We carried out an unannounced inspection on 20 October 2017. When we last inspected the service in November 2016, we rated the service as 'requires improvement' and we found it in breach of regulations relating to the safe administration of medicines. We returned to the service to carry out a further comprehensive inspection to ensure that improvements had been made.

Widecombe Nursing Home provides accommodation, personal and nursing care for up to 38 older people, some of whom may be living with dementia or physical disabilities. The service also supports people who require palliative and end of life care. At the time of our inspection, there were 30 people using the service.

The service has 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. In our previous inspection we had found that people’s medicines were not managed in a safe manner. In this inspection we found that this was no longer an issue and the provider had created more robust processes to ensure that people's medicines were managed safely.

There was enough staff available to support people to be safe in the home. In our previous inspection we had found that the home did not have enough staff to deploy effectively around the home and safely meet people's needs. During this inspection we found that this was no longer a concern and there was adequate staff employed and deployed around the home to support people.

Detailed audits were now in place to monitor the management of the service and identify any issues with documentations but we found that this was still a work in progress.

The provider had robust recruitment processes in place. Staff understood their roles and responsibilities and would seek people's consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people's individual needs.

People were supported by caring and respectful staff who knew them well. Staff were given the opportunity to get to know the people they supported through keyworker roles.

People's needs had been assessed, and care plans took account of their individual, preferences, and choices. Staff supported people to maintain their health and well-being.

Feedback was encouraged from people and the manager acted on the comments received to continually improve the quality of the service. The provider had quality monitoring processes in place to ensure that they were meeting the required standards of care. There was a formal process for handling complaints and concerns, which were investigated and resolved in a timely manner.

This inspection took place on the 30 November 2016 and was unannounced. When we last inspected the service in June 2016, we rated the service as ‘requires improvement’. We returned to the service to carry out a further comprehensive inspection due to an increase in concerns about the safety and effectiveness of the service raised by the local authority.

Widecombe Nursing Home provides accommodation, personal and nursing care for up to 38 older people, some of whom may be living with dementia or physical disabilities. The service also supports people who require palliative and end of life care. At the time of our inspection, there were 34 people using the service.

There was no registered manager in post, however a new manager was in place and intended to make an application to register. 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.

Some improvements had been made in the assessment of staffing numbers, but there were still issues with the regular deployment of sufficient staffing numbers. People consistently told us that staffing numbers at weekends were too low. Because of the high needs of people using the service, there were not enough staff deployed during the night to keep them safe.

The quality of people’s care plans had improved and were now more person-centred and reflective of people’s changing needs. However there was not always evidence of how people or their relatives had been involved in the care planning process. There were risk assessments in place which detailed control measures that could be taken to keep people safe. However the management of behaviour which might have impacted negatively on others was not always fully accounted for. People’s healthcare needs were met although pressure relieving equipment was not always set at the correct weight. People had enough to eat and drink and had their choices and dietary needs met. Medicines were accounted for correctly, but the storage arrangements were not always safe. The environment was kept safe and was subject to regular health and safety checks. There were emergency evacuation plans in place for people and contingency plans in case of emergencies affecting the service.

The requirements of the Mental Capacity Act 2005 (MCA) were met, but not always recorded appropriately within care plans. People provided consent to the delivery of their care and support.

People felt their regular staff were kind and caring, and we observed good practice around the home. However the high use of agency staff meant that people did not always receive consistent care from staff who knew them and understood their needs. People were encouraged to share their views through key worker meetings, but outcomes were not always evidenced in response to comments they made.

Staff felt supported, but reported being under pressure due to staffing shortages and changes in management. Supervisions and appraisals had been infrequent, but the manger had recently begun to carry out some supervisions with staff. New staff were recruited safely and received a full induction to the service when they joined. Meetings were held frequently to enable them to contribute to the development of the service.

There was a manager in post who was not yet registered with the Care Quality Commission. While there had been some improvements since our last inspection, the changes in management meant that there were still shortfalls in the service which had not been addressed. There were regular audits carried out to identify improvements that needed to be made across the service.

During this inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see wh

This inspection took place on the 26 and 28 April 2016 and was unannounced. When we last inspected the service in March 2015 we rated the service as ‘good’ in each of the areas we looked at.

Widecombe Nursing Home provides accommodation, personal and nursing care for up to 38 older people, some of whom may be living with dementia or physical disabilities. The service also supports people who require palliative and end of life care. At the time of our inspection there were 31 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 2008 and associated Regulations about how the service is run.

There were robust recruitment policies in place and staff were recruited safely to work in the service. However there was no on-going system in place for assessing staffing dependency. Because there was a high turnover of people using the service, this meant that people might have been at risk of not having their needs met due to insufficient numbers of staff. People did not always receive prompt responses to call bells and sometimes had to wait to receive care.

People were safeguarded from avoidable risk of harm and staff understood the process to follow to report concerns regarding people’s safety. There were risk assessments in place which detailed how people could be supported safely, however there were not always clear protocols for the management of behaviour which might have impacted negatively on others. Accidents and incidents were recorded but there was not always evidence of what learning had been taken from these or how the risk of recurrence was being minimised. People’s medicines were stored and managed appropriately and administered by trained staff. The environment was regularly audited and checked for safety and there were robust emergency plans in place. Staff received training in moving and handling which allowed them to move people safely using the correct equipment.

Staff received a variety of training and this was refreshed and updated as required. However staff did not always demonstrate a full understanding of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards (DoLS). Staff were supported by management through a programme of supervision and performance reviews.

There was evidence that people consented to their care and treatment but we observed a lack of consent being sought during the inspection when staff were providing care. People’s healthcare needs were identified and met by the service and a dedicated team of nurses with a variety of specialisms. External healthcare support was sought if required from community-based professionals. People had enough to eat and drink and were offered drinks and snacks throughout the day.

The design and decoration of the service was inconsistent. A recent program of refurbishment and redecoration had taken place but some elements of the environment were not always in good condition or following the latest guidance for good practice in dementia care.

People were treated with dignity and respect and had a named nurse support system in place so they had a point of contact for expressing their concerns or issues. Staff were kind and caring and demonstrated a patient and compassionate attitude.

People received a thorough assessment of their needs and care plans were detailed enough to enable staff to deliver responsive care and support. However there was not always evidence of involvement from people or their families and there was limited information regarding people’s social histories and backgrounds. Care plans were reviewed and adapted according to people’s changing needs. There was a programme of activities on offer so people could pursue their interests in and out of the

When we inspected Widecombe Nursing Home on 12 September 2013, we spoke with people who used the service about their experiences in the home, and observed care practices. One person said, "I'm very happy with all my care." Another person told us, "I would really like to go home, but I can't grumble really."

We observed positive engagement between staff and people who used the service, and found that people's care was delivered in a caring and compassionate way.

People had care plans and risk assessments in place so that care could be delivered safely and with continuity. Robust medication systems ensured that people received their prescribed medication on time and in a way that suited their needs.

People we spoke with told us they were happy with the staff that supported them, and the staff we spoke with were knowledgeable and competent in their roles.

There was information displayed relating to the complaints procedure, so that people who used the service and visitors to the home knew how to raise any concerns with the provider.

During our visit to Widecombe Nursing Home we did not talk with the people using the service about the medication administration processes. However from the records we looked at we saw that people were given the correct medication at the correct time and could ask for pain relief, and be given it, at any time.

Due to the varying levels of communication that people in Widecombe Nursing Home had, it was difficult to always discuss their care with them in any depth. Therefore we also used a number of different methods including observations, and talking with people’s relatives, to help us understand the experiences of people using the service.

When we visited Widecombe Nursing Home on 03 July 2012 we found that people were treated with dignity and respect, and were assisted to make choices about their care whenever possible. We spoke with six of the 37 people living at the home. Everyone told us that the staff asked them to make decisions about when they got up and went to bed, what they had to eat and what they wore.

People’s needs were assessed, and care and treatment was planned and delivered in line with their individual care plans.

People told us that they were well cared for. One person said, “the staff are all very good, nothing is too much for them”. We observed a relaxed atmosphere between the staff team and the people living at this home and that the care staff were caring in their approach to people, and took time explaining what they were doing.

We were told that the food was good. One person said, “my appetite is not very good, but I always look forward to my meal”. People confirmed that they were offered choices at mealtimes and an alternative was always available.

During our visit on 21 February 2012 found the staff treated people with respect and encouraged them to make choices about their day to day life. People told us, and we heard, staff speak with them in a kind and respectful manner. People said the staff knew how to support them and understood their needs.

The people we spoke with were all happy with the care provided but told us they sometimes had to wait what seemed like a long time for the call bells to be answered or assistance to be provided.

We were told that the food was of good quality and that there were always alternatives to the menu.

People who use the service made positive comments about the staff who care for them. People told us they felt that any concerns they raised with the manager or nurses would be addressed, that staff listened to them and that they trusted the staff who work at the home.

This unannounced inspection was carried out on 09 and 10 March 2015.

Widecombe nursing home is a registered care home which provides accommodation for up to 38 people with nursing needs. This includes people with dementia and people who require end of life care. The home offers accommodation over one floor. There were 33 people living at the home when we inspected it.

At the time of our inspection, 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 and associated Regulations about how the service is run.

People were assisted by staff in a way that supported their safety and they were treated with respect. People had care plans in place which took account of their needs and individual choices.

People’s medication was administered by staff who had received training to ensure that the medication was administered safely and in a timely manner.

Staff cared for people in a warm and caring manner.

Staff were trained to provide effective and safe care which met people’s individual needs and wishes.

Staff were supported to maintain and develop their skills and knowledge by way of regular supervision, appraisals and training.

There were enough skilled, qualified staff to provide for people’s needs. The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home.

People were supported to have a healthy and nutritious diet and to access healthcare professionals when required.

People were able to raise any suggestions or concerns they might have with the manager and were listened to as communication with the manager was good.

Arrangements were in place to ensure the quality of the service provided to people was regularly monitored.

People were involved in meaningful activities in the home.