The inspection took place on 28 February 2017 and was unannounced.

Woodview is registered to provide accommodation and nursing and personal care for up to 63 older people, younger adults or people living with a dementia type illness. There were 56 people living at the service on the day of our inspection. The service is divided into two units. "Woodview" provides care to older people or people living with a dementia type illness and "Greenwood" provides care for younger adults with physical disabilities or long term medical conditions.

There was a registered manager in post at the time of our inspection, although they were not present on the day of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Four people at the time of our inspection had their freedom restricted under a DoLS authorisation.

People were not always protected from avoidable harm because not all risks had been identified. Staff were aware of the signs of abuse and knew how to escalate their concerns. There were sufficient staff on duty to keep people safe and meet their care needs. People received their medicine safely from staff that were competent to do so. However, some protocols were not in place for the safe administration of "as required" medicines. People were cared for in clean environment.

People received effective care from skilled and knowledgeable staff who received training to meet most people’s care needs. Some staff lacked the skills to care for people when they became anxious or distressed. Staff had received appropriate training, and understood the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and where able people were asked for their consent to care. People were not involved in planning their menus and their feedback on their choice of food was not actioned. People were supported to access their GP, dentist and other appropriate healthcare professional when needed.

People were cared for with kindness and compassion by committed and caring staff. Staff involved people and their families in decisions about their care. People were cared for by staff who respected their privacy and dignity.

People received care that was personal to their individual needs. Staff supported people to engage in meaningful activities and pastimes of their choice, both in and outside the service.

The registered manager has been absent for some time and staff were concerned about the lack of visible leadership and support. There were systems in place to monitor the quality of the service, but these systems did not always identify areas for improvement.

The inspection took place on 11 February 2015 and was unannounced.

Woodview is registered to provide accommodation and personal care for up to 63 older people or people living with a physical disability. There were 49 people living at the service on the day of our inspection. The service is divided into two areas, Woodview for older people and people living with dementia and Greenwood for people living with a physical disability who require nursing care.

There was a registered manager in post at the time of our inspection. 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 the last inspection in July 2014 we asked the provider to take action to make improvements to respecting and involving people, to their care and welfare, safeguarding them, cleanliness and infection control and how they ensured the quality of the service. The provider sent us an action plan and told us that these actions would be completed by October 2014. On this inspection we found that the provider had made improvements.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves or others. At the time of the inspection the registered person had made referrals to the local authority for DoLS authorisations.

People felt safe and secure and staff knew what action to take to report any concerns about the safety and welfare of people in their care. However, we found that there was not always enough staff on duty to respond to people’s needs in timely manner. We also found that the management of people’s medicines was not robust.

People were looked after by kind and caring staff who supported them to have nutritious and well-presented food. We found that there was a menu choice and the availability of snacks and hot and cold drinks to ensure that people always had enough to eat and drink.

People had a good rapport with staff who treated them with dignity and respect. We found that people had their care planned in line with their individual needs and preferences.

People were supported by designated activity coordinators to take part in hobbies and pastimes of their choice. People told us that they enjoyed being involved in the local community and maintaining contact with family and friends.

Staff were not happy in their work and told us that the registered manager was not always approachable. Although the provider had made some improvements to their quality assurance processes, these were not always effective.

Prior to our inspection we reviewed all the information we had received from the provider. As part of our inspection we spoke with four people who used the service. We also spoke with the chef, two care workers, a senior care worker, a unit manager and the registered manager.

We spoke with two relatives about their views. We observed the support staff gave to people who used the service. We also looked at records, including care files of six people and carried out a tour of both units.

We found people gave consent to their care and where people lacked capacity to do so the provider had acted in accordance with legal requirements.

We asked people who used the service what they thought of the food that was provided for them. One person told us, "The food is good, there is always a choice of two hot meals at lunchtime and one for vegetarians as well.”

We found there were sufficient skilled and experienced staff to support people who used the service and saw the building was clean, safe and effectively maintained. A person told us, "I like the fact I have an en suite room, it is so convenient.”

We found the service to be well led.

We carried out an inspection of Woodview to follow up an area of non-compliance identified in a previous inspection. We reviewed the evidence that demonstrated the provider's compliance in this area.

We reviewed all the information that the provider had sent us, visited the premises and talked with the registered manager.

We saw that the provider had taken the appropriate measures to meet the essential standards of care for people who used the service provided at Woodview.

We used a number of different ways to help us understand the experiences of people who used the service. This was because some people had complex needs which meant that they were not able to tell us about their experiences.

Prior to our visit we reviewed all the information we had received about the service. During the visit we spoke with four people who used the service. We spoke with one relative of a person who had used the service. We also spoke with five members of the staff team, the registered manager and the regional manager who was visiting on the day of our inspection. We also looked at some of the records held in the service including the care files for four people.

People who used the service were supported to make their own decisions where they were able to do so. We saw staff asking people for their views and preferences. One person told us about various community resources they used.

We observed people contributing towards everyday tasks including being supported in preparing breakfasts and beverages.

The building was clean, odour free and had recently been re-carpeted throughout.

We identified concerns regarding a shortage of equipment used to assist people in mobilising.

There were fifty-nine people living at Woodview on both days of our visit. 38 older people lived in single room accommodation in the main building. A further 21 people living with a physical disability were accommodated in a part of the service called Greenwood in either single rooms or one or two bedroomed self-contained flats which had their own kitchen and bathroom.

At the time of our inspection the home was without a registered manager. We spoke with the acting manager who told us they had submitted their application for registration to become a registered manager. We observed they had arrangements in place to provide leadership and support in the interim period.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service caring?

We saw where people were able that they were involved in their home. One person told how proud they felt when they had recently been involved in staff interviews for the recruitment of new staff. They said, “I asked them about their interests and what they wanted to do and explained the home to them.” This person also told us they had attended a staff meeting on 18 July 2014. They said, “It was of mutual benefit, I gave them the resident experience, I would do it again.”

We found staff did not always refer to people in a person centred way. For example, we heard one member of care staff say, “I’ve done the feeds.” We asked this member of staff to explain what they meant by this. They said, “I’ve fed people who need help eating.” This meant people were not always treated with consideration and respect.

Is the service responsive?

We looked at nine care files and saw that people had their care needs assessed and care planned prior to admission to the service. We saw as a person’s care needs changed this was recorded in their care files. This meant staff had accurate information on the person’s care and treatment needs.

We spoke with four members of care staff who told us how they would respond to a person in an emergency situation such as when a person had a sudden collapse. We found that most staff had been trained in first aid and new how to keep a person safe until assistance arrived.

We observed that staff used different communication tools to communicate with people who were unable or had difficulty communicating verbally. This helped people to communicate their needs.

There were several lengthy delays in answering the call bells during our visit. The manager spoke with senior staff and requested that care staff answered call bells in a timely manner. However, we noted that this did not improve the time it took staff to answer the call bells.

Is the service safe?

The provider had policies and procedures in relation to safeguarding vulnerable adults. Care staff told us that they were unsure if there was a policy for safeguarding and would not know where to find the policy. Care staff were unsure about the training they had received and actions to take if a person was at risk of abuse.

We looked at several areas of the home including people’s self-contained flats and shared areas such as bathrooms and shower rooms. We found the provider did not always maintain an appropriate standard of cleanliness and hygiene.

The unit managers for Woodview and Greenwood had been identified as infection control leads and were involved in the local authority infection control link nurse network. The network provides the link nurses with up to date guidance on infection control practices to be shared with other staff.

We found that there was little evidence that audits of the quality of service provided to people had been undertaken prior to the new manager coming into post in April 2014. The manager had introduced a programme of audit. However, not all of the completed audits had an action plan in place to ensure that any shortfalls identified had been addressed.

Is the service effective?

We spoke with a relative who told us their relative had improved since moving into the service. They said, “They are brilliant with her, proactive with her. Their physical and mental health wellbeing has improved.”

We found that staff were supported to undertake nationally recognised diploma level qualifications in adult health and social care to ensure that they had the skills and knowledge to support people.

Is the service well led?

Staff told us the service was well led. One staff member said, “There’s been lots of changes to the management, XX [manager] is very new. We have the unit managers, thoroughly compassionate and strong, we can turn to them for advice.” Another member of staff said, “It’s a good place to work, we keep the service users happy and morale is good. We get positive feedback from residents and their relatives. We’re a good team.”