 30 months. We will continue to monitor the service through the information we receive. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

An unannounced inspection took place on 20 & 21 March 2018.

At the previous inspection in August 2017 the provider was found to be inadequate and the service was placed in 'special measures' by CQC. We found that the provider was in breach of 2014 Regulations with regard to meeting nutritional and hydration needs and safe recruitment, as well as Regulation 18 of Registration Regulations 2009, failure to notify of incidents.

The purpose of 'special measures' is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in 'special measures' are inspected within six months of the publication of the inspection report.

At this inspection we found improvements had been made. This meant the service was no longer rated inadequate and could be removed from 'special measures' by the Care Quality Commission (CQC).

Following the inspection in July 2017 we served an urgent Notice of Decision imposing urgent conditions on the Provider's registration because the provider remained in breach of regulation 12 safe care and treatment and regulation 18 good governance and we found the provider in breach of regulation 15, failure to maintain and ensure that the premises for its intended purpose.

Woolston Mead 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.

Woolston Mead provides accommodation and personal care for up to 28 people. It is a large Victorian property with accommodation located over four floors. Steps provide access to the front of the building. Level access is available at the rear of the building. The lower and upper floors are accessed via a staircase and a passenger lift. The upper floors can also be accessed using a stair lift. There is a dining area to the ground floor and a lounge. A garden area is located at the front of the building. At the time of this inspection 18 people were living in the home.

There was a registered manager. 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.’

We found that medicines were administered and managed safely in the home. Despite efforts to reduce the temperature in the treatment room, medicines were still stored in a room at was above 25 degrees centigrade. This increased the risk of medicines not working properly if they are stored out of the required temperature range. We have made a recommendation about the safe storage of medicines.

Regular daily stock checks and weekly medication audits were completed and any issues were being addressed promptly. All staff that administered medication received medicines administration training and we saw competency checks were completed every six months.

There were no gaps in records indicating that people in the home were receiving medicines as prescribed. A person had missed five doses of a medicine as it had been returned to the pharmacy in error. This could have been managed better to ensure the person did not miss their doses.

Some medicines have specific instructions to ensure that they are taken properly and at the right time. These instructions were not present on the medicines record or on the dispensing label for a specific medicine. Immediate action

The inspection took place on 14 and 15 August 2017 and was unannounced.

Woolston Mead Care Home registered to provide accommodation and personal care for up to 28 people. Accommodation is provided on four floors with two lounges on the ground floor and a dining room in the basement. A passenger lift and stair lift provide full access to all areas of the home. The home is situated in a quiet residential area and is located close to all amenities and transport links. At the time of the inspection 15 people were living at the service.

There was a registered manager. 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.

We completed a comprehensive inspection of Woolston Mead in January 2017. We found that the provider was in breach of regulations with regard to safe care and treatment, meeting nutritional and hydration needs, staffing, premises and equipment and good governance. The service was rated as ‘’inadequate’ and was placed in ‘special measures’.

We issued two warning notices to the provider which required the service to be compliant with regulations. We received assurances from the registered manager that the actions required by the warning notices had been completed. As part of this inspection we checked to see if the necessary improvements had been made and sustained.

We found that although some improvements had been made, breaches of regulations previously identified had not been met.

A warning notice was issued following the last inspection with requirements related to medicines, which were not safely stored or monitored. During this inspection we found continued concerns regarding the storage of medicines as well as errors in the administration of controlled drugs. We also found errors in the recording of some people’s medicines on medicine administration records.

A further requirement of the warning notice related to the lack of audits competed to help ensure safe administration and storage of medicines. At this inspection we found that audits were completed regularly. However the errors found on this inspection had not been identified because checks of all medication stock were not carried out. The breach had not been met.

A second warning notice had also been issued following the last inspection in relation to the lack of any quality audit processes to monitor and improve the safety and quality of the service. On this inspection we saw that improvement had been made. Audits were now in place to check for common themes or trends for accidents and incidents which had occurred. During this inspection we found evidence that risk had been reviewed as required. Audits were now completed to help ensure the home was kept clean. Audits of the care files had not identified the inaccurate risk assessments because staff responsible for the check were absent from work and this role had not been given to another staff member. The breach had not been met.

A further requirement of the warning notice related to staff recruitment files and staff training. At the last inspection we found that files were not kept in an ordered way for individual staff members so we were unable to determine if proper recruitment had taken place and staff did not receive training, professional development, supervision and appraisal. On this inspection we saw that improvement had been made. The registered manager now had a system in place to ensure staff were regularly supervised and received mandatory training on a regular basis. However we did see that the registered manager had accepted two character references for two members of staff. It is a requirement that employers should request a reference from a person’s last employer. The breach had not been met.

The inspection took place on 30 and 31 January 2017 and was unannounced.

Woolston Mead Care Home is situated in a quiet residential area and is registered to provide accommodation and personal care for up to 28 people. Accommodation is provided on four floors with two lounges on the ground floor and a dining room on the lower ground floor. A passenger lift and stair lift provide full access to all areas of the home. The home is located close to all amenities and transport links. There were 19 people living in the home on the day of our inspection.

There was no registered manager in post at the home. The last manager had left in January 2017. The previous registered manager to this left their position in August 2016. The current manager had been in post for ten days. 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.

Before the inspection we received some information of concerns from the local Clinical Commissioning Group in respect of the safe management of medicines.

People were receiving their medicines on time, however, people’s medication was not always stored and stock recorded in accordance with good practice. The medicine trolleys where the majority of medicines were stored were not secured to a wall or in a locked room as required. This meant that the medicines were more vulnerable to theft. In addition, medicines requiring refrigeration were stored separately in a domestic fridge which was not checked regularly to ensure the temperature was suitable for storing medicines safely.

Some staff did not wear protective clothing when cleaning or giving out medicines, to prevent cross infection. The bathrooms did not always have hand washing facilities.

Safety and quality assurance audit processes were not carried out regularly and were not robust to monitor and improve the safety and quality of the service. The provider was unable to demonstrate effective oversight of the service and had failed to identify a number of issues of significant concern we identified during the inspection.

Safety checks of the environment and equipment were completed regularly. However, repairs to the home and environment were not completed in a timely manner.

Staff were not provided with support to undertake their roles effectively. They had not received supervision for several months. Staff meetings had not taken place.

Some staff had not received any training in line with their roles and responsibility in the home. New staff had not received any training following their appointment and induction.

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

Most people told us they liked the food but we found there was no choice of meals each day.

Risk assessments had been undertaken to support people safely and in accordance with their individual needs.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

Staff supported people in a timely manner and were visible throughout the home. People who lived in the home and relatives said there needed to be more staff working at during the day and at night.

Recruitment files were dis-organised and not made up to allow documentation to be seen easily. New staff had been employed through robust recruitment procedures to ensure staff were suitable to work with vulnerable adults.

Staff followed the recommendations made by health and social care professionals to make sure people received the care and support they needed.

Staff sought consent from people before providing care and support. The home followed the principles of the Mental Capacity Act (2005) for people who l

We carried out an unannounced comprehensive inspection of this service on 23 July 2015 and identified four breaches of regulation in the ‘Safe’ and ‘Effective’ domains. The breaches of regulation were related to concerns we identified about: the management of medicines; protecting people from abuse; the management of individual risk and the arrangements for seeking the consent of people to provide support and care. We asked the provider (owner) to take action to address these concerns. We issued the provider with a warning notice in relation to the management of individual risk and told the provider to address these issues by 17 April 2015.

In addition, we identified minor concerns within the ‘Responsive’ and ‘Well-led’ domains. We made a recommendation in relation to the concern identified in the ‘Responsive’ domain.

Following the comprehensive inspection the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 23 July 2015 to check that the provider had met legal requirements identified in ‘Safe’ and ‘Effective’. We also looked at whether the concerns identified in the ‘Responsive’ and ‘Well-led’ domains had been addressed. The domain ‘Caring’ was not assessed at this inspection as it was rated ‘Good’ at the inspection in February 2015. You can read the report from our comprehensive inspection, by selecting the 'all reports' link for ‘Woolston Mead' on our website at www.cqc.org.uk.

Woolston Mead care home is situated in a quiet residential area and is registered to provide accommodation and personal care for 28 people. Accommodation is provided on four floors with two lounges on the ground floor and a dining room in the basement. A passenger lift and stair lift provides access to all areas of the home. The home is located close to local amenities and transport links.

Twenty people were living at the home at the time of our inspection.

A registered manager was not in post at the time of our inspection. The registered manager had left the service in April 2015. A new manager had started in November 2014 and they had submitted an application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that significant improvements had been made in all areas we had concerns about and the previous breaches had been met. The improvements also meant that the requirements of the warning notice had also been met.

Risk assessments and care plans had been revised for the people living at the home. These were individualised to the person and the care plans provided clear and concise information about how each person should be supported. We observed a person being supported with a personal care activity and staff did this in accordance with the care plan. Risk assessments and care plans were reviewed on a monthly basis or more frequently if needed. They were revised to reflect people’s changing needs.

The staff we spoke with could clearly describe how they would recognise abuse and the action they would take to ensure actual or potential abuse was reported. Staff confirmed they had received adult safeguarding training and were aware of what to do if they had a safeguarding concern. The adult safeguarding policy had been revised in April 2015 and was now reflective of the service provided at the home and the local area safeguarding procedure.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People living at the home, families and staff told us there was sufficient numbers of staff on duty at all times.

Staff told us they were well supported through regular supervision and appraisal. They said the new manager had arranged training and they were up-to-date with the training they were required by the organisation to undertake for the job. Training records confirmed this.

Safeguards were in place to ensure medicines were managed in a safe way. Medicines were administered from a trolley that was stored in a secure and dedicated medication room when not in use. Staff wore a red tabard to highlight they must not be disturbed while giving out medicines. A new controlled drug cupboard had been purchased and the a new thermometer for the medicines fridge.

The building was clean, well-lit and clutter free. Measures were in place to monitor the safety of the environment and equipment. A refurbishment programme was in place; internal decoration had taken place, a new nurse call system had been fitted and new carpets were on order.

The local fire and rescue service had visited the home on four occasions between April and May 2015 and concerns with fire prevention measures had been identified. On the last visit, the manager confirmed that the fire officer was satisfied that all concerns had been addressed. We found that staff had wedged some fire doors in the open position. In addition, we found some closure devices on fire doors were ineffective in fully closing the doors and other fire doors were ill-fitting. The manager said they would address this with the maintenance person for the home.

Pictorial signage had been put in place to ensure different formats of communication were available for people. For example, the menus were available in pictorial format.

People’s individual needs and preferences were respected by staff. They were supported to maintain optimum health and could access a range of external health care professionals when they needed to.

People told us they were satisfied with the meals. Two relatives we spoke with said the food was good and one relative said the menus had improved. A relative told us the chef prepared a different meal if his relative who lived at the home did not like what was on the menu.

Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living at the home and staff throughout the inspection. An activities coordinator had been appointed and a varied programme of recreational activities was available for people to participate in.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority.

The culture within the service was and open and transparent. Staff and people living there said the management was both approachable and supportive. They felt listened to and involved in the running of the home.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Opportunities were in place to address lessons learnt from the outcome of incidents and complaints.

A procedure was established for managing complaints and people living at the home and their families were aware of what to do should they have a concern or complaint. No formal complaints had been received within the last 12 months.

Audits or checks to monitor the quality of care provided were in place and these were used to identify developments for the service.

This was an unannounced inspection of Woolston Mead care home. The inspection set out to answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Arrangements were in place to monitor accidents and incidents, including a process for analysing incidents each month so that any emerging themes could be identified.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection nobody who lived at the home was on a Deprivation of Liberty Safeguards (DoLS) plan.

The staffing levels had been reduced at night due to six residential vacancies. A risk assessment had not taken place to determine what impact this reduction in staff could have on the quality of care and safety of the people living at the home. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People we spent time with were satisfied with the home and care they received. A person told us, “I wouldn’t leave here for anything.” Another person said, “I’m quite happy with my room, it’s like a hotel.”

Equally, family members we spoke with were pleased with the home. A family member said to us, “The staff are very friendly and always welcoming.”

Care plans were in place for each person. Although the manager informed us that care plans were reviewed each month, we observed that some care plans had been reviewed less frequently. Action had not been taken for a person who had lost a significant amount of weight. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff were up-to-date with mandatory training and received regular supervision from the manager.

Is the service caring?

People who lived at the home told us staff were caring and respectful. One of the people said, “The carers are particularly kind.” Another person told us, “The staff are absolutely excellent.”

Throughout the inspection we observed staff supporting people in a respectful and kind way. We heard staff prompting and encouraging people in a dignified manner with various care related activities.

Is the service responsive?

People’s needs had been assessed before they moved to the home. Records confirmed people’s preferences, interests and preferred routines had been recorded, and staff provided support in accordance with people’s wishes.

Families said they were involved in decisions about their care. A family member told us the manager communicated well and involved them in the care of their relative.

Is the service well-led?

Processes to seek people’s views about the quality of the service were in place. Feedback questionnaires had been introduced for people living at the home to complete. Questionnaires had also been sent to family members and professionals who visited the home. In addition, monthly meetings were held for people living at the home. Families were also invited to attend these meetings.

A range of audits and checks had been introduced to monitor the safety of the service provided. These included a medication audit, an infection control audit and a monthly audit of the care records. The care records audit was ineffective as it had not identified concerns we highlighted through looking at the care records. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

As part of our inspection we invited people to share with us their experience of living at Woolston Mead care home. People were happy with the care and spoke highly of the care staff. One person said to us, “The carers are very kind.” Another person told us, “It is lovely here. Everybody is good to us.” People told us the meals were good and they got plenty to eat and drink.

Equally, relatives and friends were satisfied with the care at Woolston Mead. One of the visitors said, “I haven’t any concerns regarding my friend’s care.”

Throughout the day we observed staff treating people with respect. We heard staff prompting and encouraging people with their care in an inclusive, kind and understanding way.

Care records were in place for each person and they provided an overview of the care people were receiving. Assessments and care plans had been developed for each person. Not all care plans were an accurate reflection of the care being provided at the time of the inspection.

The staffing levels were sufficient to meet the needs of the people who were living at the home. Not all staff had been recruited in an effective and safe way. Staff training, supervision and appraisal were not up-to-date.

Systems were in place to monitor the quality of the service.

The sharing of electronic personal information was not done in a secure way so we could not ensure it remained confidential.

People living in Woolston Mead had varying needs, and not all people living in the home had capacity to make their own decisions. During our inspection we spoke to four people living in the home and two relatives of people who were unable to speak with us directly.

People living in the home told us: “They treat me very well, the staff are very nice, they get me anything I need.” “This is my home; it feels like home, people here are my family.” “It’s a very good home; staff are awfully kind and very capable.” “What more can you ask for? I get my washing and cleaning done, nice food and no washing up.”

We found from reviewing records and speaking with people and their relatives, that they understood the care and treatment choices available to them.

Care plans were written in such a way that staff could clearly see the care, support and treatment requirements for individuals.

Two people living in the home and one relative told us that they felt people living there would benefit from more activities and stimulation within the home.

We saw that there were effective recruitment and selection processes in place, and there were enough qualified, skilled and experienced staff to meet people’s needs.

We noted in the entrance hall that satisfaction surveys were available for people to complete and return, and a notice advertising the relative’s monthly forum.

People spoken with said the staff were fully aware of how they liked things done and discussed their care with them regularly. They confirmed that they were fully aware of their care needs as these had been discussed with them. They had expressed their individual preferences and these had been respected.

People spoken with said they enjoyed the meals at the home and were aware that the chef would try to arrange for any particular preference to be provided.

People spoken with said they were happy in the home and felt safe.

When asked about the recent surveys that people had been asked to complete, they confirmed they had been given the opportunity to make comment about the home. One person said "Its lovely here and I said so on the form."

People living at the home and relatives were positive about the care staff. They informed us that the staff are respectful, caring and helpful. We heard that there is plenty of staff available and people are not left waiting too long for their requests and needs to be met.

Although some people were satisfied with the food provided at the home, the majority of people we spoke with said the food is not very good. We heard that plenty of food is available but people described the meals as basic and bland, with the menus described as lacking imagination.

All the people we spoke with said that the days can be long as there is not much to do. We heard that occasionally there are activities but these do not happen very often. One person suggested a quiz on a regular basis would help to keep the mind active. Another person told us that ‘we used to do exercises but not anymore’.

Some people we spoke with either could not recall if they attended resident meetings or were not keen to attend these meetings.

The inspection was unannounced and took place on the 24 and 25 February 2015.

Woolston Mead was inspected on 21 August 2014 and found to be in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Satisfactory improvements had not been made and we found a continued breach of Regulation 9. The Care Quality Commission (CQC) did not receive an action plan from the provider to outline how improvements would be made.

Woolston Mead care home is situated in a quiet residential area and is registered to provide accommodation and personal care for 28 people. Accommodation is provided on four floors with two lounges on the ground floor and a dining room in the basement. A passenger lift and stair lift provide access to all areas of the home. The home is located close to local amenities and transport links.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was in the process of deregistering and a new manager had recently started at the home and planned to apply to register.

People told us they felt safe living at the home. Staff were aware of what to do if they were concerned that a person living there may have been abused. Over half the staff team had not received training in adult safeguarding. The safeguarding policy was not reflective of local safeguarding procedures. You can see what action we told the provider to take at the back of the full version of this report.

Both staff and people living at the home said there was sufficient staff on duty at all times to meet their needs. Staffing levels had been increased at night recently. The manager was in the process of recruiting a housekeeper and activities coordinator.

Effective staff recruitment processes were in place. All the relevant recruitment checks had been undertaken to ensure new staff were suitable to work with vulnerable adults.

Controlled drugs were not always stored securely and second signatures were missing from the records when controlled drugs had been administered. You can see what action we told the provider to take at the back of the full version of this report.

People’s risk assessment and care plans did not always reflect their current needs. Assessments and care plans had been regularly reviewed but people’s changing needs or increased risk had not being taken into account as part of the review. You can see what action we told the provider to take at the back of the full version of this report.

There were gaps in staff training but the manager had organised training to take place over three days in March 2015. The approach to staff supervision and appraisal had been made more robust since our last inspection and staff confirmed they had received supervision from the manager.

Changes had been made to the menus recently and overall people were happy with the meals. We observed staff supporting people in an engaging and warm way with their meal if they needed it. Drinks were available throughout the day.

Staff sought consent from people before providing personal care. However, staff had not received awareness training regarding consent and mental capacity. They had a limited understanding of how it applied in practice. Mental capacity assessments were completed in a generic way and were not specific to the decision the person needed to make. Restrictions were in place for a person to minimise their risk of falling but this had not been agreed in accordance with the principles of Mental Capacity Act (2005). You can see what action we told the provider to take at the back of the full version of this report.

People had access to a range of health care practitioners when they needed it.

We observed staff supported people in a kind, caring and unhurried way. Personal care activities were carried out in private. A keyworker system had recently been introduced.

The manager was promoting a person-centred culture and this was starting to have a positive impact for staff and people living at the home. We made a recommendation about this.

A complaints process was in place and an easy-read leaflet was displayed in the foyer advising people what to do if they were concerned about anything.

Regular meetings with people living at the home and their relatives had started in December 2014. Suggestions people made and any feedback about the service had been actioned by the manager.

Structures to monitor the quality and safety of the service had been made more robust since our last inspection. An overarching quality monitoring tool was being used each month to monitor the service. Medication audits were established and medicines were checked weekly and monthly. Staff meetings had started and they were being held each month.

A health and safety policy had been developed for the home and environmental risk assessments had been undertaken. Policies and procedures were in place but a number of those we looked at were not reflective of the service provided.