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Inspection carried out on 8 August 2017

During a routine inspection

We carried out this unannounced inspection of Woodland on 8 August 2017. The last comprehensive inspection took place in 27 July 2016 when we identified two breaches of regulations. Not enough was done to protect people and staff, from identified risks and monitoring records were inconsistently completed. The service sent us an action plan telling us what they were doing to meet the breaches. At this inspection we found people’s risks were being identified and responded to so they were protected. Records to ensure people’s needs were being responded to, were complete and demonstrated how they were being met.

Woodland is part of Cornwall Care and is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 38 people living at the service. Some of these people were living with dementia. The accommodation is spread across four wings. There are several lounge areas where people can choose to spend their time. There was a large garden to the rear of the building.

On the day of the inspection visit there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. People told us, “They (staff) are always careful about our privacy and dignity” and “They (staff) are very nice here.”

Details in care plans included the level of risk and how it was going to be managed. This had improved since the previous inspection when there was little evidence of how individual risks were being managed safely and effectively. There were examples of when people were at risk, for example from falls. Guidance for staff contained detailed information on the action staff could take to minimise the risk. All records relating to the care and support of people were complete and provided staff with current information about the needs of the person. This had improved since the previous inspection when gaps were noted in a number of records relating to the care and welfare of people.

Some people told us they thought the levels of staff could be improved on. The registered manager acknowledged there had been a period of instability when agency staff had and were continuing to be used, but far less than earlier in the year. On the day of the inspection there were suitable numbers of staff on duty to meet the needs of people using the service. There was one agency staff member who had worked at the service on a regular basis and knew people’s needs. Staff told us, “It’s been difficult at times but things have got a lot better. Comments were mixed and included, "The staff are pretty good, although there is never enough of them" and "When I ring my call bell I find that as a rule they respond quite soon.”

People and relatives told us they thought Woodland was a safe place to live and that staff were kind, friendly and treated people well. They told us that the registered manager was always available and approachable. Comments included, “Always there if I need to speak about anything” and “I have every confidence in the manager and staff. There have been some changes but I think they have improved the home.”

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

The registered manager used effective and systems to record and report on, accidents and incidents and take action when required.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this p

Inspection carried out on 26 July 2016

During a routine inspection

This unannounced comprehensive inspection took place on 26 July 2016. The last inspection took place on 18 June 2015. At that inspection we identified breaches of the legal requirements and told the provider to take action to address the breaches of the regulations. Following the inspection in June 2015 the provider sent the Care Quality Commission an action plan outlining how they would address the identified breaches. We carried out this comprehensive inspection to check on the actions taken by the service to meet the requirements of the regulations.

Woodland is part of Cornwall Care and is a care home which offers care and support for up to 37 predominantly older people. At the time of the inspection there were 35 people living at the service. Some of these people were living with dementia. The accommodation is spread across four wings. There are several lounge areas where people can choose to spend their time. There was a large garden to the rear of the building.

The service had a registered manager in post. 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. The registered manager had been in post since December 2015.

Some people found it difficult to manage their emotions which could lead to them becoming distressed and agitated. This meant they could put themselves and others at risk of harm. Risk assessments were not always in place to describe the risk and guide staff on how they could deal with it in order to keep themselves and others safe. Staff had not had training to enable them to deal with these potentially risky situations.

In order to help sustain the correct staffing levels agency staff were frequently used, either from an external agency or Cornwall Cares' own flexible staff team. This happened more often at weekends. Although five new members of staff had recently been recruited they were not yet working at the service at the time of the inspection. This was because they were waiting for pre-employment checks to be completed. Staff were effectively deployed across the service and people’s needs were usually met in a timely manner.

At the last inspection on 18 June 2015, we asked the provider to take action to make improvements to the management of medicines and this action has been completed. Systems for the administration and storage of medicines were robust. People received their medicines as prescribed.

Staff received a thorough induction when they started working for Cornwall Care. Training was regularly refreshed and staff told us it was effective. Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure staff were suitable to work in the care sector.

At the last inspection on 18 June 2015, we asked the provider to take action to make improvements to the way in which they responded to reported defects within the service and this action has been completed. A caretaker was employed who had oversight of the maintenance of the building. They helped ensure any repairs or necessary refurbishments were carried out within a reasonable time frame. Since our previous inspection most of the service's communal areas had been redecorated.

Staff supported people to be involved in and make decisions about their daily lives. People chose where they spent their time, when they got up and when they went to bed. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were protected from the risk of abuse because staff had a good understanding of the potential signs of abuse and how to report it. All were confident that any allegat

Inspection carried out on 18 June 2015

During a routine inspection

Woodland is a care home which offers care and support for up to 37 predominantly older people. At the time of the inspection there were 34 people living at the service. Some of these people were living with dementia. The service had a registered manager in post. 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.

This inspection took place on 19 June 2015. The last inspection took place in July 2014. At that inspection the service was meeting the requirements of the regulations.

We looked at how medicines were managed and administered. We found it was not always possible to establish if people had received their medicine as prescribed. There were gaps in the medicine records for eight people. Transcribed handwritten entries on the medicine records had not been signed by two people to help ensure the risk of errors was reduced. One person’s medicine record had been re-dated by hand, which meant the records were not clear for staff administering medicines. Cream application records did not clearly direct staff when to apply prescribed cream and were not regularly completed by staff. The medicine fridge temperature had been recorded regularly at temperatures that were outside of the safe temperatures required for the cold storage of some medicines. A recent medicines audits had identified this as a concern which had not been actioned by the provider.

The service had 16 outstanding defects which had been reported to the organization regularly by the registered manager at meetings with the provider. Some defects had been outstanding since January 2014.

On one bedroom door was a printed sign stating, “Be aware that this door is heavy to open and may shut abruptly”. We were told that the doors had been checked by a maintenance person but no change in the operation of the doors had taken place. We were told one person should be able to operate their door themselves but this was not currently possible due to the defect. This did not ensure the risk of injury to the person had been addressed.

Staff received supervision and appraisals. However, some staff had not received supervision since January 2015. The service policy stated all staff should receive supervision every three months.

The registered manager was supported by a deputy manager and senior care staff. The registered manager told us their personal supervision had not been formally recorded and their external coach no longer provided services to the provider. The provider’s representative assured us the registered manager’s necessary support would be formalised in the near future.

The service kept money on behalf of people who lived at the service. We checked the cash balance held with the records, they did not balance. There was a small surplus held. A member of the administration staff usually managed the cash for people but they had left at the end of the week prior to this inspection. There were no records to show that the cash balance held had been regularly checked against the records. We were told this would be actioned immediately.

The service did not hold residents or families meetings at present. This meant the service was not providing a regular opportunity for people, their friends and families to express their views and share ideas for improving the service provided. However, the service had carried out a survey of people that used the service in 2014.

There were systems and processes in place to monitor the quality of the service. However, we did find some gaps which demonstrated audits and checks were not always carried out effectively. For example, the medicine fridge temperature records, defects in the premises that had an impact of people who lived at the service, staff supervision and the management of people’s money.

Training and informal support helped staff to be effective in their care and support of people in the service. Staff were aware how to report any concerns of potential abuse. However, staff were not aware of Cornwall Council being the lead authority in investigating allegations of abuse. We were told training would be reviewed to help ensure staff were clear on this in the future.

People were well cared for. Staff were kind and mostly respectful when supporting people. Comments included; “The staff are wonderful always happy,” “We can always talk to staff if we need anything” and “We are very happy.”

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. Staff felt there were enough staff at the time of this inspection but commented they had been through a recent period of staff shortages.

The service had robust recruitment processes in place to ensure new staff were safe to work with older people. The service had vacant staff positions for a cook and administrator, with a housekeeping post becoming vacant in the near future which had already been recruited to.

New staff were supported with an induction for a period by experienced staff until they felt confident to work alone. Staff working at the service understood the needs of people they supported.

Care plans at the service contained information to direct staff regarding the needs of each person, and how they wished their care to be provided. Staff were aware of people’s preferences and choices. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Staff meetings were held regularly for all groups of staff. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

A visiting healthcare professional told us; “They (staff) do call if they need help, they seem to be doing everything well. They know their patients well, no concerns.”

People were offered choices. Mealtimes provided a choice of food and drinks. The kitchen provided food in line with people's dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Activities were provided regularly, people could spend time in the secure garden independently and people enjoyed regular trips out in to the local area.

The service had a good relationship with external healthcare professionals who ensured effective care delivery for people whenever they needed or wanted it.

Families and staff felt they could raise any concerns or issues they had with the registered manager or the deputy manager. Both were considered to be approachable and people and staff felt their views and experiences were listened to.

We found a breaches of 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.

Inspection carried out on 23 July 2014

During an inspection to make sure that the improvements required had been made

The inspector gathered evidence against the outcomes we inspected to help answer one of our five key questions: Is the service safe? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

At the previous inspection in April of this year we found the service to be potentially unsafe because some records were not up to date or accurate. At this inspection we found the service to be safe because record keeping had improved since the last inspection.

People told us they felt safe and we saw people who lived at Woodland spontaneously approaching staff for assistance or for a chat.

Woodland had regular support from the district nursing team and GPs from the six local GP practices. This ensured people received appropriate care in a timely way.

We saw that care plans had been updated, rewritten and reviewed with the involvement of the person concerned or their relative/representative shown by their signature on the documents. The information provided in the care plans was detailed and individualised. This helps to ensure people are provided with care that reflects their care needs.

The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) provide a legal framework that protects people who lack the mental ability to make decision about their life and welfare. We saw that appropriate assessments had been completed for people who did not have the mental capacity to make decisions in relation to specific issues, and we saw the home had made appropriate DoLS applications to Cornwall Council.

Staff told the inspector that Woodland was a happy place to work and that the manager and deputy manager were supportive. The manager and deputy manager were not available at this inspection.

Inspection carried out on 2 April 2014

During a routine inspection

The inspection team included an inspector and an expert by experience (a person who has experience of caring for people who have used care services, or who has used services themselves). We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? The expert by experience gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe? People told us they felt safe. Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives. The registered manager wrote the staff rotas and took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. Woodland alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Woodland had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people’s needs were met.

We inspected Woodland's medication systems and found them to be in order. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective? People’s health and care needs were assessed with them, although it was not always clear that they were involved in writing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were not always up-to-date. People who used the service, and their representatives, were not always involved in their care plan reviews. We saw people, or their representatives did not consistently sign care plan reviews to show they had read and agreed to the content of the care plan.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met. Woodland had regular support from the district nursing team and GPs from the five local GP practices. This ensured people received appropriate care in a timely way.

Is the service caring? We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “They’re [carers] very nice” and “Staff are kind”. Two relatives said “This is a flagship of how dementia care should be, they keep us informed” and “Since Mum’s been here we’ve had no concerns whatsoever. It’s more than a job for them; they put the care into caring”. When speaking with staff it was clear that they genuinely cared for the people they supported.

We saw people were able to have keys to their individual rooms. This promoted people’s privacy.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with. People’s preferences, interests, aspirations and diverse needs had usually been recorded although this was not always evident.

Is the service responsive? Many people who lived at Woodland had complex health needs and were either not able, or chose not, to join in group activities. The care records did not evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities.

At the time of the inspection there was enough staff on duty on each shift to meet the care needs of the people who used the service, but we could not see any documented evidence for how staffing levels were determined at the care home.

Is the service well-led? We saw minutes of regular meetings held with the staff. This showed management consulted with staff regularly to gain their views and experiences and improve support for people who lived at Woodland.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and of the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

Inspection carried out on 28 May 2013

During a routine inspection

We met with the, deputy manager, staff and people who used the service. We spoke with three people who told us they were happy at Woodland and that their care needs were met.

We saw that people who used the service were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We observed the lunch time meal and saw staff respected peoples' dignity when assisting them to eat.

During our inspection, we found people’s privacy, dignity and independence were respected. Where people were able to express their views and experiences, these were taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us training was provided, and also confirmed they had received supervision.

Care plans and associated documentation provided sufficient detail to direct and guide staff as to the actions necessary to take in order to meet people’s assessed care needs. People's records were personalised and provided clear information about the person’s wishes and abilities.

Inspection carried out on 21 November 2012

During a routine inspection

Some of the people who used the service were not able to comment in detail about the service they receive due to their healthcare needs. We spoke to one visitor who told us they were pleased their relative lived at Woodland. We spoke to another relative who felt communication between the home and relatives could be improved upon. We spoke to three people who used the service and they told us they were happy living at Woodland. One person said, “I like it here, the staff are kind”. We spent time observing people and staff. We saw people’s privacy and dignity was respected by staff. We saw people chatted with each other and with staff.

We spoke to a visiting community nurse who told us communication between the home and community nursing services was very good. She said “they (staff) know what they are doing”, “I wouldn’t mind living here myself”.

During our observations we saw staff helping people to mobilise. We saw staff assisting people to eat their lunch. We saw people talking to each other at lunch.

We witnessed staff interactions with people, which were generally positive.

We heard care workers ask people what they would like to do and gave them ideas if they could not make a choice.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Inspection carried out on 16, 22 February 2011

During a routine inspection

People, who were able, told us that they liked living at the home. They told us that staff were kind and looked after them well. One person told us ‘It’s lovely here, far better than I thought it would be’, another person told us that ‘The staff are good company’.

People were very complimentary about the quality and choices of food. They told us that they were asked what they liked and that a choice was always provided if they didn’t like what was on the menu.

Visitors told us that they were happy with the care their relatives received. They said that when they had concerns they could talk to the manager and that they were contacted if their relative needed the doctor or had a fall. They said the home had undergone changes in management which meant that things were being done differently.

Staff told us that they liked working at the home. One staff member told us, ‘This is a homely place; we say they are like our second family’. Staff appeared to have good relationships with people using the service and demonstrated knowledge of people’s choices and preferences.

Reports under our old system of regulation (including those from before CQC was created)