We inspected Woodstock Nursing Home on the 15 March 2017. Woodstock Nursing Home is a residential and nursing home for up to 28 older people. Many of these people were living with dementia. 16 people were living at the home at the time of our inspection. This was an unannounced inspection.

At our inspection on 15 March 2017, there was a manager in post who had been in post since October 2016. They were in the process of registering with the Care Quality Commission. 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 last inspected in June 2016 and found that the provider was not meeting a number of the regulations. We found that the provider did not always ensure staff were of good character before they were recruited and did not have effective systems to monitor the quality of the service. Additionally people did not always receive care which was personalised to their needs. The provider did not always notify CQC of notifiable events within the home. Following our inspection in June 2016, the provider sent as an action plan of the actions they would take to meet the legal requirements. We found some improvements had been made.

People and their relatives were generally positive about the home. They felt safe and well looked after. People enjoyed the food they received in the home and had access to food and drink. People and their relatives felt there were enough activities and we saw that a range of activities and outing were on offer. The provider was continuing to work on improving records in relation to people’s preferences and interest to ensure that activities they offered were tailored to people’s needs.

People’s medicines were mainly managed well and the manager and provider had systems to identify concerns and take effective action. However some people did not always receive their medicines as prescribed. Where people were prescribed topical creams there was not always clear guidance on the support they required to apply these creams. While immediate action was being taken we have made a recommendation to the provider.

The provider and manager had implemented systems to monitor and improve the quality of service people received. Where concerns had been identified the service were working to improve the service. People, their relatives and staff spoke positively about the improvements made at the service since the appointment of the manager. Relatives told us they felt their views were listened to and acted upon.

People’s care and risk assessments were now reflective of their needs. Care assessments give care staff and nurses clear information in relation to people’s needs. Care staff generally kept a clear and consistent record of people’s care needs.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. All staff had received training to meet people’s healthcare needs. Staff felt supported by the management and spoke positively of the new manager and improvements being made in the home.

We inspected Woodstock Nursing Home on the 15 June 2016. This was an unannounced inspection. Woodstock Nursing Home is a nursing home for up to 28 older people. 19 people were living at the home at the time of our inspection. Nearly all of the people living at the home had been diagnosed with dementia.

We last inspected in July 2015. At the June 2015 inspection we found that the provider was meeting all of the requirements of the regulations at that time. A recommendation was made to the provider regarding record keeping in relation to maintaining a current record of people’s care.

There was a manager in post who was applying to become registered with the Care Quality Commission. The last registered 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.

People’s care records were not always personalised to their needs and preferences. They were not always current and accurate and did not always give staff adequate information and guidance such as people’s required fluid intake,

However staff monitored and recorded people’s support needs, such as repositioning or assisting people with their nutritional needs.

People were at risk of being cared for by unsuitable staff because recruitment processes were not as robust as they should be. People were at risk of not receiving their medicines as prescribed, however the manager and clinical lead were taking action to address this concern.

The management had systems to monitor the quality of service people received. These systems however were not always effective and were not always consistently used. People and their relative’s views were not always consistently sought. The provider had not always informed CQC of notifiable incidents.

The provider had assessed people’s mental capacity to make specific decisions and ensured the outcomes of these assessments had been documented. The provider worked with external healthcare professionals to ensure people’s legal rights were protected.

People and their relatives were positive about the home, the staff and management. People told us they were safe and looked after well. Staff managed the risks of people’s care and understood their responsibilities to protect people from harm. People, Relatives and staff felt there were enough staff to meet people’s needs.

People had access to plenty of food and drink and received a diet which met their needs. Staff ensured their on-going healthcare needs were met. There was a friendly, pleasant and lively atmosphere within the home. People enjoyed the time they spent with each other and staff. People were offered choices about their day.

The manager and clinical manager had plans to ensure that staff received support and had access to effective training, supervision and professional development. Staff spoke positively about the recent change in management and felt supported.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulation 2009.

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

The inspection took place on 16 and 17 June 2015 and was unannounced.

Woodstock Nursing Home can accommodate up to 28 people who live with dementia. At the time of the inspection there were 22 people receiving care and treatment.

There was a registered manager in place who demonstrated strong leadership. 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 been acquired by a new provider in October 2014. A new approach and different administrative arrangements and expectations had resulted in period of change. The care and services provided were well monitored by the registered manager using the already established systems in place. One of the provider’s Directors visited the service to check on maintenance issues and to oversee the current refurbishment/redecoration. The registered manager’s immediate line manager visited regularly to monitor the overall management of the service. Staff however told us they felt unsupported and not valued by the new provider. Relationships between provider and the staff needed to improve for the service to be able to move forward smoothly.

Many of the staff were experienced in delivering dementia care; they had been well trained and kept well informed of current legislation. They supported less experienced and newly recruited staff well. Designated staff supervisions were in the process of being caught up with. A slip in the usual one to one supervision opportunities had not had an impact because staff were good at supporting each other. There were also enough senior and skilled care staff to monitor the practices of less experienced staff so this had not had an impact on care delivery either. Staff were committed to caring for those who lived with complex needs resulting from dementia. The home needed to recruit more staff, in particular nurses which it was trying to do. A shortfall of permanently employed nurses had resulted in additional pressure on the registered manager. Nurse shifts had needed to be covered by the registered manager on top of her usual management tasks. This had resulted in care records being maintained but in a somewhat disorganised manner which potentially could hamper staff being able to find pertinent information. Records of people’s activities had not been maintained since March 2015.

We recommended that the service seek advice and guidance from a reputable source, about the maintenance of accurate record keeping

People were cared for with compassion and their needs were understood. People were seen as individuals and their dignity, privacy and rights maintained. People lacked mental capacity and they were protected because staff adhered to current legislation. Staff encouraged simple decision making and supported independence where possible. Risks to people were identified and managed. Where staff required advice or support from external health care professionals, for example, to manage falls and behaviours that could be perceived as challenging, they actively sought this. The service had good working relationships with health specialists and local health services which helped to meet people’s needs effectively. People received support to eat and drink and where additional action was needed to help maintain people’s nutritional well-being this was taken. People’s medicines were managed safely and were frequently reviewed to ensure people were not being over medicated.

The registered manager had additional experience and qualifications in end of life care and therefore there were good arrangements in place to care for people at this time. Relatives told us they had also been exceptional well supported at this time. Arrangements had been made to improve on this area of care further and the service had signed up to complete and attain the Gold Standards Framework in end of life care.

We were told by relatives and staff that activities were usually provided. At the time of the inspection the activities co-ordinator was not present. Care staff were often too busy to really give designated time to this, although we saw some activities taking place in the main lounge when staff were able to give time to this. Unfortunately, records relating to the activities provided to individual people had not been maintained since March 2015. It was therefore difficult for us to make a judgement as to whether meaningful activities had been provided since March 2015 and if these had been of value. Two social events were planned for the summer; a boat trip along the canal and a garden party. The Pets for Therapy (PAT) dog visited during the inspection and was well received. A communion service also took place which is provided on a regular basis. This was well attended and was followed by tea and a chat provided by volunteers. A voluntary gardening scheme maintained the garden but also helped people to garden if they were able or simply just enjoy the garden. One member of staff told us the person they had been looking after had been looking at the garden from the window, so, they had suggested they visit it which the person enjoyed.