This inspection took place over four days on the 27 and 28 November 2018, 10 and 18 December 2018. The service was last inspected in November 2017 when it was rated ‘requires improvement’ for the fourth time; with an ongoing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 - Safe care and treatment. At this inspection we found further breaches in relation to staffing levels and governance.

The service is a care home with nursing and is registered to care for 44 older people. On the first day of inspection there were 29 people living at the 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. Woodleigh Christian Care Home is based in an old convent and has been extended to provide additional accommodation. The two halves of the building are joined by a long corridor on the ground floor, there are multiple lounges and communal areas for people and families to sit and chat. There is access to a communal garden from the older building and a lift at either end of the building.

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 2008 and associated Regulations about how the service is run.

Medicines were not managed safely. We found examples of errors in medicine administration records. People did not always receive their medicines as prescribed and we found some people had missed their medicines, with gaps in-between doses or incorrect doses. We also found occasions when the provider had run out of medicines for people.

Incidents were not always identified or investigated. Inadequate recording meant improvements were not made to people’s care and similar incidents were often repeated. Risks to people from known health conditions were not always managed safely and risk assessments and care plans were not consistently reviewed after incidents.

Staff did not always follow advice or recommendations from specialist healthcare practitioners, or senior staff. Communication across teams was not always effective and staff were not always informed of changes to people’s needs in a timely way. There were inadequate staffing levels at night and a lack of permanent nursing staff to ensure consistent care. This impacted on the quality and consistency of care people received and increased the risk of errors and poor communication about people’s changing needs.

Staff did not effectively monitor people’s food and fluids when they were identified as at risk of weight loss, poor skin integrity and diabetes. People who were dependent on others to provide food and drink were not always offered drinks or snacks in-between meals. Record keeping was inconsistent and could not always be relied upon when people’s care was being reviewed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act (2005) were not consistently applied. Mental capacity assessments were not always decision specific and best interest decisions were made without full consultation of relevant people. Appropriate steps were not always made to keep people safe.

Staff had access to relevant training that supported them to meet the individual needs of people. Staff used evidence based guidance and tools to assess people’s needs.

We observed occasions when staff did not always promote people’s dignity. The service was not always adequately staffed to meet people’s needs and this

We inspected this service on 31 October 2017 and the inspection was unannounced. The service is registered to provide accommodation with personal care for up to 44 older people with varying support needs, including nursing needs. On the day of our inspection there were 29 people living at the service.

Woodleigh Christian Care Home 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 home is run. At the time of our inspection a registered manager was in place but not available on the day of our inspection. The provider’s operations manager had day to day responsibility for the service and was present during the inspection.

People could not be assured their prescribed medicines were managed appropriately. Some concerns were identified with the deployment of staff that meant staff were not always available in communal areas placing some people at risk. Whilst action was taken on the day to address this, continued review and monitoring is required to ensure people’s safety is not compromised. Safe staff recruitment procedures were in place and being used.

People’s needs had been assessed and any associated risks were planned for. However, staff did not always follow information provided impacting on some people’s safety. Accidents and incidents were recorded and reported by staff. These were analysed to ensure appropriate action had been taken to protect people, and to consider if there were any themes or patterns that required further action. Contingency plans were in place to support staff to provide a safe service in the event of an untoward incident affecting the service.

Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm or if they needed to report concerns.

People were not always supported effectively by staff. Some staff required further training and support to improve their practice. New staff received an induction and all staff had ongoing training. Staff had not received the required frequency of supervision meetings to discuss and review their development needs as stated in the provider’s supervision policy and procedure.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Whilst people’s mental capacity had been assessed where required, best interest decisions had not been recorded to show who and how decisions had been made and that less restrictive options had been considered. This is a requirement of this legislation.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People were appropriately supported with their eating and drinking needs if required, choices were offered and respected, and independence encouraged as fully as possible.

People’s health needs had been assessed and planed for. However, further improvements were required in some areas of clinical care.

Staff on the whole were kind and caring; experienced staff knew people well and supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt staff were understanding of their needs and that they had developed positive relationships with them. Information about an independent advocacy service was available for people should this support have been required.

People and or their relative where appropriate, were involved in the assessment and review of their needs. Care plans informed staff how to support people and were on the whole personalised to people’s needs, routines and preferences. Activity staff provided a range of one to one and social activities and opportunities. Peop

We carried out an unannounced comprehensive inspection of this service on 7 and 8 September 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Need for consent, Safe care and treatment, Safeguarding service users from abuse and improper treatment, and Good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Woodleigh Christian Care Home on our website at www.cqc.org.uk.

We found that the provider had carried out the improvements and met the legal requirements.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff deployed. Appropriate pre-employment checks were carried out before staff began work at Woodleigh Christian Care Home.

People received their prescribed medicines when required and these were stored and administered safely. Procedures were in place to ensure people received their medicines safely when they were away from the service.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and we saw they had sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. People had access to healthcare professionals when required and staff followed their guidance to ensure people maintained good health.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on.

Robust quality monitoring systems were in place to identify areas for improvement and ensure these were acted on.

We inspected Woodleigh Christian Care Home on 7 and 8 September 2016. The inspection was unannounced.

Woodleigh Christian Care Home is situated in the Nottinghamshire town of Mansfield. The service is registered to provide accommodation for a maximum of 44 people, who require nursing or personal care on the premises. There is always a nurse within the home and they are also registered to provide Diagnostic and screening procedures and Treatment of disease, disorder or injury. At the time of our inspection, 37 people were living at Woodleigh Christian Care Home.

At the time of our visit the service did not have a registered manager in place. However the manager was progressing through the application process to become registered with CQC. The previous registered manager left the service in May 2016. 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.

Risks to people’s safety were not always identified and managed and assessments intended to minimise the risk of harm were not always effective or updated when required. The building was well maintained and regular environmental safety checks were carried out.

People did not always receive care and support in a timely way as sufficient numbers of suitably qualified and experienced staff were not always available. Appropriate pre-employment checks were carried out before staff began work at Woodleigh Christian Care Home.

People did not always receive their prescribed medicines when required. Medicines were not always stored safely and records of available stock were not always accurate.

Staff knew how to protect people from harm and referrals were made to the appropriate authority when concerns were raised.

Staff received training and support to enable to meet people’s needs but they did not always have the time and opportunity to do so. Ongoing training and assessment for care staff was scheduled to help maintain their knowledge.

Evidence that people had given consent to any care and treatment provided was not always available. Where they did not have capacity to offer informed consent their best interests and rights were not always protected under the Mental Capacity Act (2005) as thorough assessments were not always carried out. People’s wishes regarding their care and treatment were respected by staff.

People were not always supported to have sufficient food and drink to help them maintain healthy nutrition and hydration. People had access to health professionals, however, the service was not always proactive in making referrals and requesting input when required. Staff followed their guidance to ensure people maintained good health.

People were generally treated with dignity and respect, however we noted a number of occasions when people’s dignity was not protected. We observed limited opportunities for positive interactions between staff and noted that staff seemed to be task driven in their approach to ensure they were able to meet peoples basic needs.

People did not always receive personalised care that was responsive to their needs. Care staff had an understanding of people’s care needs but could not always ensure that the care was provided at the right time. They knew how to raise an issue and were confident these would be listened to and acted on.

There was an open and transparent culture at the service. People, their relatives and staff were encouraged to have their say on their experience of care and their comments were acted on. Quality monitoring systems were in place to identify areas for improvement however these were not effective as their findings were not always acted on.

During this inspection there were forty one people using the service. We spoke directly with three people who used the service and with the relatives of three people who were unable to express their own views. We also spoke with two care staff, the activities co-ordinator, deputy manager/maintenance person, domestic assistant, registered manager and owner.

We saw evidence that people were consulted before receiving care. One of the people who used the service told us, “They talk to me about my care, they don’t force things.” A relative we spoke with told us, “I am fully involved; they (staff) always gain my consent when it is needed.”

We saw staff were friendly and patient with people. One person we spoke with told us “I receive good care here, and I get on great with the care workers.” A relative we spoke with told us, “They (staff) never stop, they are fantastic.”

We saw that the building was safe, clean and adequately maintained. One relative told us, “It is a nice, large building; it is airy, warm and clean. It never smells and it meets my family member’s needs.”

We saw that staff were trained for their role. One staff member told us, “The training meets my needs, I feel confident in my role.”

We saw that records relevant to the management of the service were accurate and up to date.

We spoke with three people who live in the home and one relative. People told us the staff had discussed with them about how they wished to be cared for. A relative told us, "Its a fabulous place. They go the extra mile with everything." She said was given a great deal of the relevant information to make an informed decision about using the home and is involved in what is happening.

We spoke with two people who were able to clarify the help they needed and confirmed that their needs were being met. One said, "I'm enjoying being here." The other said, "This is definitely the best place I've been in, because they know what I need."

A relative told us that in her opinion people were safe in the home and the staff cared for them in an "appropriate way." Two other people told us that they felt safe and secure in their own rooms. The people we observed in the lounge areas were relaxed and staff were interacting positively with them.

People told us that most of the staff knew what to do with everything and there were some new staff who were learning from other staff. One person said. "All the staff are good. There's no back biting here."

We carried out an unannounced inspection of the service on 13 and 14 January 2015. Woodleigh Christian Care Home provides accommodation for people who require nursing or personal care, diagnostic and screening procedures and the treatment of disease, disorder or injury for up to a maximum of 44 people. On the day of our inspection 33 people were using the service and 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. 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 knew how to report concerns if they thought they or others were the victim of abuse. People were protected by staff who were able to identify the signs of abuse. People’s safety was protected as access to the home was secure and prevented unauthorised access to the home.

People were supported by staff to maintain their safety without unnecessarily restricting their freedom. The registered manager had processes in place that protected people’s safety through the timely investigation of accidents, incidents and other concerns raised by staff or people.

There were enough staff to meet people’s needs. Robust recruitment procedures were in place. People were protected against the risks associated with the unsafe management of medicines.

People received care from staff who felt supported by the management. Staff undertook a detailed induction and received regular assessment of their work. Staff understood people’s needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager was aware of these safeguards. People told us they had the freedom to leave the home when they wanted to and did not feel unlawfully restricted.

People were encouraged and supported by staff to eat and drink as much as they could. People told us they were happy with the access they had to their GP other health care professionals. Appropriate plans were not put in place to monitor the fluid intake for a person who had been diagnosed with a Urinary Tract Infection (UTI). A UTI is an infection in any part of the urinary system such as the kidneys, ureters, bladder and urethra. We were informed after the inspection that monitoring of this person’s fluid intake was now in place.

People spoke positively about the staff, however we observed some poor staff practise. We saw a person left for too long in the middle of the lounge in their wheelchair whilst waiting to be moved which caused them distress. We observed the staff handover and the language used to describe some people was not appropriate. Phrases such as being; “Being shirty” were used and were disrespectful.

This was a breach of Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010, which corresponds with Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

You can see what action we told the provider to take at the back of the full version of the report.

People responded positively to the staff. People were supported by staff who understood their life history and the things that were important to them. Staff told us people were given a choice of whether they wanted a male or female member of staff to support them with their personal care. The majority of people told us this choice was offered although two did say they did not always happen. All people told us their dignity was maintained by the staff.

People were provided with information about how they could obtain independent advice about their care from Independent Mental Capacity Act Advocate (IMCA) to make major decisions. IMCAs support and represent people who do not have family or friends to advocate for them at times when important decisions are being made about their health or social care. People received support from staff were able to describe the steps they took to preserve people’s privacy and dignity when providing personal care. People told us they felt able to do things that were important to them and staff supported them in following their hobbies and interests.

People’s care records were written in a person centred way. People’s records were stored on an electronic care record system. However we found that the use of this system did on occasions lead to gaps in the recording of the daily care and support provided for people.

People were supported in an environment that had been adjusted to ensure people living with physical or mental health conditions were able to lead as independent and fulfilling a life as possible. People knew how to make a complaint and the registered manager told us they encouraged people to raise concerns with them.

The registered manager carried out regularly audits to assess the quality of the service people received and whether it met people’s current level of need. However when we raised the concerns identified within this report they were not always aware of them. This could place people’s health and safety at risk.

This was a breach of Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010, which corresponds with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The registered manager told us they had an ‘open door’ policy if people wished to discuss any concerns. People were encouraged to access other organisation within local community. The registered manager was aware of, and could explain how they met their CQC registration requirements. However upon review we did find some examples of statutory notifications that were not sent in a timely manner.

People were supported by staff who felt valued and listened to. Staff understood their roles and told us they enjoyed working at the home. The provider used innovative ways to provide support for people and their relatives. External professionals visited the home to offer people and relatives advice about the challenges of living with or supporting some who is living dementia.