The inspection took place on 13 and 16 February 2018 and was unannounced. The service had previously been inspected on 10 and 20 January 2017 and was in breach of the legal requirements in relation to safe care and treatment and governance. Following the last inspection, we met with the provider to confirm what they would do and by when, to improve each key question to at least good.

Alwoodleigh 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.

Alwoodleigh accommodates 40 people in one adapted building. There were 34 people living at the home during our inspection.

There was a manager in post who was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

At our previous inspection we found improvements were required in the assessment for some risks such as the use of assistive equipment and there was not always detailed guidance for staff to follow. At this inspection although some improvements had been made, further improvements were still required and the manager had implemented an action plan to address these issues.

Staff received an induction and training to ensure they had the skills to meet the needs of the people who lived there. Staff were supported to continually develop by on-going supervision and appraisal.

People were supported to eat their meals by care staff appropriately and sensitively and people told us how much they enjoyed their meals. People’s nutritional needs were met and they were encouraged to drink throughout the day. The dining experience in the main dining room was a pleasant experience although we have recommended the manager reviews the dining experience in the first floor unit.

Records showed people had regular access to healthcare professionals to help meet their wider health needs.

We found the home was well maintained, clean and tidy and people's bedrooms had been personalised. The décor was dementia friendly with pictures and signage which helped support people living with dementia to navigate their way around the home.

The home was compliant with the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations to the local authority. Decision specific capacity assessments were in place and the home kept a record of Lasting Power of Attorney.

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 practice.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. We observed staff to be kind and compassionate throughout our inspection.

Care provision was personalised and support plans were reviewed regularly to ensure they were relevant to the people who lived there. Families were invited to input into the reviews of their relative to ensure known preferences and views were incorporated into people’s care plans.

People enjoyed the different activities available and we observed activities taking place on the residential unit. Our observations during our inspection found there were limited activities taking place on the nursing unit.

Complaints were handled appropria

The inspection took place on 10 and 20 January 2017 and was unannounced. The service had previously been inspected in March 2016 and was found to be in breach of the Health and Social Care Act 2008 Regulations in relation to record keeping, safe care and treatment, consent and good governance. The overall rating for this service was ‘Inadequate’ and the service was placed in ‘Special measures’. This inspection was to check that improvements had been made and the service could sustain improvements.

Alwoodleigh is registered to provide nursing and personal care for up to 40 people. There were 34 people staying there at the time of our inspection. The home provides support for older people some of whom are living with dementia. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The nursing unit is based on the upper floor and the residential unit on the ground floor.

There was a manager in post on the day of our inspection who was in the process of registering with the Care Quality Commission. 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.

At our previous inspection we found there had not been enough staff to meet the needs of the people at the home. There was now a system in place for determining staffing levels and there were sufficient numbers of staff at the service on the days of inspection to meet the needs of the people at the home in a timely way.

All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents. They were confident their concerns would be acted upon.

The ordering, storing and administration of medicines was safe. Staff had had an annual medication management competency check and regular audits were undertaken. There was an issue with a person receiving their medicines without their knowledge hidden in a drink but this had been resolved by the second day of inspection.

We found personal emergency evacuation plans in place, although equipment people required was not included on this information. Standardised risk assessments were in place around pressure sores and nutrition and these were regularly reviewed. We found a lack of recorded information regarding assessments for assistive equipment and moving and handling care plans lacked the method and a description of the equipment to be used. This meant a safe system of work had not always been clearly recorded.

We found the environment to be clean and we observed good infection control practices in place. There was a programme in place for replacing carpets where malodours were present and could not be removed by carpet cleaning.

The registered provider supported staff to develop by offering mandatory training courses and enabling staff to undertake e-learning whilst on shift. Staff received supervision to help them develop into their roles and all new staff received an induction into the service and shadowing opportunities.

Staff had received training in assessing mental capacity or the Deprivation of Liberty Safeguards. However, we found decision specific capacity assessments had not always been undertaken and capacity assessments had not led to recorded best interest decisions, when a person had been assessed as lacking capacity. Staff were able to advise us how they would act in the person’s best interests whilst providing care. We found consent for care and treatment was recorded in some care plans but not in all the care plans we reviewed and decisions made on behalf of people who lacked capcity were not in line with the requirements of the Mental Capacity Act 2005.

People told u

The inspection took place on 30 March 2016 and was unannounced. The service had previously been inspected in February 2015 and was found to be in breach of the Health and Social Care Act 2008 Regulations in relation to record keeping and staffing. At this inspection we checked to see whether improvements had been made and sustained and found the service was still not meeting the regulations around record keeping and staffing. We also found the service was in breach of regulations around consent, person centred care and good governance.

Alwoodleigh is registered to provide nursing and personal care for up to 40 people. There were 33 people staying there at the time of our inspection. The home mainly provides support for older people some of whom are living with dementia. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The nursing unit is based on the upper floor and the residential unit on the ground floor.

There was a registered manager in post on the day of our inspection who had been registered since 2015. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

We found that the assessment of risk was inadequate. There were no personal emergency evacuation plans and missing risk assessments for identified risk. We found no moving and handling care plans in five out of the nine care plans we reviewed. This meant staff were moving and handling people without clear guidance and although we did not evidence any poor practice during our inspection, the service was not able to evidence it had complied with the legal requirements to ensure the safe moving and handling of people.

There was no robust system in place for determining staffing levels. The service had recently taken on a high number of people with end of life care needs, requiring intense support from staff. This meant staff were only able t

The inspection took place on 2 February 2015 and was unannounced. We also visited the home on 11 February and this visit was announced.

Alwoodleigh is registered to provide nursing and personal care for up to 40 people. The home mainly provides support for older people and for some people who are living with dementia. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The nursing unit is based on the upper floor and the residential unit on the ground floor. The service has a manager in place however, they are not yet registered with the Care Quality Commission. The manager had applied to the Care Quality Commission for registration and was awaiting the outcome of their application. 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 did not feel safe at the time of our inspection as a result of a person who displayed behaviour which challenged others. This person had been transferred to more suitable accommodation the day before our second inspection day. Staff and people who lived at the home told us that staffing levels were not always sufficient to meet the needs of the people in the home and people had to wait to be assisted at busy times. Staff we spoke with had a good understanding of safeguarding and knew what to do should they suspect any form of abuse occurring. Although we saw evidence that staff had not always followed the correct procedure for reporting abuse.

The home used safe systems when new staff were recruited. All new staff completed thorough training before working in the home and undertook a comprehensive induction.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The manager told us there were no people staying at Alwoodleigh during our inspection who were subject to a DoLS authorisation.

Feedback from people who lived at the home, was that staff were caring. Staff had developed positive, respectful relationships with people and were kind and caring in their approach. People were given choice in their daily routines although this was not detailed in their records. We saw many positive interactions between people in the home and staff. People’s nutritional needs were met and they received the health care support they required. People had a choice of meals, snacks and drinks which they told us they enjoyed.

Staff were able to tell us how they respected peoples’ privacy and dignity by closing doors, closing curtains and covering people with a towel when undertaking personal care.

We found there was little opportunity for people to be involved in any stimulating or meaningful activity and people told us they would like more activities. The registered provider had a system in place to deal with complaints, however, not all complaints had been recorded.

We found a number of examples where people’s care and support records were not always fully completed. We saw the registered provider completed a detailed quality monitoring report every month and undertook a thorough audit of the service provided. The manager had been in place for a short time but had a vision for the service to ensure that the people who lived at Alwoodleigh received the best possible care. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with the relatives of two people who lived at the home. One person's relative spoke to us about their frustration at having to wait for their relative to receive personal care, especially at lunchtime. They told us 'I'm happy with the care otherwise but it seems that at this time of the day the staff are really busy and I just wish they'd check on my relative first'. Another person's relative told us they were very happy with the care their relative received 'We were given the choice of five different rooms when we decided our relative was coming to live here'.

However, during our inspection we observed that some interactions between staff and people who lived at the home were not respectful. We saw one staff member telling two people they were 'toileting' them before they had their dinner. We saw one person being brought into the dining room in their wheelchair backwards with their feet on the floor asking 'Where am I going?'. During lunch being served we heard a staff member asking one person if they wanted the staff member to 'feed' them. We also saw a staff member telling a person they were putting a 'bib' on them whilst they ate their lunch. We saw another staff member who was handing out people's meals picking up the person's knife and fork and cut the person's food up without asking the person. This showed little regard for people's dignity and was not respectful.

We spoke to a number of people at this visit they included six people who use the services, three visiting relatives and one health care professional. People living at the home told us they were comfortable and felt safe in their surroundings. They all told us that the staff cared for them well, they were kind and they were able to talk to staff about any concerns or worries.