This inspection took place on 3 July 2018 and was unannounced. A second, announced, day of inspection took place on 5 July 2018. At the last inspection in May 2017 Woodlands was rated requires improvement and recommendations were made in relation to medicine care plans, the disposal of medicines and food and fluid monitoring. The location has a history of non-compliance with regulations. This was the locations fifth inspection since July 2015 and concerns had been found at each inspection resulting in an overall rating of requires improvement. Following an inspection in February 2017 the location had been rated inadequate.

During this inspection we found some improvements however there were some ongoing concerns identified in relation care records and risk assessments, fire safety, staff training and governance and quality assurance.

Woodlands 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 can accommodate 42 people in one adapted building across two floors. At the time of the inspection 19 people were living at the home, some of whom were living with a dementia.

The service did not have a registered manager. The current manager had been in post since February 2018 and had not yet made an application to register with the Commission. They had applied for their Disclosure and Barring Service (DBS) check to be completed. 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.

We found there were ongoing concerns in relation to medicine care plans and protocols for the administration of 'when required' medicines. Whilst the manager was working on developing these care plans this was an ongoing concern since the last inspection. Staff administered medicines safely and knew how people liked their medicines to be administered however this was not always recorded.

Some risk assessments were in place however, we found that if people were at risk of choking or presented with behaviour that staff found challenging, the risks had not always been assessed. Some care plans had not been kept up to date following a change in the person's needs and some lacked the level of detail needed to ensure care and support was personalised and met the person's individual preferences.

We discussed some concerns with the fire service, who were completing a visit during the inspection. The fire alarm panel did not meet the required standard which meant there may be a delay in identifying the location of the fire. Some staff did not fully understand the fire evacuation procedure, they had not been trained in the use of evacuation equipment and some fire doors did not fully close.

We have made a recommendation with regards to environmental improvements to ensure it meets the needs of the people living at Woodlands.

Governance procedures were in place and quality assurance audits had been completed however, there was no robust action plan in place for the accountability and monitoring of the required improvements. There were complexities in relation to level of authority the management agency had with regards to approving some improvements and this had led to a level of frustration for the manager and the regional manager.

Staff understood safeguarding and whistle-blowing procedures. Safeguarding concerns and complaints had been fully investigated and the appropriate authorities had been notified of any concerns and the actions taken to minimise the risk of reoccurrence.

Staff training had not been provided which meant staff, including the management team and the ancill

The unannounced inspection took place on 22 and 24 May 2017. The previous inspection undertaken in November and December 2016 found the service inadequate overall with breaches in Regulations 9, 10, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in connection with people not receiving person centred care and not being supported in a respectful and dignified way. Medicines were not safely managed and moving and handling procedures were not carried out appropriately. Risks to people’s health were not managed safely and people did not always have prompt access to medical attention. Safeguarding concerns were not always reported for investigation and quality assurance audits and checks were not robust, with records needing improvement.

After the last inspection, the provider sent us regular action plans to show how they would rectify our concerns and we returned to check all regulations were now being met. We found the provider had made improvements and was no longer inadequate, but there remained some areas for further improvement to be made or further time to be given for us to be assured the improvements made could be maintained.

At the previous inspection, the service was put in special measures due to the rating they received. We found that, although further improvements were required, the service was no longer in a position to continue to be in special measures and these have been removed.

Woodlands is situated in Wideopen on the outskirts of Newcastle. It provides residential care for up to 42 people, some of whom are living with dementia. At the time of our inspection there were 18 people living at the service. The lower occupancy figure was due to a voluntary suspension having been put in place by the provider until they were able to confirm they were meeting all of the regulations and had made satisfactory improvements. After consultation we agreed with the request to lift their voluntary suspension and this is no longer in place.

The service had a registered manager 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 we spoke with told us they felt safe living at the service. Family members also confirmed that they felt their relatives were safe and that the service had improved.

Staff we spoke with had a good understanding of safeguarding procedures. They also knew how to report any concerns they had. The provider had a system in place to log and investigate safeguarding allegations. People were moved and handled in line with guidance and best practice.

Risk assessments were in place and had improved, although guidance for staff was in the process of being put in place. Checks on the premises and equipment were undertaken to ensure the safety of people who lived at the service. Accidents were recorded and monitored by the provider to ensure that no trends were forming.

We found some further improvements with medicines needed to be taken but found no evidence this had impacted on people’s health. Medicines were largely managed well, but we have made a recommendation in this area.

There were enough staff in place. The provider had recruitment procedures and checks to ensure staff were suitable and had the right skills to support people at the service. Staff received suitable training which they put into practice and felt supported by their line manager.

The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own deci

Woodlands is a residential care home based in Wideopen, Newcastle Upon Tyne that provides accommodation and personal care and support for up to 42 people, some of whom are living with dementia. At the time of our inspection there were 25 people in receipt of care from the service.

Our last inspection of this service was carried out in June 2016 to check that improvements had been made, in respect of breaches of regulations, identified at a comprehensive inspection in May 2015. At our last inspection we found that some of the previous breaches had been addressed and compliance achieved, but that serious failings still existed in respect of the safety of the premises and good governance. We issued a requirement notice in respect of the breach in safe care and treatment and issued a warning notice, in respect of the continuing breach in good governance. The service was also placed in special measures at that time.

At this inspection we found that some improvements had been made, but shortfalls still existed in respect of both of the above regulations. We identified further concerns about the way people were treated with a lack of dignity and respect, and established that staff did not always protect people from improper treatment. This inspection found that there was not enough improvement to take the provider out of special measures and the Commission is continuing to work with the provider to improve the quality of the service delivered.

A registered manager was in post who had been registered with the Commission to manage the carrying on of the regulated activity since August 2013. 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.

We found failings in the standards of care delivered which compromised people's safety. Medical attention was not consistently sought in a timely manner for all people, when they presented with changes in their physical or mental wellbeing. Some staff adopted moving and handling procedures that were not safe or in line with best practice guidelines. In addition, we could not be sure that the management of pressure area care was safe, as documented instructions for staff to refer to, were not in place.

The management of medicines was not safe. Some people's medicines had gone out of stock and were not available to them. The recording of the administration of medicines was poor and it was not always possible to reconcile if people had received their medicines or not. In addition, people did not always receive their medicines in a timely manner.

Safeguarding policies and procedures were in place to help protect people from harm and abuse. However, we found evidence of staff not alerting the manager to inappropriate treatment of people by their colleagues, until sometime after the event. Staff had received training in the safeguarding of vulnerable adults but they had not always safeguarded people in practice.

Improvements to the premises had been made since our last visit. Accidents and incidents were appropriately recorded and monitored for any patterns or trends. Health and safety checks and checks on equipment were carried out regularly to ensure they remained safe for use. The environment within the home did not reflect best practice guidance about steps that could be taken to support those people living with a cognitive impairment or dementia. We have issued a recommendation about this.

Staffing levels were appropriate to people's needs, but we found that people's needs were not always met in a timely manner due to the way staff carried out their duties and how they were deployed. Some people had to wait for their care to be delivered, but this was linked to how staff organised themselves, how they com

The inspection took place on 28 June 2016 and was unannounced. This meant that the provider and staff did not know that we would be visiting. A second announced visit was carried out on 29 June 2016 to complete the inspection.

We carried out a comprehension inspection in May 2015 where we found four breaches of the regulations. These included meeting nutritional and hydration needs; staffing; premises and equipment and good governance.

After the comprehensive inspection, the provider wrote to us on 11 September 2015 to say what action they were taking to meet legal requirements.

We inspected the service again on 28 and 29 June 2016 to check that action had been taken. We found that improvements had been made with regards to staffing and meeting nutritional and hydration needs. However, we identified serious shortfalls with the safety of the premises.

Woodlands provides care to a maximum of 42 older people, some of whom have a dementia related condition. There were 27 people living at the home at the time of the inspection.

A stairgate had been fitted to the main stairwell. This was neither secure nor fit for purpose. The fitting of some window restrictors in the home did not conform to the Health and Safety Executive (HSE) guidelines to prevent any serious accidents or incidents. Some of the flooring was uneven and concerns had been raised about a number of fire doors. The kitchen freezer had a crack in the bottom and was an electrical safety risk and a gas safety check had highlighted that the secondary boiler was not safe to use. One person with a dementia related condition had left the home unobserved on several occasions, placing them at risk of harm. Although some measures had been implemented such as bolts on the front door and key pads; the manager said that they were still waiting for anti-tamper locks to be fitted to the fire exits, since this person could override the key pads by pressing the emergency exit buttons. Some of the décor and furnishings were worn and damaged. Five of the lounge chairs had damaged cushion covers. The lounge/dining area carpet was stained and was covered with ingrained food and debris and the first floor carpet was threadbare in places. The chairs and carpets not only looked unsightly, but were an infection control risk because they could not be cleaned easily. Further work was required to ensure that the environment met the needs of people who had a dementia related condition.

There were deficits in the governance of the service since action to address the premises shortfalls was not taken in a timely manner.

Following our inspection, the regional manager emailed us to state that immediate action had been taken to ensure the safety of the premises. Whilst we acknowledged the work which had been carried out; we considered that action should have been taken in a timely manner and not, as it appeared, in response to our intervention.

There was a registered manager in post. 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.

Staff told us that the service had been through a period of uncertainty. They told us that there had been changes in the provider’s management structure. Although the provider’s legal entity remained the same - ‘North East Care Homes Limited,’ a new management company was now overseeing the service; this had been the second management company within 12 months. Staff told us that these changes had affected morale.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. They were fully aware of the whistle blowing procedure.

Safe recruitment procedures were followed. No concerns about staffing levels were raised by people or relatives. We observed that staff ca

We carried out this inspection to check whether the provider had taken action to improve the premises, cleanliness and infection control, assessing and monitoring the quality of the service and records.

We spoke with eight people to find out their opinions of the service. We also talked with the provider’s representative, registered manager, deputy manager, laundry assistant and the activities coordinator. We contacted a local authority contracts and commissioning officer and had spoken previously to an environmental health officer.

An infection control practitioner from the local NHS trust was present at the home at the time of our inspection. She had carried out infection control training for staff and supported the manager to address the concerns we raised during our last inspection in July 2014. She told us, “It’s much improved. There are just a few minor issues to sort out.”

We considered our inspection findings to answer questions we always ask;

• 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:

Is the service safe?

We found that improvements had been made to the environment and premises. All areas of the home were clean and maintenance and servicing had been carried out in a timely manner.

Records were now fit for purpose. Care plans documented people’s likes and dislikes and aimed to meet people’s physical, emotional and social needs. Risk assessments were in place for identified risks. Accident and incident records were correctly completed.

• Is the service effective?

This question was not reviewed. Our inspection was carried out to check whether the provider had taken action to improve the premises, cleanliness and infection control, assessing and monitoring the quality of the service and records. Therefore this question will be answered at a later date.

• Is the service caring?

This question was not reviewed. Our inspection was carried out to check whether the provider had taken action to improve the premises, cleanliness and infection control, assessing and monitoring the quality of the service and records. Therefore this question will be answered at a later date.

• Is the service responsive?

This question was not reviewed. Our inspection was carried out to check whether the provider had taken action to improve the premises, cleanliness and infection control, assessing and monitoring the quality of the service and records. Therefore this question will be answered at a later date.

• Is the service well-led?

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that issues raised in health and safety audits and maintenance checks and servicing were now carried out in a timely manner. Any issues or actions highlighted during these checks had been addressed.

The manager has applied to become registered with the Commission.

We found that people who used the service were able to express their views and were involved in making decisions about their care and treatment. People were given the opportunity to join in activities both inside and outside the service. People told us they were felt they were well cared for and the staff were attentive to their needs. Comments included, "This is my home now, I like it here" and "Nowhere is the same as home but we are well looked after here, there are plenty of nice staff around". We concluded people's care needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

We found people were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found there were effective recruitment and selection processes in place so appropriate staff were employed to care for people who used the service.

People told us they knew how to make a complaint and felt their comments would be taken seriously and investigated. Comments included, "I have never needed to complain but I would tell them if I wasn't happy about something" and "I can speak my mind and they listen to what I say". We concluded people had their comments and complaints listened to, and acted upon, without the fear they would be discriminated against for making a complaint.

One person said; "I am happy here, I am treated well."

A visitor described the care; "it is as good as it gets." And added " I feel the manager is responsive to any concerns, I am happy to raise things with her."

Another visitor said, "it is very good, the staff are very helpful, kind, busy and caring."

The inspection took place on 11 May 2015 and was unannounced. We carried out a second visit to the home announced on 15 May to complete the inspection.

The last inspection was carried out on 10 October 2014 and we found that the provider was meeting all the regulations we inspected.

Woodlands is a purpose built home which provides accommodation and care for up to 42 people, some of whom were living with dementia. At the time of the inspection there were 31 older people using the service.

There was a registered manager 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 and associated Regulations about how the home is run.

Prior to our inspection, we received information of concern regarding how people’s dietary needs were met at Woodlands which we found to be substantiated. The provider used a contract caterer who supplied all of the home’s kitchen staff. We found concerns with the provision of meals. We read two people’s nutritional care plans which stated they should have high calorie liquid shakes. We did not see either person receive any high calorie drinks during the inspection. There was confusion about the consistency of one person’s diet. We noticed that the menu had to be changed because certain foods were out of stock. The registered manager told us that this was due to the change in menus. Following our inspection, she sent us an update to state that the concerns we raised had all been addressed.

Certain areas of the home were in need of redecoration and some of the furniture looked worn. Some of the chairs and sofas in the main lounge gave off an offensive odour when we sat on them. Some staff and a relative expressed concern about an open stairwell which they considered was a falls risk. We found the design and decoration of the premises did not fully meet the needs of people who had a dementia related condition. However, when we visited the home again on 15 May 2015, many areas had been redecorated and new signs had been obtained to ensure that the environment aided the orientation of people who were living with dementia. Further work was required to ensure that all areas of the premises met the needs of people who lived with dementia.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. We noted that there had been a number of confrontations between people since January 2015. These had been referred to the local authority’s safeguarding adults team.

Concerns which we received prior to our inspection in relation to controlled drugs were found to be unsubstantiated. We checked medicines management overall and saw that safe systems were in place to receive, store, administer and dispose of medicines.

Safe recruitment procedures were carried out. Pre-employment checks were undertaken to help ensure that staff were suitable to work with vulnerable people. Staff told us training courses were available in safe working practices and to meet the specific needs of people, such as dementia care. However, practical training in areas such as moving and handling and first aid had not always been carried out. The registered manager told us that she had identified this as an issue and further practical training was being planned or had already been completed.

We received mixed comments about staffing levels from people, relatives and staff. Most told us that more staff would be appreciated to enable staff to have more time to spend with people. We saw that most people sat in the main lounge on the ground floor and that some people spent time sleeping; others watched the television or listened to music. We found that more staffing was required at certain times of the day.

Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We found that the home had made a number of applications to the local authority to deprive people of their liberty in line with legislation and case law. Mental capacity assessments had been carried out in some of the care plans however; these were identical and not decision specific and therefore not in line with the MCA principles. We have made a recommendation that the provider ensures that there is documented evidence that care is always sought in line with the Mental Capacity Act 2005.

Most of the interactions between people and staff were positive. We heard one staff member’s tone of voice and words they used were not as positive. The registered manager told us that she would look into this. We observed that staff promoted people’s privacy and dignity.

An activities coordinator was employed to help meet the social needs of people living at the home. Some relatives and staff felt that more activities could be provided. We have made a recommendation regarding activities provision for those people who live with dementia.

The registered manager carried out a number of audits and checks to check the quality of the service provided. We acknowledged the prompt updates from the registered manager to show that immediate action had been taken to address the concerns we raised particularly on the first day of our inspection. However, these issues should have been identified by the provider and registered manager as part of their own governance arrangements and checks on the quality of service being provided and not, as it appeared, in response to issues identified by inspectors.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the premises and equipment, meeting nutritional and hydration needs, staffing and governance. The action we have asked the provider to take can be found at the back of this report.