Woodlands Manor

We found the following examples of good practice:

• Staff donned, doffed and disposed of personal protective equipment (PPE) safely and in line with the relevant national guidance.

• Staff and people living at the home accessed regular COVID-19 testing and appropriate action was taken upon receipt of any positive test results.

• Staff had supported people to keep in touch with their loved ones, such as via telephone, video calls, window visits and outdoor visits when possible. Relatives had also been supported to safely visit people in the home in exceptional circumstances, such as when a person was approaching the end of their life.

• The home was clean and hygienic. A team of domestic staff and carers carried out frequent cleaning around the home throughout the day and night.

• Staff had engaged positively with other relevant professionals for further support, such as the local infection prevention and control team. Any advice provided had been promptly acted upon.

Further information is in the detailed findings below.

People’s experience of using this service: People we spoke with felt safe living at the home. Risks to people’s health and well being were assessed and there were measures in place to help reduce these risks. People’s medication was also being stored and administered safely, by staff who had been trained to do this. There was a process in placed to analyse incidents and accidents for patterns and trends. The home was clean and well maintained, and staff were recruited and selected safely after checks had been made on their character and suitability to work.

People were provided with good care by staff who were trained to do so. Staff were supported by their line manager to engage in regular supervision and had an annual appraisal. Staff supported people with their eating and drinking needs and the environment was adapted to support those living with dementia. People were supported in line with the principles of the Mental Capacity Act 2005. People who had restrictions on their liberty had appropriate DoLs referrals in place which were regularly reviewed.

Staff were kind and caring. People told us they liked the staff and we spent most of our time during the inspection sitting with people who lived at the home and talking to them and the staff. We observed positive familiar conversations taking place, and saw that staff clearly had good relationships with people who lived at the home.

Staff asked people for consent before providing care. People’s care plans also reflected how they wanted their routines to be carried out and what was important to them. We saw staff prepare drinks for people in a specific way, and observed staff helping people to mobilise. We sat with people while they engaged in an activity and everyone was observed to be enjoying themselves. Complaints were investigated in line with policy and procedure. The home was accredited with the Gold Standards Framework which they were exceptionally proud of.

There was a registered manager in post who had been at the home for a long time. There was a care manager who assumed the day to day operational running of the home, and people said they knew them well. The registered manager was aware of what to report to the Care Quality Commission CQC by law. The registered manager, registered provider and quality assurance team undertook audits which took place at certain times in the year. Audits were effective for highlighting and correcting any issues with service provision.

Rating at last inspection: Last rated ‘Good’. Report published July 2016.

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. 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

Situated in a quiet residential area on the outskirts of Southport and close to local amenities and public transport, Woodlands Manor is a residential care home providing accommodation for up to 27 people with dementia care needs. The service provides upper and ground floor accommodation, some with en-suite facilities. There is a passenger lift which gives access to each floor. The home has a large garden to the rear of the building and small car parking area at the front.

A registered manager was 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.

People told us they felt safe living at the home.

There was a safeguarding adult’s policy and procedure in place, which had been reviewed recently. All of the staff we spoke with could recognise the signs of abuse.

There were risk assessments in place. People who were at risk of falls or malnutrition had additional risk assessments completed which explained what support that person needed and highlighted the impact of the risk the person could be exposed to.

Staff records viewed demonstrated the registered manager had robust systems in place to ensure the staff recruited were suitable to work with vulnerable people.

There were safe practices and procedures with regards to the administration and storing of medication.

Procedures were in place for responding to emergencies and in the event of a fire.

The environment was clutter free and well-presented and it contained objects of reference and memorabilia for people to pick up and move if they chose to.

The staff and the people who lived at the home told us staffing levels were good, and we observed staff at various intervals throughout the day undertaking their roles without being rushed or pressured.

The registered manager and the staff had knowledge of the Mental Capacity Act (2005) and their roles and responsibilities linked to this.

Staff had regular supervision and appraisal. The induction process for the home was in line with The Care Certificate.

Staff told us and records showed, that all staff had undertaken their training required by the provider to enable them to do their job effectively.

People’s care records informed us they had regular input from professionals if they needed it, including the dentist, optician, chiropodist and GP.

The mealtime we observed was not rushed, and the food looked appetising. There were menus, and we could see people were given a choice of what they ate.

People were complimentary about the staff and we saw that they were caring in their approach.

The home was working towards an accredited qualification in end of life care.

People were involved in their care plans, and information was stored securely.

There was a complaints procedure in place. People and relatives that we spoke with confirmed they knew how to complain. We saw evidence of complaints being addressed and followed up in line with the home’s policy.

There were lots of activities at the home. In addition to this, outside support groups visited the home to give people and their families the option to be involved in new projects. We saw evidence of this during our inspection.

Care plans were person centred and reflected people’s current needs as well as their preferences. There was information around peoples likes, dislikes and religion recorded. People were being supported to vote in the EU referendum at the time of our inspection.

People and relatives were complimentary about the registered manager and other senior staff.

Staff were aware of the home’s whistleblowing policy and told us they would not hesitate to report any concerns or bad practice.

Systems were in place to monitor the standard of the service and drive forward improvements. This included a number of audits for different areas of practice, and clear and transparent action plans when areas of improvement were identified by the audit process.

' 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?

The people we spoke with told us staff were caring and treated them with kindness and respect.

The home was clean, hygienic and odour free. Measures were in place to ensure the environment was safe and suitable for the people who were living there.

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

A range of audits and checks were established to monitor the safety of the service provided. These included weekly medication audits and a monthly check of the care records.

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. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The manager and senior care staff had attended DoLS training.

Is the service effective?

It was not always possible to get the views of people who lived at the home due to their frailty and level of confusion. We spoke with four relatives who told us they were happy with the support their family member received from the staff.

People's health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People's care plans reflected their current needs.

Where specialist support was needed, for example, with a person's nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people's health, well-being and independence.

Is the service caring?

The people we spoke with told us the staff were kind and helpful. People's comments included, 'The staff look after my relative well', 'My relative looks well cared for. The family are very happy with the service' and 'My relative is well cared for. The staff are excellent. They can't do enough for them.'

Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. Care and support was given when people requested and needed it. The staff ensured people's comfort and dignity at all times.

Staff had a good knowledge about people's care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirement.

People who lived at the home and their relatives had the opportunity to participate in regular satisfaction surveys.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, and needs had been recorded and care and support had been provided in accordance with people's wishes.

From our discussions with staff and looking at a number of care records we could see that people's plan of care was revised to meet any change in need: for example, deterioration in a person's medical condition. Care documents showed medical intervention had been sought at the appropriate time.

People knew how to make a complaint or raise a concern if they were dissatisfied with something. The complaints procedure was usually displayed in the reception area. The policy had recently been updated and a copy had not yet been put back for people to see.

From our discussions with staff and looking at a number of care records we could see that people's plan of care was revised to meet any change in need: for example, deterioration in a person's medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Staff ensured people had a choice of menu and when they requested something different this was provided.

Is the service well-led?

The home had a Registered Manager in place at the time of our inspection.

People had to opportunity to provide feedback about the home by completing an annual questionnaire.

The home had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

Staff we spoke with said they received good quality training. We saw that staff received supervision every four to six months and an appraisal each year.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

On arrival at the home, we were shown around by the assistant manager. We saw that all bedrooms, bathrooms and living areas were well kept, clean and tidy.

The areas of care we had asked the provider to make improvements in, now met the required standards. We found people and their families were included in decisions about how their care could be delivered to meet individual needs. We found care plans were signed which indicated people agreed with the way in which their care was provided. We found policies and procedures, particularly on gaining consent and any decisions made in a person's best interest, were up to date and that staff had access to these. The complaint policy of the home had been reviewed and updated. The information about how to make a complaint was accessible and a copy of this was displayed on the main notice board in the home.

During our time at the home, we saw that people were able to take part in activities if they wished to do so. We were able to talk to one person who lived in the home, who told us staff "were kind and helpful."

We saw that staff knew the people using the service. They had read service users' care plans and interacted with people patiently and cheerfully.

We did not see evidence of appropriate actions where people had been assessed as lacking capacity to consent and most of the staff that we spoke to when we visited did not understand capacity to consent or deprivation of liberty standards.

We looked at staffing rotas for different days of the week at random dates for the last three months to see that staff numbers were consistent and we reviewed the training records for all staff. We talked to staff about complaints, comments and suggestions made by people and how they were responded to and we saw records of these.

The manager of the home was on leave on the day that we visited but we later talked by telephone with her.