This inspection took place on 30 and 31 August 2018; the first day of the inspection was unannounced. This was the first inspection since a new provider had taken over the running of the service in July 2017.

Northwood Nursing and Residential Care (referred to throughout the report as Northwood) is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. the Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

TOB Care Ltd is registered to provide accommodation at Northwood for up to 27 people who require support with personal care or have nursing needs. At the time of the inspection, there were 24 people accommodated in the home.

The service had a registered manager in place. A registered manager is a person who has registered with 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 2008 and associated Regulations about how the service is run. However, we were told the registered manager had taken the decision to step down from this role and was intending to de-register with CQC. A new manager had been appointed and had been in post for one month when this inspection was carried out. They told us they intended to apply to register as manager with CQC.

During this inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not always provided with care which met their individual needs and preferences. The provider did not have effective systems for the safe handling of medicines and for identifying, handling and responding to complaints. The systems in place to monitor the quality and safety of the service were not sufficiently robust.

This was the first inspection for the service and the first time it has been rated as ‘Requires Improvement’. At the time of the inspection, the provider had already identified many of the issues we found and had put an action plan in place to improve the quality and safety of the service. However, this had not yet been embedded in the governance arrangements for the home.

Although there were systems in place to monitor the quality and safety of the service, these had not been effective; this had resulted in many of the shortfalls we identified during the inspection.

We found there was a culture in the home of staff doing things to people rather than checking this was what each individual wanted.

Some areas of the home, particularly the bathroom and toilets, were not clean. We have therefore made a recommendation in relation to infection prevention. Following the inspection the provider sent us evidence to show that sluice rooms had been refurbished.

We were told one person was at risk of wandering at night. Although there was an alarm on their door to alert staff if they left their bedroom, we were concerned this room was located very close to a door which opened directly onto a flight of stairs. We were also concerned that staffing levels at night, as well as the layout of the home, meant there was a risk staff would not be able to respond in a timely manner if the alarm was activated, placing the person at risk of falling down the stairs. Following the inspection we received evidence to show the manager had taken action to reduce the risk of people accessing the stairwell.

Safe systems were in place for recording the administration of oral medicines. However, some improvements were needed in relation to topical medicines and medicines prescribed ‘as required’. At the time of the inspection, storage of medicines needed to be improved to ensure it was safe. Following the inspection, the provider sent us evidence to show medicines had been moved to a larger and more secure room.

The complaints procedure