This comprehensive inspection took place on the 31 December 2018 and 2 January 2019, and was unannounced. Woodlands Retirement Residence 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. Woodlands Retirement Residence accommodates up to 19 people across two adapted buildings. At the time of our inspection 17 people were living at the home.

At the last inspection in June 2018, we judged that improvements were required in delivering a safe, effective, caring, responsive and well-led service. We found the provider continued to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. In addition, the registered provider was failing to comply with Regulations 9 (Person centred care), 10 (Dignity and respect), 11 (Need for consent), and 13 (Safeguarding service users from abuse and improper treatment).

After our inspection in June 2018 we met with the provider to stress the level of concerns we had about the service. We imposed a condition on their registration, (a condition is one of our enforcement powers). This required them to be compliant with regulation 17 related to governance and effective systems to monitor the quality and safety of the service. As part of this condition, the provider has been required to submit monthly reports to us at the Commission so that we can monitor their progress in improving the key questions ‘Safe, Effective, Caring, Responsive and Well-Led' to at least good.

We also placed the provider in 'special measures' because the management of the service was inadequate at the February 2018 and June 2018 inspections. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, we inspect the service again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

This inspection on 31st December 2018 and 2nd January 2019, was conducted to assess if there has been improvement.

At this inspection we saw action had been taken to address all the areas of concern, but some improvements were still needed and those made needed to be sustained.

Risks to people’s safety had been identified and plans were in place and followed by staff to support people safely. Staff had been provided with training in how to protect people from abuse and the process for reporting any concerns was now accessible to staff. Staff recruitment had improved with checks on the required documentation made. People received their medicines as prescribed and the arrangements for administering, storing and checking people’s medicines had improved. Staffing levels had improved to meet people’s needs but these levels had not been maintained across all shifts. The provider was recruiting to fill staff vacancies and needs to ensure the required levels of staff are consistently in place. Equipment and supplies to the service were checked and maintained safely. However, further improvement was needed on acting on fire safety within the environment.

At the last inspection we found people's capacity was not always assessed and considered when decisions were made. At this inspection we found the provider was applying for authorisations where people lacked capacity and needed their liberty restricted for their safety. People enjoyed the meals provided although promoting choices around cooked breakfasts for people unable to make a choice needed further improvement. People were supported to drink enough and risks of dehydration were monitored but needed review. There had

This unannounced comprehensive inspection took place on the 12 and 13 June 2018. Woodlands Retirement Residence 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. Woodlands Retirement Residence accommodates up to 19 people across two adapted buildings. At the time of our inspection 16 people were living at the home.

At the last unannounced comprehensive inspection in February 2018, we judged that improvements were required in delivering a safe, effective, caring, responsive and well-led service. We found the provider continued to be in breach of the regulation related to governance. This was because the registered provider had failed to establish and operate effective systems to ensure compliance with the regulations, or to monitor the quality and safety of the service. In addition the registered provider was failing to comply with Regulations 9 (Person centred care), 10 (Dignity and respect), 11 (Need for consent), 13 (Safeguarding service users from abuse and improper treatment) and 18 (Staffing) . After our inspection in February 2018 we served Warning Notices to the registered provider which required them to be compliant with these regulations by 6 April 2018. A Warning Notice is one of our enforcement powers. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe, effective, caring, responsive and well-led service’ to at least good.

At this inspection we found the required improvements had not all been made since February 2018. Some of the improvements we had identified as required at our previous comprehensive inspection in February 2018 were on-going or had not been made and the provider remained in breach of several regulations. Despite previous inspections identifying shortfalls in governance systems, we found that insufficient progress or improvement had not been made to the systems and processes to audit and improve the quality of care provided at Woodlands Retirement Residence and to meet the Regulations. We are considering what further action to take.

There was a registered manager in post who was present throughout the 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.

Risks had not always been assessed to keep people safe and protected. There was insufficient guidance available for staff to ensure that people’s conditions were managed appropriately to protect people from potential risks. Most staff knew how to protect people from abuse. Staff recruitment was not robust. People received their medicines as prescribed but the management of medicines was not effective.

People’s capacity was not always assessed and considered when decisions needed to be made to ensure their rights were protected in line with legislation. The registered provider had not ensured that the staff team knew which people were subject to a Deprivation of Liberty Safeguards (DoLS). People had access to a variety of food and drink to maintain good health. People were supported when necessary to access a range of health care professionals. Health care records did not contain sufficient information and guidance for staff to follow. People felt staff had the skills and experience to care for and support them, but staff did not always receive the training they needed to support people effectively and in-line with current guidance.

People were supported by staff who they described as kind and caring. However, we saw instances when

This unannounced inspection took place on 14 February 2018. At our previous inspection in December 2016 we had concerns about the quality of care and the management of the service. We found a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. At this inspection we found that the provider was still in breach of Regulation 17 and we found a further five breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

Woodlands Retirement residence 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 accommodates 19 people in one building. At the time of the service 17 people were using the service.

There was a registered manager who was also the registered provider. 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 had not responded and improved the quality of care following our previous inspection and feedback. There was a culture of keeping people safe by restricting their freedom to be independent.

The registered manager did not always follow policies and guidance to ensure people were receiving care that met their individual needs. Staff did not always feel the registered manager was approachable and staff or people were not involved in the running of the home

Risks to people were assessed and lesson learned however actions taken to reduce the risks were restricting people's freedom. There were still insufficient numbers of care staff to maintain people's safety. The registered manager had not recognised and responded to potential safeguarding injuries.

The principles of the Mental Capacity Act 2005 were not being followed to ensure that people were consenting to their care at the service.

People's needs had been assessed however staff did not always have the information they needed to care for people effectively. Staff received training and supervision however they did not feel supported by the registered manager.

The environment was well maintained and nicely presented however consideration to supporting people living with dementia required further action.

People were not always treated with dignity and respect and their right to privacy was not always upheld. People were not always involved in making decisions about their care and support.

People were not all receiving care that was person centred and that met their individual preferences.

People's medicines were safely stored and administered and the infection control procedures in place prevented the spread of infection.

People's nutritional needs were met and they had access to a range of health care agencies when their needs changed or they became unwell.

There was a complaints procedure and people felt able to complain.

People's end of life wishes were noted and when necessary they were cared for to ensure a comfortable and pain free death.

The inspection took place on 6 and 7 December 2016 and was unannounced. This was the first rated inspection of this service since it registered with us in December 2015. The registered manager and provider of this service was the same under a different company name.

Woodlands Retirement Residence is registered to provide accommodation and support for 19 people who have conditions related to old age and /or dementia. On the day of our inspection there were 17 people living at the home. There was a registered manager in post who was also the provider. 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.

People told us they felt safe living in the home. Staff were able to explain the actions they would take to keep people safe from harm, but had not received the appropriate safeguarding training. People were able to receive medicines for pain relief when needed, but the medicines were not always being administered safely. The provider did not have a dependency tool in place to be able to identify and demonstrate they had sufficient staff to meet people’s assessed needs.

While staff had received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards, further training was still needed as they were unable to explain how people who lacked capacity their human rights would be protected. Staff were not able to access a good level of support by way of regular supervisions or staff meetings.

While the majority of staff showed that they were caring and kind, it was important that this was demonstrated at all times as we observed a member of staff shouting at a person. The environment of the home was warm and welcoming.

We found that people were encouraged at the point of receiving support from staff to make choices and decisions as to how staff supported them. People’s privacy and dignity was not always being respected.

We found that while there was an assessment and care planning processes in place there was not sufficient information being gathered to ensure people’s needs were met appropriately. We found that while reviews were taking place they were not happening on a consistent basis and there was no evidence to show that people were involved in the process.

We found that the provider was unable to show how people were able to socialise or take part in activities that interested them. Information about people’s interest and hobbies was not being gathered to enable them to take part in things they like to do. The provider had a complaints procedure in place but there was no process for logging complaints.

The provider carried out spot checks and audits on the service however these were not sufficiently effective enough to identify areas for improvement.

The provider used quality assurance surveys to gather some views on the service. However it was unclear how people who lived with dementia shared their views and how any identified actions were discussed as part of making the required improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.