This inspection took place on the 5 and 6 November 2018. The inspection was unannounced. At the previous inspection in March 2018 the provider was in breach of Regulations 9, 12,13,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of that inspection we served a requirement notice in respect of breach of Regulation 9 and 13. We also served a warning notice in respect of the breach of Regulation 18 and imposed positive conditions in respect of breach of Regulations 12 and 17.

We carried out a focused inspection in June 2018. That inspection was to follow up on the warning notice we had served in relation to the breach of Regulation 18. We found the warning notice had been complied with and that progress had been made in meeting Regulation 12 and 17. However the service was not fully complaint with Regulation 12 and 17 and we continued to monitor that through the actions plans been submitted to us.

Following the last two inspections, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well- led to at least good. At this inspection we found improvements had been made to the caring domain. However, there were continued breaches of Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and improvements were still required to ensure the service was safe, effective, responsive and well-led.

Woodland Manor is ‘a care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Woodland Manor accommodates 64 people across four separate units. Two of the units specialise in providing care to people living with dementia. The other two units are described as nursing care units. At the time of the inspection there was 45 people living in the home. The home is purpose built, with all bedrooms having an en-suite shower, shared communal dining and sitting room facilities. It has a separate dining room for special occasions, a cafe bistro at the entrance to the home, a cinema and activity room which is accessible to people.

The service is required to have 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.’ The service had a manager who had applied to the Commission to be registered.

The majority of people and relatives spoken with felt the service had improved since the two previous inspections. This was because they had built positive relationships with staff, the staffing levels were better, team work was promoted and they reported staff seemed happier, communication between people, relatives and the service had improved and activities were more varied and appropriate to the needs of people.

The staffing levels had increased on some units. A host was consistently provided on the ground floor units to serve meals and take the pressure of serving meals away from the care staff. The service still had a high use of agency staff but requested regular agency staff to promote continuity of care. Permanent named staff were allocated to specific units which promoted better continuity of care to people. However, some people and staff felt the staffing levels were not maintained and gave examples where there was a delay in their care needs being met. The rotas and allocation sheets viewed showed the suggested staffing levels were not consistently maintained, but this had not been audited and addressed by the service.

Risks to people were identified but not alw

The inspection took place on the 5 and 6 June 2018. The inspection was unannounced. We undertook this focused inspection to check that improvements to meet the legal requirement of Regulation 18 – staffing planned by the provider after our comprehensive inspection in March 2018 had been made. The team inspected the service against three of the five questions we ask about services: Is the service safe, is the service effective and is the service well led. This report only covers our findings in relation to those domains and requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

The concerns and improvements required in the key questions responsive and caring are being reviewed through our ongoing monitoring so we did not inspect them at this inspection. However the ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Woodland Manor 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.

Woodland Manor accommodates 64 people across four separate units. Two of the units specialise in providing care to people living with dementia. The other two units are described as nursing care units. At the time of the inspection there was 46 people living in the home. The home is purpose built, with all bedrooms having an en -suite shower and shared communal dining and sitting room facilities. It has a separate dining room for special occasions, a cafe bistro at the entrance to the home, a cinema and activity room which is accessible to people.

The service is required to have 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. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. At this inspection the deputy manager was acting up to manager. The nominated individual confirmed during the inspection that the deputy manager would be taking on the manager’s role and would be applying to the Commission to be registered.

People and their relatives felt the home had improved since the previous inspection in March 2018.This was because staffing levels had increased across all the units and agency staff were used to cover gaps in the rota. The home had a high sickness rate and a high turnover of staff and the use of agency staff lead to inconsistent care for people. However people and their relatives recognised this was not something that could be solved instantly and were reassured that the on-going recruitment of staff was continuing. The provider had met the warning notice in relation to breach of Regulation 18- Staffing levels. This needs to be sustained and maintained and will be reviewed again at the next comprehensive inspection.

The acting manager had started to address the conflict within the team and the deployment of staff. They had reviewed the staff skill mix and allocated staff to the units they felt best suited their skills and experiences. Staff breaks were planned and staff felt communication within the team and staff morale was improving.

The service was more responsive to accident and incidents. They took action to address recurrent accidents and incidents. Staff were aware of risks to people however further improvements are requi

The inspection took place on the 6, 7 and 8 March 2018. The inspection was unannounced. At the previous inspection in January 2017 the service was in breach of regulation 12, 17 and 18 of the Health and Social Care Act 2008.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) safe, effective, responsive and well-led to at least good. At this inspection we found the provider was still in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008. There were further breaches identified in relation to regulations 9 and 13.

Woodland Manor 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.

Woodland Manor accommodates 64 people across four separate units. Two of the units specialise in providing care to people living with dementia. The other two units are described as nursing care units. At the time of the inspection there was 48 people living in the home. The home is purpose built, with all bedrooms having an en -suite shower and shared communal dining and sitting room facilities. It has a separate dining room for special occasions, a cafe bistro at the entrance to the home, a cinema and activity room which is accessible to people.

The service is required to have 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.’ At the time of the inspection the service had a registered manager. The registered manager had resigned and was due to leave the organisation later in the month. However they left two days after the inspection ended without giving the provider appropriate notice of an early departure date. A manager from another location was been inducted to take on the manager’s role until a new registered manager was recruited.

Some people were happy with their care, however the majority of people we spoke with were dissatisfied with their care which they contributed to the lack of sufficient staff. They gave examples where there was a delay in their needs being met. All of the relatives we spoke with were unhappy with the care provided. They felt the staffing levels were not safe or sufficient. They gave examples where their family members were not provided with appropriate supervision. Two relatives told us they visited at meal times to ensure they were available to support their family member with their meal. The provider told us for one of those people they will only eat their meal for their relative and the relative had made the decision to be present to support that.

Staffing levels were not sufficient. Throughout the three days of the inspection there was a delay in people getting their meals, medicines, appropriate supervision and support. Staff had completed some aspects of training however staff were not suitably skilled, trained and supported in their roles.

Risks to people were identified but there was no intervention to minimise risks. Accident and incident reports were completed but recurrent trends such as falls were not addressed. The provider told us falls were reported and actions put in place which included third party referrals to other relevant professionals. This was not always recorded or communicated appropriately. Staff were not aware of the risks people presented with and they failed to safeguard people who were at risk from pressure sores, malnutrition, falls and use of lap belts.

The delivery of high-quality care is not assured by the leadership, governance or culture in the service. People’

This inspection took place on 30 and 31 January 2017. It was an unannounced visit to the service. This meant the service did not know we were coming.

Woodland Manor is a care home with nursing which provides accommodation and personal care for up to sixty four people. At the time of our inspection there were thirty five people living in the home.

Woodland Manor is made up of four units each which accommodate 16 people. At the time of our visit three units were operational.

The home did not have 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. An interim manager was in post and providing management of the service. The nominated individual was looking to recruit a manager to become the registered manager of the service.

This inspection was a responsive comprehensive inspection and was carried out in response to information of concern we had received. This was the first inspection of the service since it had been registered with us in December 2015. Therefore we looked at all of the domains to enable us to provide a rating for the service.

People and their relatives were generally happy with the care and were complimentary of individual staff members. They described staff as “Compassionate, patient, kind, enthusiastic, genuinely caring, so amazing, professional, genuine and always helpful”. They told us the home had a happy welcoming atmosphere. However some people, relatives and staff told us the staffing levels were not always adequate. Two relatives told us it lead to inconsistent care for people.

At this inspection we found some people did not get the required level of staff supervision and support they required in a timely manner. People had risks assessments in place but not all areas of risk were identified. Risks were not reviewed and updated in response to changes in people’s conditions.

Some people’s medicines were not given as prescribed and medicine required for use in an emergency was not available.

Systems were in place to safeguard people and keep people safe. However the deficiencies identified in staffing, risk management and medicines did not always promote people’s safety. There was also a delay in recognising and reporting safeguarding incidents which meant systems in place to safeguard people were not followed. We have made a recommendation to improve those practices.

People had care plans in place. Some were detailed and specific, whilst others were contradictory and not updated as people’s needs changed. We have made a recommendation to address this.

Some people’s records were not suitably maintained and fit for purpose. This was because fluid and turning charts were incomplete, pressure damage assessments had conflicting scores and falls risks assessments were not updated to reflect increase in falls and management of the risk.

People were involved in making decisions on their care. The principles of the Mental Capacity Act 2005 were not followed for people who lacked mental capacity. This was because an MCA assessment was not carried out in respect of decisions on care and treatment. We have made a recommendation to address this.

People’s health and nutritional needs were met. The majority of people and relatives were happy with the meals provided. People had input from other health professionals to promote their health and well-being.

Staff completed inductions. The provider had in place training to enable the staff to be competent in their roles. Staff felt supported. Formal one to one meetings and team meetings with staff were being re-established. Daily stand up meetings had been introduced and monthly head of department meetings were scheduled to commence.

Staff were