At the last inspection on 9 February 2016 we found some improvements had been made to the service and the registered provider had achieved compliance with four breaches. However, we found continued breaches in three regulations: Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. Following that inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan and to confirm that they now met all of the legal requirements. At this inspection on 28 February 2017 we found sufficient improvements had been made and the service had achieved compliance for Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

Woodland view is a care home providing accommodation for older people who require nursing and personal care. It accommodates people who have a diagnosis of complex and enhanced dementia. Since the last inspection the registered provider had closed one of the units known as ‘cottages’ and reduced the number of people the service can accommodate to 45 people. At the time of the inspection there were 44 people living at the service. There are three units at the service called, Willow, Oak and Beech.

The service did not have a registered manager in post at the time of the inspection. One of the senior operational managers was applying to become the 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.

People we spoke with told us they felt ‘safe’ and had no worries or concerns. Relatives we spoke with felt their family member was in a safe place.

At the last inspection in February 2016, we found issues relating to the management of medicines. At this inspection we found the service made sufficient improvements to ensure medicines were managed safely at the service.

Staff recruitment procedures ensured people’s safety was promoted.

Staff had undertaken safeguarding training and were knowledgeable about their roles and responsibilities in keeping people safe from harm.

We found there were satisfactory arrangements in place for people who had monies managed by the service.

People we spoke with made positive comments about the quality of care they had received. Relatives we spoke with were very satisfied with the quality of care their family member had received.

We did not receive any concerns from relatives or people living at the service regarding the staffing levels at the service. Our observations during the inspection told us people’s needs were being met in a timely manner by staff.

People had individual risk assessments in place so that staff could identify and manage any risks appropriately. Care plans were detailed and person centred. Care plans were reviewed regularly and changed to reflect current needs. Care staff spoken with were able to tell us how they supported people who may have behaviour that could challenge others.

The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

There was evidence of involvement from other health care professionals where required and staff made referrals to ensure people’s health needs were met.

We saw the service promoted people’s wellbeing by taking account of their needs including activities within the service and in the community.

Staff had underta

This inspection took place on 9 February 2016 and was unannounced. The home was previously inspected on 28 and 29 October 2014 when we found seven breaches of regulations. These included failing to ensure people received care that was appropriate and safe, and not having suitable arrangements in place for obtaining, and acting in accordance with, the consent of people who used the service. We found that suitable arrangements were not in place to ensure choice and support, where necessary to enable people to eat and drink sufficient amounts for their needs. There were not suitable arrangements in place to ensure that people’s dignity and independence were maintained .People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the safe administration and recording of medicines. The provider did not have suitable systems in place to ensure there were sufficient numbers of suitably qualified, skilled and experienced persons employed. The systems to monitor the quality of the service were ineffective.

Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan and to confirm that they now met all of the legal requirements.

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

Woodland view is a care home providing accommodation for older people who require nursing and personal care. It accommodates people who have a diagnosis of complex and enhanced dementia. It can accommodate up to 60 people in four units known as ‘cottages’. The cottages are called, Oak. Willow, Chestnut and Beech. The service is situated in Norton near Sheffield.

The home had 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 this inspection we found improvements had been made and the provider had achieved compliance with four breaches. However, we found continued breaches in three regulations: Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

Care and treatment was not always person centred and was not always provided in an appropriate way to meet people’s needs who were living with dementia.

People were not protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines, but we found these were not always followed.

We found there were systems in place to monitor and improve the quality of the service. However, these were not always effective.

We found that people had care and support plans in place these were regularly reviewed and updated. They identified people’s needs and were updated when needs had changed. There were also risk assessments in place.

A well balanced diet that met people’s nutritional needs was provided. People’s weight was monitored and appropriate tools were in place to ensure people received adequate nutrition. Although there was room to improve people’s mealtime experience, so that it was more person centred and less task orientated.

We saw there were robust recruitment procedures in place; most staff had received formal supervision. Qualified nursing staff had also received some clinical supervisions, although they told us they would like more frequent supervision of their practice. Annual appraisals had either taken place, or had been scheduled to take place in the next few months. These ensured devel

We found people who used the service and their relatives were able to influence and be involved in aspects of their care and welfare.

We used periods of observation to see how members of staff interacted with people who used the service. We saw that staff treated people with respect and were able to anticipate their needs. We talked with four relatives who told us they thought their family members were well cared for, happy with the care given, liked the majority of staff who looked after their family member and thought the home was kept clean. Some comments captured included, “I can tell they [staff] really care about people”, “staff are wonderful”, and “this (the home) is the best!”

We found processes were in place to safeguard people from the risks of abuse.

We found staff were adequately supported because they received regular training sessions, supervision and an annual appraisal.

We found there were effective systems to regularly assess and monitor the quality of service that people receive.

This unannounced inspection took place on 27 and 28 October 2014. Woodland View provides accommodation and nursing care for up to 60 people who are living with dementia and have complex needs. The home is level access and consists of four individual ‘cottages’ linked by corridors.

We last inspected this service in July 2013 and found that it was meeting the requirements of the regulations we inspected at that time.

During our visit we spoke directly with four people who lived at Woodland View and with three relatives. We also spoke with three nurses, seven support workers, two clinical educators, an activities coordinator, a member of the housekeeping staff, the site operational manager, the overall operations manager and the 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.

Our inspection identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People’s safety was being compromised in a number of areas. This included how people were monitored and how they sought assistance when in their bedrooms. We also found that medicines were not safely recorded and monitored. Whilst the registered manager had reassessed the number of staff needed to meet people’s needs and was in the process of recruiting to these positions, our review of records identified that staffing levels were frequently below those assessed as required.

Our review of accident and incident records did not provide an accurate record of the concerns observed during our inspection. Similarly, we found gaps within people’s care plans which meant that people may not be protected against the risks of unsafe or inappropriate care and treatment. Care plans contained detailed risk assessments about people’s behaviour, however, risk assessment for other areas of care were less detailed or absent.

Most staff had received safeguarding training and were aware of the possible indicators of abuse and how to report these. Appropriate systems were in place to safeguard and manage people‘s finances. An effective recruitment process was in place.

Whilst there were sufficient staff to support people to eat, we found that the overall meal time experience was not positive and was at times unsafe. Overall, the support observed was task centred with little or no interaction between people and the staff supporting them.

Staff were not always following the Mental Capacity Act (MCA) 2005 for people who lacked capacity to make particular decisions. For example, staff demonstrated varied degrees of knowledge and records provided evidence that the staff were not always making decisions in line with the MCA Code of Practice.

Woodland View had submitted Mental Capacity Act Deprivation of Liberty Safeguards applications for each person living at the home. The safeguards are part of the MCA and aim to ensure that people are looked after in a way which does not inappropriately restrict their freedom.

Staff received supervisions less frequently than the provider’s 6-8 weekly timescale but were not concerned by this. They said that senior members of staff were approachable and felt able to go to them should they need any support or guidance. Staff received a variety of mandatory and other training courses and plans were in place to address any training shortfalls.

Woodland View was in the process of a programme of re-decoration and improvement to make the environment more dementia friendly. Specialist architects had been involved and people, their relatives and staff had been involved in choosing the new décor. Dementia friendly signs to orientate people and pictures to prompt memories and conversations had been ordered.

Whilst relatives were positive about the way in which people were cared for, our observations did not always correspond with these views. We observed some positive and caring interaction but overall found that care was task centred with little interaction with people and few examples of people being offered choice. ‘This is Me', books were in place for some people to provide staff with information about people, their preferences and the things which were important to them. We saw little evidence of this information being used. For example, two staff did not know the surnames of the people they were supporting and the records for one person did not reflect their preferred name.

We observed some good practice about end of life care and the plans the registered manager had to further develop staff practice and support relatives.

Activity coordinators were in place; however, we saw few activities or opportunities to engage people who were less active and found that interactions and engagement were often prompted by people and not members of staff.

We identified a number of shortfalls in various aspects of the service and asked about how the provider monitored the quality of the care provided. We were told that the operations manager conducted audits of the service and requested copies of these. Copies of these audits were requested during and following our inspection but were not provided. The provider later forwarded some documents relating to monitoring the quality of the service. A comprehensive process to monitor the quality of care was not in place.

The registered manager had been in place since November 2013. We received mixed reactions from staff about management and leadership within the service. The registered manager had clear goals for the service and had made a number of changes since being in post. He was aware that some staff were resistant to the changes and plans for the home and had introduced a weekly ‘open door’ session to enable him to address any concerns directly with staff.