Woolston Mead

Woolston Mead is a residential care home providing personal care to up to 28 people. The service provides support to older people, a number of whom live with dementia. At the time of our inspection there were 24 people using the service.

People’s experience of using this service and what we found

Ongoing improvements were needed to ensure people who used the service had appropriate risk assessments and care plans which reflected their current care needs. A particular focus was needed on new admissions to Woolston Mead or following people’s return from hospital.

Governance systems were in place to monitor the safety of the environment as well as the quality of the care being delivered. Further work was needed to ensure all bedroom areas were maintained to a high standard of cleanliness and decoration.

The registered manager and provider was responsive to any improvements we identified and took immediate action to address any issues raised. There was a commitment to delivering high quality care.

People spoke positively about the care they received and were supported by staff who knew them well. Support was delivered in a caring and patient manner. People were comfortable in the presence of staff and positive relationships had developed. There were enough staff on duty to meet people’s needs and staff told us they felt well supported.

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

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 August 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The inspection was also prompted in part by notification of an incident. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls and providing a safe environment. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woolston Mead on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Woolston Mead is a residential care home providing accommodation and personal care to up to 28 people. The service provides support to older people aged under and over 65. At the time of our inspection there were 23 people living at the home.

People’s experience of using this service and what we found

People did not always receive their medicines safely and as prescribed. Some parts of the environment needed refurbishment, repair and/or redecoration. The registered manager confirmed immediate improvement works had been started following our inspection to address these environmental issues and a longer-term refurbishment plan was also in place.

The home had scored poorly in a recent audit carried out by the local infection prevention and control (IPC) team. However, the most recent IPC audit found improvements had been made. Longer-term refurbishment works were needed to make further progress in this area. During our inspection the home was clean and hygienic. Enhanced cleaning schedules in response to COVID-19 were in place. Staff followed the relevant guidance and best practice in relation to IPC and wore the required levels of PPE.

People and relatives explained they felt safe at the home. One relative said, “[Relative] is safe because the staff can calm her, they know what to do immediately. They are marvellous.” There were systems in place to effectively record and respond to accidents, incidents and safeguarding concerns.

There were enough staff at the home to meet people’s needs. Staffing levels were assessed and planned based on people’s dependency levels. People and relatives’ feedback about staffing levels at the home varied, some felt there were enough staff, but others felt there could be more staff. Staff were visible around the home and were available to assist people when needed. New staff were recruited safely.

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

Systems to assess, monitor and improve the quality and safety of service being provided were not always effective. Issues we found during this inspection had not been effectively identified or addressed.

The registered manager, along with other staff at the service, were open and responsive to feedback given during this inspection. They also demonstrated a clear commitment to driving the necessary improvements at the home. There was a kind and caring culture amongst staff at the service. Staff were knowledgeable about the people they were supporting and had a good rapport with them.

People and relatives told us staff at the home, including the registered manager, were approachable and communicated well with them. Comments included, “[Registered Manager] is very good and comes around and has a chat. I would speak with [Registered Manager] if I had any concerns or worries. I have no complaints” and “[Registered Manager] is approachable and always willing to have a chat. I get on well with all the staff and I know any of them would act if I said there was a problem.”

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

Rating at last inspection

The last rating for this service was good (published 10 April 2019).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

This focused inspection only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woolston Mead on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

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 was taken to make the information available to all staff.

At our last inspection in August 2017, the registered provider had been issued with an enforcement notice from the fire service and urgent work was required to be completed. Since then the registered provider has worked with the fire service and this work is nearing completion. Safety checks, including fire alarms, emergency lighting and water temperatures were completed each week. Personal emergency evacuation plans (PEEPs) were completed for the people living in the home to help ensure effective evacuation of the home in case of an emergency.

The registered manager had instigated a programme of quality assurance checks, audits and procedures since our last inspection which were used to improve the quality of care provided.

There was a sufficient number of suitably trained and qualified staff on duty to meet the needs of the people who lived at the home. The staff presented as caring, kind and knowledgeable about people’s needs.

Safeguarding systems processes and practices helped staff to understand how to protect people from abuse, neglect, harassment and breaches of their dignity and respect. Risk assessments were undertaken to support people safely and in accordance with their individual needs. They were updated each month to reflect any changes in people's needs monthly to ensure they received the appropriate care and support.

The home was odour free, clean and there were provisions for hand sanitizer on the walls. Personal protective equipment (PPE) such as aprons and gloves were available and used when supporting people with personal care and administering medication.

At our last inspection in August 2017, we found that people did not have sufficient choice regarding meals and a varied diet was not provided. At this inspection improvements had been made and people enjoyed a varied diet that met their needs and preferences. Staff were monitoring people’s dietary intake and weight. People’s food allergies and intolerances, likes/dislikes and requirements were recorded.

Care staff respected and promoted people’s privacy, dignity and independence. They were caring and compassionate in their approach and encouraged people to express their views. People were actively involved in making decisions about their care and support. Managers and staff acted in accordance with the Mental Capacity Act and ensured that people received the right kind of assistance to support them in making decisions.

Healthcare professionals were involved in people's care.

People living in the home and relatives were able to share their views and were able to provide feedback about the service. People’s concerns and complaints were listened to respond to.

Staff were aware of the need to support people approaching the end of their life and care planning arrangements were person centred to ensure their wishes and needs were respected.

Urgent conditions imposed upon the registered provider's registration had been met; the registered provider and registered manager had completed training relating to governance.

The home was well managed by the registered manager and staff were well supported.

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.

At the last inspection we found that people were not routinely offered a choice of meals. At this inspection we found whilst the menus had been changed to offer an alternative meal, for their main meal the alternative offered was always a jacket potato. This meant that some people did not receive a balanced meal to meet their dietary preferences. The breach had not been met.

At the last inspection we found that any repairs that were discovered were not always attended to in a timely way. Despite the absence of a maintenance person the provider now had a system in place to help ensure repairs were completed until the post was filled. The breach was now met.

At the last inspection we found that people's personal records were not stored securely. The medicine and care records for people were now stored in locked cabinets to ensure the contents remained private. The breach was now met.

On this inspection we found that medicines were not always managed safely in the home. We found errors had occurred when administering medication to some people, which meant they did not receive the correct dose prescribed by their GP. Records could not be found to demonstrate staff had applied barrier creams and antibiotic creams regularly.

We found the premises were not checked regularly to ensure they were safe. Checks of fire alarms, emergency lights and window restrictors were not completed. The fire service had visited in July 2017 and issued an enforcement notice requiring urgent repairs and actions were undertaken to ensure the building was safe and equipment and procedures were in place to evacuate people in an emergency.

There were enough staff on duty to provide care and support to people living in the home. 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 were trained to ensure that they had the appropriate skills and knowledge to meet people’s needs. They were well supported by the registered manager.

Staff were received support to undertake their roles effectively. They received regular training, supervision and appraisal. Staff meetings took place regularly.

The home was clean and tidy with no odours. Staff wore protective clothing (aprons and gloves) whist they worked. We observed staff use sanitising gel. Disposable aprons and gloves plus hand sanitisers were available on all floors for staff to use.

Equipment was in place in the bathrooms to assist people with bathing.

Staff sought the consent of people before providing care and support. The home followed the principles of the Mental Capacity Act (2005) for people who lacked mental capacity to make their own decisions.

People had access to a range of health care professionals to maintain their health and wellbeing.

We observed positive interaction between the staff and people they supported. People at the home had their views taken into account when deciding how to spend their day.

Care plans were completed which provided information to inform staff about people's support needs, routines and preferences. Risk assessments had been undertaken to support people safely and in accordance with their individual needs. However we found risk assessments for two people had not identified their recent weight loss.

A limited programme of activities was available for people living at the home to participate in. People told us they were bored. People were supported to access the community for pre-arranged visits.

People living in the home and relatives were able to share their views and were able to provide feedback about the service in monthly ‘residents and relatives’ meetings.

People knew how to raise a concern or make a complaint. A process for managing complaints was in place. No complaints had been received.

Systems and processes were in place to assess, monitor and improve the safety and quality of the service. However some checks completed by the senior staff and registered manager were not robust to find the issues we found during the inspection. The audit completed by the provider each month failed to address the issues relating to medication addressed by the CCG in their audit to ensure changes were implemented. The lack of fire safety checks was not addressed to ensure the work was carried out to ensure the safety of people living in the home. The provider had failed to notify CQC of a recent fire safety Enforcement notice that had been issued despite having the opportunity to do so.

The service had a registered manager. Feedback from people, relatives about the manager and staff was complimentary.

The overall rating for this provider is 'Inadequate'. This means that it remains in 'Special measures' by CQC. 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.

The concerns we identified are being followed up and we will report on any action when it is complete.

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 lacked mental capacity to make their own decisions.

Staff had a good understanding of people’s care needs including people’s individual preferences which were respected by staff. Care plans provided information to inform staff about people's support needs Preferences and people’s care needs were documented briefly in the care plans.

People living at the home told us they were listened to and their views were taken into account when deciding how to spend their day. They were able to provide feedback about activities through one to one discussions with the activities coordinator. We viewed questionnaires which had been given to everyone in the care home in order to seek their views in 2016. The feedback obtained by a small number of people who completed the questionnaire was positive.

People told us staff were kind, polite and maintained their privacy and dignity. We observed positive interaction between the staff and people they were supporting. However, people’s privacy was sometimes compromised as confidential documentation was not always stored securely

A programme of activities was available for people living at the home to participate in.

A process for recording, investigating and responding to complaints was in place.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. 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 will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the provider's registration.

' 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.

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 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.