Woodhorn Park is a residential care home close to the centre of Ashington. The service provides care for up to 60 people, over two floors. There were 57 people using the service at the time of the inspection; with 27 people cared for on the ground floor residential unit, and 30 people in the upstairs 'Memory Lane' unit for people living with dementia.

The inspection took place on 25 January and 3 February 2017 and was unannounced. A previous inspection in September 2015 found three breaches of legal requirements.

A registered manager was 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.

At the previous inspection we found that risks to the health and safety of people who used the service had not always been assessed and mitigated. At this inspection we found improvements in this area. Individual risks to people were assessed and reviewed regularly. Checks on the safety of the premises and equipment were also carried out and staff demonstrated an awareness of maintaining a safe environment as they worked.

The premises were clean and staff were aware of procedures to follow to prevent the spread of infection. Suitable personal protective equipment such as gloves and aprons were readily available, and cleaning chemicals were safely stored.

There were mixed views about the number of staff on duty. The registered manager was staffing the service in line with the dependency assessment rating tool used by the provider, although she had identified certain times of the day that could be very busy and had requested additional staff hours. We found that staffing on the ground floor, up to and including the lunch time period was insufficient to consistently meet the demands of people in a timely manner. Immediately following our inspection additional staff hours were agreed and an additional staff member was deployed without delay to support this busy period. Due to the concerns raised about staffing we made a recommendation that staffing remains under review.

Medicines were managed safely. There were suitable procedures in place for the ordering, receipt, storage and administration of medicines. Staff competency to administer medicines safely was assessed on a regular basis, and medicine audits were carried out internally and by the dispensing pharmacy.

Safeguarding policies and procedures were in place, and staff were aware of what to do in the event of concerns of a safeguarding nature. Suitable staff recruitment procedures were in place which helped to protect people from abuse.

At the last inspection we found that support provided at mealtimes was not always person centred. At this inspection, we found that improvements had been made in this area. Staff supported people to make choices by providing written menus and visual aids. The individual needs and preferences of people were supported including people receiving meals in their bedroom. Nutritional risks were assessed and appropriate advice sought for people at risk of malnutrition.

Staff received regular training considered mandatory by the provider. Clear records of training were maintained. Additional specialist training related to people's individual psychological and physical needs was also provided. Staff received regular supervision and annual appraisal, and told us they felt well supported.

At the last inspection, we found that improvements had been made to the environment in the Memory Lane unit, for people living with dementia. At this inspection, we found that there had been further improvements with more planned. People's bedrooms were personalised and homely.

The service was operating within the principles of the Mental Capacity Act (2005) (MCA). MCA care plan

At the time of our visit the home had a nominated manager who was not registered with us. This person was off duty and the deputy manager was in charge of the home. We were later told the manager had applied to register with us.

We talked to two visitors and three people.

We found people of varied needs and abilities were all involved in making decisions about their care as far as they were able. Their representatives were also involved, where possible and appropriate. People's independence and community involvement was promoted. One person said, "I like it here, I think it is quite settled, it is working out well, I am getting to know them and they are getting to know me."

We found the provider acted in accordance with people's wishes and the legal requirements regarding people's consent to care and treatment. People's care needs were assessed and care was planned and reviewed regularly. Care was delivered safely and in line with the care plans and people were happy with their care. One person said, "This is a nice home, the staff are good, there are activities and we have a car that is used to take people out for short trips."

We found the provider had taken steps to raise staff awareness about abuse of vulnerable people, to encourage staff to report concerns and prevent abuse occurring.

We found that the record keeping ensured people had their care delivered safely and maintained confidentiality.

People who had capacity told us they were asked for their consent to care and treatment. Two visitors said that they had been asked to be involved in giving consent on behalf of a relative for the recent flu vaccination. We found that for some people who had refused treatment and care their capacity to do so had not been taken into account. Therefore it was unclear whether this was or was not in their best interests

People told us they enjoyed the food. One person commented, “The food is brilliant, it reminds me of when I was younger.” Another person said, “The food is lovely and we always have plenty to eat and drink. We can have a full breakfast." We found that people were provided with a choice of suitable and nutritious food and drink.

People and relatives, who we spoke with, told us that they were happy with the care provided. One relative said, “The place is very good, the staff are obliging, they have arranged for a walking aid so mum is more independent now, they pick up on when a doctor is needed, or an optician or chiropodist, there are trips out and things to do, we are delighted with the care Mum gets.” We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people’s complaints were fully investigated and there were enough staff to meet people’s needs. We found that some people's records were not up to date or held securely.

We spoke with people to gain their views about living in the home. People said they liked living at the home. They said staff were helpful and kind. They said they were given choices about things that were important to them, such as food and daily routines. People we spoke with said they knew to contact the manager if they had any concerns about the care provided at the home. One relative spoken with said they would like to see more activities available for people.

Woodhorn Park is a care home located in Ashington which can accommodate up to 60 people. At the time of our inspection 51 people received care from the service, some of whom were living with dementia.

This inspection took place on 15, 16 and 17 September 2015. The inspection was unannounced.

The last inspection we carried out at this service was in July 2013 when we found the provider was meeting all of the regulations we inspected at that time

A registered manager was 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.

Risks were not always appropriately managed. Some risks had been assessed and action taken to minimise the impact of those risks. However, during our inspection we saw people were at risk of tripping due to tools which had been left in a communal area of the home. Risks to people’s safety and skin integrity had also not been mitigated.

People we spoke with told us they felt safe living at the home. Staff had undertaken safeguarding training in how to recognise and respond to any potential abuse.

Accidents and incidents were analysed to determine where action should be taken to reduce the likelihood of reoccurrence. Medicines were well managed.

There were enough staff to meet people’s needs and recruitment processes had been followed to confirm new employee’s identities and previous employment details.

Staff training was up to date. Staff received basic training in dementia care. However, observations showed this training was not consistently put into place. Staff met regularly with their supervisors to discuss their role and personal development.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Staff we spoke with, including the registered manager had a good understanding of the MCA. Deprivation of Liberty Safeguards had been applied for and approval granted.

People who were able to communicate their views spoke highly of the food provided in the home. However, we saw food served to some people who were cared for in bed was not always appetising. Whilst the chef was aware of people’s individual nutrition needs, steps had not been taken to ensure these were met.

Some adaptations had been made to the environment to take into consideration the needs of people living with dementia. However, visual signage around the home was poor.

People told us staff were very caring and kind. Care records were personal and included information about what was important to people. We saw that the majority of staff responded well when people were distressed.

Relatives told us they always felt welcome at the home and people described how staff supported them to maintain relationships with their family and to be independent.

Staff had received training in end of life care, and those people who wished to, had considered and planned for how they would like to be cared for as they approached the end of their lives.

People’s needs had not always been met. We saw examples where planned care, related to people’s continence and moving and handling needs was not delivered as it was described their care records. Records showed some people received inconsistent care.

Records were not always accurate, complete or stored securely.

A range of activities were available in the home, and people we spoke with told us they enjoyed taking part in these. Complaints records showed complaints had been fully investigated and responded to. People’s feedback on the quality of the service they received was welcomed through satisfaction surveys and regular meetings.

People and relatives spoke highly of the registered manager. They told us she was approachable and that the service was well-led. Staff confirmed this, telling us she was a visible presence in the home and always available for them to talk to.

Feedback from staff was valued. They were asked to share their views on the home during regular staff meetings.

A range of audits were carried out to assess and monitor the quality of the service, however these had not identified the shortfalls in care delivery or in record keeping that we had found during our inspection. The manager acknowledged that care records audits should be carried out more frequently.

The home had built relationships with the local community.

We found three breaches of regulations. These related to the Safe Care and Treatment, Person Centred Care and Good Governance. You can see what action we told the provider to take at the back of the full version of the report.