This inspection took place on 3 July 2018 and was unannounced.

Woodbine Manor Care Home is registered to provide accommodation and care for up to 29 older people who live with dementia. It is situated in a residential area of Bognor Regis in West Sussex. At the time of this inspection, there were 29 people living at the service. Woodbine Manor is a ‘care 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.

The service is purpose built and accommodation is provided over two floors in single occupancy rooms. A passenger lift provides access between the floors. There is a dining room on the ground floor and two communal lounges, one on the ground floor and one on the second floor.

We observed seating areas along the hallways where people could rest. Books were available to read and windows where people could sit and look outside. Two resident cats, Daisy and Dylan, were popular with people living at the service. In June 2017 the service installed a replica pub in the garden for people to use.

The appointed manager registered with the Care Quality Commission in February 2017. 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 registered manager was not present during the inspection visit; however, we spoke to them after the inspection.

When we completed our previous inspection on 17 February 2017, we found concerns relating to there being no systems in place for auditing care plans and people’s behaviour monitoring charts had not been fully completed. Systems to assess, monitor and improve quality and safety of the service, ensuring people's needs were properly monitored and reviewed to inform their care planning, were not effective. After this inspection the provider sent us an action plan describing what they had done to ensure compliance with the legal requirements.

On 3 July 2018 we found that the provider had followed their action plan and had made significant improvements. Robust management systems were now in place to assess, monitor and improve the quality of the service. Incidents and accidents were recorded and reviewed and risk assessments for people contained advice and guidance for staff on how to manage and mitigate potential risks to people.

Staff were trained in adult safeguarding procedures and knew what to do if people were at risk of abuse or if they needed to raise a concern. People told us they felt safe at the home.

There were sufficient staff to meet people's needs and keep them safe. The registered manager used a dependency tool to determine staffing levels. Information was reviewed following falls or changes in a person's health condition.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and people were encouraged to make decisions about their care and treatment. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The members of the management team and care staff we spoke with had a full and up to date unde

The inspection took place on 20 February 2017 and was unannounced.

The inspection was brought forward due to concerns the Commission was notified about in relation to the care and support people received. We had also been informed that the service had experienced another management change. Since September 2015, Woodbine Manor Care Home has had three management changes. At the last inspection in May 2016, the service was meeting the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, but some improvements were still required. We had rated the service as Requires Improvement overall, because although significant improvements had been made to address previous shortfalls raised at the inspection in October 2015, where the service was rated as Inadequate, these improvements were yet to be embedded and sustained.

Woodbine Manor Care Home is registered to provide accommodation and care for up to 29 older people who live with dementia. It is situated in a residential area of Bognor Regis, West Sussex. At the time of this inspection, there were 18 people living at the service. The home is purpose built and accommodation is provided over two floors in single occupancy rooms. A passenger lift provides access between the floors. There is a communal lounge and dining room on the ground floor. On the first floor is another lounge, which is more private and used when the hairdresser visits on a weekly basis. We also observed other seating areas along the hallways where people could rest, where books were available to read and windows where people could sit and look outside. Two resident cats, Daisy and Dylan, were popular with people living at the home.

A new manager was appointed in October 2016. The appointed manager registered with the Care Quality Commission in February 2017. 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 the subject of a safeguarding enquiry by social services following one incident in August 2016. The previous registered manager, current registered manager and staff had worked closely with social services. They had taken steps to make improvements and follow recommendations to enhance the quality and safety of the service. Woodbine Manor was providing a safe service and we observed people receiving support in line with their needs and preferences.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and people were encouraged to make decisions about their care and treatment. The provider had installed CCTV in all communal areas but it was not clear what the use of CCTV was trying to achieve and how people had been consulted before and after it was installed. We have made a recommendation in the effective domain about the use of CCTV for surveillance purposes to ensure that it is proportionate, fair and complies with relevant legislation to protect people’s rights and privacy.

At the last inspection, the management team had identified the need to improve the standard of care planning within the service. For example, whilst we found that people received appropriate care, this was not always reflected in the care plans, which contained unclear information and guidance to staff. The management team had plans to develop the care plans on a new electronic system, to ensure they were comprehensive and up to date. Following the inspection, the previous registered manager informed us this would be completed by September 2016. At this inspection, whilst we could see that all care plans had now been transferred onto the electronic system, they still contained unclear information and guidance to staff. However, we found that staff demonstrated sound knowledge of people’s needs and

Woodbine Manor Care Home is registered to provide accommodation and care for up to 29 older people who live with dementia. It is situated in a residential area of Bognor Regis, West Sussex. At the time of this inspection, there were 21 people living at the service. The home is purpose built and accommodation is provided over two floors in single occupancy rooms. A passenger lift provides access between the floors. There is a communal lounge and dining room.

We previously carried out an unannounced comprehensive inspection of this service on 5 and 6 October 2015. At that inspection, a number of breaches of legal requirements were found. As a result, the service was rated ‘Inadequate’ overall and the provider was placed into Special Measures by CQC. We met with the provider to discuss our concerns and issued three Warning Notices, which required the provider to take immediate action in relation to assessing the risks to the health and safety of people, safeguarding people from abuse and improper treatment and the effective governance of the service.

Since our last inspection, we have continued to engage with the provider. We required the provider to submit regular action plans that updated us about the steps they had taken to improve the service. At this inspection, we confirmed that the new registered manager and provider had taken sufficient action to address previous concerns and comply with required standards. As a result, the provider has complied with the Warning Notices and requirements we issued and had sustained improvements across all domains.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there were sufficient improvements made to take the provider out of special measures.

Following our last inspection, the registered manager at that time left the service. The provider appointed another manager in October 2015.The appointed manager registered with the Care Quality Commission in December 2015. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Since our last inspection, the service had experienced a period of considerable change. It was evident that the new registered manager had effected improvements to the leadership of the service. Although significant improvements had been made to address previous shortfalls raised in our last visit, Woodbine Manor is on an improvement journey and these improvements were yet to be embedded and sustained.

The recent focus had been on changing the culture at Woodbine Manor. Other areas of improvement had been identified, but not wholly implemented. For example, the management team had highlighted the need to improve the standard of care planning within the service. For example, whilst we found that people received appropriate care, this was not always reflected in the care plans, which contained unclear information and guidance to staff. The management team had plans to develop the care plans and a new electronic system, to ensure they were comprehensive and up to date.

The service had a relaxed and friendly atmosphere. Staff were kind and caring towards people and upheld their privacy and dignity at all times. Staff had a good understanding of people's needs, engaged with, and supported them effectively.

We found the environment offered a range of ‘dementia-friendly’ features to support people with visual, hearing and mobility impairments associated with dementia. These included furniture in a contrasting colour to the carpeting, wardrobes and chests of drawers with easy to use openings and warm colour tones used on walls, which were easier to see. The service had matt surfaces and slip resistant flooring; avoiding pa

We spoke with three people who lived at the home. They were satisfied the care and support they received and were happy living at Woodbine Manor Care Home. One person told us, "This place is top class. I couldn't ask for more". Another said, "The staff are lovely and very caring". A visitor said,"When we first walked into the home, we knew it was the one for them (family member)". We noted that the home provided a wide range of social events and activities; the people we spoke with were happy with the number and variety of activities on offer.

We saw that people's privacy and dignity were respected and that they were involved with their care as much as practicable. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from the risks associated with poor medication management. We saw that medicines were properly handled and administered in line with the providers policy. We noted that staff were properly supported to carry out their duties. We also found that systems were in place for people and relatives to make a complaint about the service if necessary.

The people that lived at Woodbine Manor Care Home had dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had we spent time observing what was going on in the home, how people spent their time, the support they received from staff and whether they had positive outcomes.

We spoke with four people who lived at the home and all those spoken with said they were happy at the home. One person said “The staff are very nice and always treat me well”.

Another person said “I am well looked after”.

We also spoke to four visitors who were at the home during our inspection visit. They told us that their relatives were supported by staff to receive the care they needed.

Staff said that they would always respect people’s wishes and when asked what they would do if they felt there may be a conflict between a person’s wishes and their care needs they told us that they would speak with the manager.

The people that live at Woodbine Manor care home have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We spent 40 minutes watching people in one of the lounges and found that overall people had positive experiences. The staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own. The support that we saw being given to people matched what their care plan said they needed.

All people who we were able to have a conversation with said they were happy with staff and the care they received.

The inspection took place on 5 and 6 October 2015 and was unannounced. Woodbine Manor Care Home is registered to provide accommodation and care for up to 29 older people who live with dementia. It is situated in a residential area of Bognor Regis, West Sussex. At the time of this inspection, there were 27 people living at the home. The home is purpose built and accommodation is provided over two floors in single occupancy rooms. A passenger lift provides access between the floors. There is one communal lounge and dining room.

During our inspection the registered manager was present. 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 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 on 16 and 17 October 2014, we asked the provider to take action to improve as a result of breaches of regulations relating to quality and safety including notifying CQC of incidents, safe staffing levels, consent to care and treatment, respecting and involving people in their care and treatment, cleanliness and infection prevention and monitoring the quality of the service. At this inspection we found that some improvements had been made, however we found that other requirements were not met and new concerns were identified.

People’s safety was compromised in many areas. Risks to people’s health, safety and well-being had not been mitigated and staff had not followed risk management strategies set out in people’s care plans. People were at high risk of receiving unsafe care. Some staff had not received recent vulnerable adults safeguarding training and lacked insight into what might constitute institutional abuse and neglect by omission of care. Whilst staff were safely recruited there were not enough staff to meet people’s needs. The majority of staff had not completed training in many key areas. Staff did not have updated knowledge to ensure they carried out their role effectively. The staff felt that staffing was an issue and that the provider was aware of this. Some staff had received an appraisal of their work performance and most had received regular support and supervision. However this had not always been effective in identifying inconsistencies in staff knowledge and practice.

People were not given appropriate support at mealtimes and staff focussed on tasks rather than interacting with people they were supporting. There were unsafe practices at meal times and throughout the inspection, with variations in food consistencies given with little information about the risks and rationale for this. Therefore people may have been at risk of choking or receiving food in a way which did not meet their needs or preferences. People told us they felt rushed.

Staff were not consistently responsive to meet people’s healthcare needs.

The majority of the staff had completed training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Applications had been made to the local authority for DoLS and some assessments had been carried out of people’s mental capacity. Some information in people’s care plans was out of date and not reflected in the applications made to local authorities for DoLS. We identified one person whose rights may not have been protected because the registered manager had not assessed their capacity to consent to receiving care in bed and had not considered whether they had their liberty deprived unlawfully.

Some staff practices showed a lack of respect for people and did not promote their privacy and dignity. We had to intervene on several occasions to ensure people received safe and appropriate care. There were few opportunities to engage in activities and people were seen sitting in the lounges or their bedroom with no meaningful activity or positive interaction taking place. Whilst people had an individual care plan, there was no evidence people or their families had been involved in reviews of their care. Care plans had not always been updated in line with people’s changing needs and staff did not follow the plans when delivering care. People were at risk of harm because the service failed to respond promptly and appropriately to their care needs.

The management of the service was inconsistent and lacked continuity. There were no effective systems or processes in the home to ensure that the service provided was safe, effective, caring, responsive or well led.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Within four working days of our visit at the service the registered manager handed in their notice with immediate effect and is now no longer working at the service. The home was being managed by the deputy manager and supported by another service manager with the oversight of the provider.

The significant concerns we identified at this inspection have been shared with the local authority safeguarding team and commissioning to alert them to the risks to people using the service.

During this inspection we found the provider was in breach of several regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014, some of which were continued concerns from our previous inspection. You can see what action we have asked the provider to take at the back of the full version of the report.