This inspection was carried out on 4 February 2019 and was unannounced. At the last inspection in May 2017, the provider was not meeting the standards we inspected and were rated as requires improvement. This was because they had failed to take the action they assured us they would in relation to people’s safety and welfare. At this inspection we found that they had made improvements in some areas however, they were not complying with all regulations and meeting fundamental standards. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

Woodlands Care and Nursing Home 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.

Woodlands Care and Nursing Home provides accommodation for up to 50 older people, this included people with nursing care needs and some people living with dementia. At the time of the inspection there were 27 people living there.

The service did not have a registered manager. The previous registered manager was no longer working in the service; however their name remains on this report until they are de-registered. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The provider had appointed a new manager who was planning to apply to the Commission for registration.

The provider’s quality assurance systems had not been effective in learning lessons and ensuring timely improvements were made within the service. People’s care was not always fully assessed and not all their needs were responded to, including how risks were managed. People’s care records did not always reflect how they needed to be supported. People felt there were sufficient staff available to provide their care and support, however the staffing arrangements did not allow for staff to be involved with meaningful activities with people.

Medicines were not managed safely. Safe systems were not in place to ensure medicines were suitably administered and stored. Infection control practices were adhered to by most staff, but we observed people did not have an opportunity to wash their hands before meals and people did not use individual slings when being supported to move. Staff had received training to develop and maintain their skills and knowledge; however, we found this had not always enabled them to provide care under best practice guidelines.

People felt that the staff were kind and caring. However, dignity was not always promoted in relation to personal care and ensuring people received the care they needed to be safe and well.

People enjoyed a variety of food and drink. Improvements had been made with how this was monitored. People were supported by staff who were recruited safely.

Where people had provided information about how they would like to be cared for at the end of their life, this was recorded. Staff felt they supported people at the end of their life with compassion and care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People made decisions about their care and staff helped them to understand the information they needed to make any decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where peopl

Woodlands Care and Nursing Home is registered to provide personal care for up to 50 adults, which may include some people living with dementia. This inspection was unannounced and took place on November and 12 December 2016. At the time of our inspection there were 43 people living there.

There was a registered manager at this service. 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 last inspection in February 2015 the provider was in breach of Regulation 12 Safe care and treatment. At this inspection we found they had met this breach. However this took the intervention of a senior manager from the provider to recognise and meet this breach.

During our inspection visit we observed that staff were friendly and approachable. However they did not spend time with people other than to meet their basic needs. At times staff walked through the communal areas without speaking or acknowledging people.

People’s physical and mental health was promoted. Some staff were trained to care for people living with dementia. Medicines were stored appropriately and were administered and recorded as prescribed. However the process of administering medicines took too long and this delay could impact on time sensitive medicines.

There was a process in the service to ensure the Mental Capacity Act and the Deprivation of Liberty was used to protect people. However we found that the registered manager did not fully understand this and made some unnecessary referrals to the Local Authority.

We saw staff ensured people were comfortable. However people’s dignity was not always promoted when they were been assisted to move using a hoist. Some people’s clothing had risen up and this left them in an undignified position they could not control themselves.

People were offered choices at meal times and were seen to enjoy their food. Although some people who struggled with eating they were not offered support. When people were offered a snack staff made the choice for them rather than taking time and allowing people the choice. There were two dining rooms and there was a marked difference between both. In one the dining experience was promoted and the other lunch was served in a haphazard manner.

Most staff were caring and communicated well with people, however some staff focused on the task they were carrying out rather than on people. Some staff spoke over people’s heads. Most staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes.

Staff understood how to keep people safe, however if they had concerns they were not always aware of who to contact outside the service to address this. Assisting people to move using a hoist was not always carried out in a safe manner as people did not have individual slings bases on their weight and size. This put them at risk of an accident or injury as the sling needs to fit people correctly to keep them safe.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time.

Records we looked at were not always easy to follow and although they contained good information they were not always personalised. They did not always included decisions people had made about their care including their likes, dislikes and personal preferences.

Staff were well supported and had regular meeting with their line manager to ensure they had the training and information to care for people.

The service was not always well managed. The management of the service lacked structure. The registered manager was not always able to recognise areas of the service that required input to ensure good outcomes for people and staff.

This inspection took place on 18 February 2015 and was unannounced.

Woodlands Care and Nursing Home provides nursing and personal care for up to 50 older adults, including some people living with dementia. At our visit, 45 people were living in the home and 23 of them were receiving nursing care. There is a registered manager at this service. 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 last inspection of this service in February 2014, we found that the provider did not have appropriate arrangements for cleanliness and hygiene. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds with Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider told us about the action they were taking to address this and at this inspection we found that not all of the required improvement had been made.

At this inspection, the provider’s arrangements for the prevention and control of infection and the cleanliness and hygiene of the premises, did not fully protect people from the risks of cross contamination. This was because not all areas of the home were being kept clean and hygienic. Staff, were not provided with all of the information they needed and recognised guidance was not being followed for the prevention and control of infection at the service.

Staff had received training about and they were aware of the key principles of the Mental Capacity Act 2005 (MCA). However, staff did not always follow the principles of the MCA when required. The MCA is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves to their care, or make specific decisions about this. Some improvements were being made by the provider to address this. We have made a recommendation about further training for staff on The Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards based on current best practice.

People felt safe in the home and both they and their relatives and staff were confident and knew how to raise any concerns they may have about people’s care. The provider’s arrangements helped to protect people from the risk of harm and abuse. People received safe care and treatment and their medicines were safely managed.

Overall, people were supported to maintain and improve their health and staff understood people’s health needs. People and their relatives were generally satisfied with the care and food provided and people’s health needs were being met. This was done in consultation with external health professionals and their instructions were followed for people’s care when required. However, a few people’s treatment records did not always fully account for, or meet with recognised guidance associated with their wound care needs. This increased the risk of people receiving ineffective care and treatment.

Staff recruitment arrangements were robust and overall staff training, supervision and deployment arrangements were sufficient to meet people’s needs.

Staff understood the provider’s aims and values for people’s care, which focused on promoting people’s rights, but they did not always put them into practice. Improvements were being made to promote people’s dignity when they received their care.

Staff supported people’s known daily living preferences, choices and routines and often took time to engage socially with people. Staff supported people at their own pace when they provided care, which helped to promote their independence. People and their relatives were confident and knew how to raise any concern or complaints they may have about the care provided. They were also appropriately informed and involved in agreeing people’s care before their admission to the home. This helped to make sure that people received personalised care that met with their needs, wishes and lifestyle preferences. However, some people felt they had not been fully involved in their care plans since their admission to the home and they were not provided with any information about relevant advocacy services that may assist them to do this.

The provider’s checks of the quality and safety of people’s care and their environment were not always effective. They did not always identify whether their arrangements were sufficient to protect people from the risks of receiving unsafe, ineffective care or inappropriate care and treatment. The provider had not always sent us written notifications about important events that happen in the service when required, until we asked them to.

People, relatives and staff were generally positive about the management of the home. However, the provider’s arrangements for seeking people’s views about the service were not consistently or proactively communicated or used to develop the service. Staff understood their roles and responsibilities for people’s care and received the information and support they needed to report any changes or concerns about people’s safety or health needs.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was unannounced which meant the provider did not know we were going to visit. Prior to our inspection we were made aware of a complaint about the service, this was being looked into under the local authorities safeguarding and protection procedures. The registered manager was aware of the concerns.

During the inspection we observed and spoke with people who used the service, a relative and staff. One person we spoke with told us, "I'm having a good time". Another said, "The food is lovely here and the staff are really nice". We found most people received the support, care and treatment they needed.

People who used the service received a sufficient and nutritious diet, and where they needed support they were provided with appropriate assistance. We observed people make choices about food and drink, and we saw that staff were responsive to people’s requests.

We saw that medication prescribed for people who used the service was securely stored and safely administered. People were protected from the risks associated with medicines because effective systems were in place to manage medicines at the home.

We noted that improvements in some areas of the home were required to ensure people's exposure to the risks associated with cross infection were not compromised. Poor levels of maintenance meant some areas of the service were not clean.

There were 45 people living in the home at the time of this review. We spoke with four

people to gain their views of the service. Many people in the home had limited

communication abilities and so we could not interview them to find out their views.

However, we were able to observe their mood and behaviour and how they interacted with staff. We also spoke with three relatives of people in the home.

People told us they were involved in making decisions about their care, treatment and daily routines.

We saw positive interaction between people in the home and staff. We observed that staff showed care and concern for people and treated them with respect.

People and relatives told us they were happy with the care provided. One person said "they treat me well". A relative said "I know they look after her properly, they understand her".