This inspection took place on 21 and 28 November 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

The service was last inspected in October 2017 and was rated requires improvement. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at that inspection, in relation to medicines management, risk assessments, staff training, supervision and appraisal and governance processes. We took action by requiring the provider to send us plans and timescales for improving the service. At this inspection we saw improvements had been made to risk assessments, staff training, supervision and appraisal, and governance but that the provider was still in breach of regulation in relation to medicines management.

We have made a recommendation about the provider’s quality assurance processes.

Woodside Grange Care Home 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. Woodside Grange Care Home accommodates up to 121 people across five separate units, each of which have separate adapted facilities. One of the units specialises in providing support to up to 12 people with learning disabilities, one supports people with nursing needs and the others accommodate people with residential care needs or people living with a dementia. The care service for people with learning disabilities had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection 88 people were living at the service across all five units.

The service had a registered manager. 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 joined the service in February 2018 and was registered in May 2018.

We identified a breach of regulation in relation to medicines management which meant continuing and sustained improvements in governance processes were needed.

Risks to people were assessed and plans put in place to reduce them occurring. The premises and equipment were monitored to ensure they were safe for people to use. Plans were in place to keep people safe during emergencies. Accidents and incidents were monitored to see if lessons could be learned to help keep people safe. People were safeguarded from abuse. The provider had effective infection control policies and procedures. Staffing levels were monitored to ensure enough staff were deployed to support people safely. The provider’s recruitment process minimised the risk of unsuitable staff being employed.

Staff received a wide range of mandatory training to support them in their roles and were supported with regular supervisions and appraisals. 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 supported this practice. People's physical, mental health and social needs were assessed to ensure the correct support was made available to them. People were supported to manage their food and nutrition and to access healthcare professionals. The premises were adapted for the comfort and convenience of people living there.

People and relatives spoke positively about staff at the service. People were treated with dignity and respect. Throughout

This inspection took place on 3 and 10 October 2017. Both days were unannounced which meant that the staff and provider did not know that we would be visiting.

The service was last inspected in December 2016 and received an overall rating of ‘Good.’ This inspection took place due to concerns raised about someone having a recent fall. During this inspection we found falls were quite low but were all monitored with an outcome and possible reason for the fall. However, we did find one fall was not documented therefore not investigated. This was not the fall we were alerted to.

Woodside Grange is a purpose built care home for up to 121 people, which provides care for both older people with a dementia and younger people with mental health needs. There are three floors to the building, each connected by two vertical passenger lifts. All bedrooms are lockable, spacious single rooms, with en-suite facilities. The building is surrounded with private grounds and has on site car parking facilities.

The service had a registered manager. 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.

Records showed risks to people arising from their health and support needs were not always assessed and plans were not always in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. We have made a recommendation about fire drills.

Staff received medicine training and had their competency assessed. Medicines which required refrigeration were stored in a fridge, however the fridges on two units were not always maintained within the recommended temperature ranges. Records regarding medicines were not always maintained accurately as we saw gaps in the recording of administration and inconsistencies with the application of patches and there was very little evidence of the application of topical medicines.

Systems were in place to monitor the safety and quality of the service; but they were inconsistent and did not identify all of the issues we highlighted during the inspection.

Staff were not given effective supervision and there were gaps in training.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. We found the provider had taken appropriate action to comply with the requirements of the MCA and therefore people's rights were protected. At the time of inspection 51 people had a DoLS authorisation in place. However, MCA assessments were generic and not fully completed and consent was not always sought.

We have made a recommendation about mental capacity assessments.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it. However where people were on weekly weights these were not happening regularly.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and

We inspected Woodside Grange Care Home on 21 December 2016 and 11 January 2017. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We completed a full inspection of the home in August 2015 and found that that action was needed to ensure the systems for overseeing the service were effective and identified risks. Following a number of concerns being raised we conducted a focused inspection on 14 and 28 April 2016. We rated Woodside Grange Care Home as requires improvement because action was needed to ensure sufficient staff were deployed and governance arrangements were improved.

Woodside Grange Care Home is a purpose built care home for up to 121 people, which provides nursing and personal care for both older people with dementia and younger people with mental health needs. There are three floors to the building, each connected by two vertical passenger lifts. All bedrooms are lockable, there are spacious single rooms, with en-suite facilities. The building is surrounded with private grounds and has on site car parking facilities.

The home has had a registered manager in since November 2016. 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 previous inspections we found that albeit the provider had systems for monitoring and assessing the service, these had failed to identify that staff were working in silos so not using the resources effectively. It was unclear as to what systematic oversight was given to the nursing service. At the inspection in April 2016 we found that staffing levels had been reduced during then night and for 96 people who used the service up until 9pm there were 12 staff members on duty and overnight there were 11 staff members. We found these staffing levels did not meet the needs of the people.

At this inspection we found action had been taken to ensure staffing levels were now sufficient to meet people needs of the 87 people who used the service and significant improvements had been made to the way the home was run.

People told us that since the change of directors, the manager and deputy manager they were happy with the service. They felt the new team had made a lot of improvements to the home and felt the staff did a good job. We heard how people felt the home was well-run and that the registered manager was extremely effective.

We found that a range of stimulating and engaging activities were provided. There were enough staff to support people to undertake activities in the home and community. We saw people went on trips to local tourist attractions and events.

People’s care plans were detailed and tailored for them as individuals. People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful.

Staff were supported and had the benefit of a programme of training that enabled them to ensure they could provide the best possible care and support. Staff were all clear that they worked as a team and for the benefit of the people living at Woodside Grange Care Home.

The registered manager understood the complaints process and detailed how they would investigate any concerns. We heard that since they had come into post work had been completed to review all of the previous complaints to ensure appropriate action had been taken to resolve these concerns. We heard how the director of operations and registered manager were actively seeking people’s views and suggestions were acted upon. They had also promoted a refle

We inspected Woodside Grange Care Home on14 and 28 April 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. The inspection was completed because 15 people had raised concerns about the safety of the staffing levels at the home.

At the last inspection on 5, 11, and 20 August 2015 we judged Woodside Grange Care Home to be rated as good but found that action was needed to ensure the systems for overseeing the service were effective and identified risks.

Woodside Grange Care Home is a purpose built care home for up to 121 people, which provides nursing and personal care for both older people with dementia and younger people with mental health needs. There are three floors to the building, each connected by two vertical passenger lifts. All bedrooms are lockable, spacious single rooms, with en-suite facilities. The building is surrounded with private grounds and has on site car parking facilities.

The home has not had a registered manager in post since June 2015. 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 last inspection in August 2015 the registered provider had employed a new manager and they had submitted an application to become the registered manager on 11 February 2016 but this was not progressed as they left the service in March 2016. At the time of the inspection a new manager had been appointed and had been working at the home for a couple of weeks. To date the new manager has not submitted an application to be the registered manager.

Not having a registered manager is a breach of the provider’s registration conditions and we are dealing this matter with outside of the inspection process.

At the last inspection it was found that albeit the provider had systems for monitoring and assessing the service, these had failed to identify that staff were working in silos so not using the resources effectively. It was unclear as to what systematic oversight was given to the nursing service. At this inspection we found these issues remained and we again found staff were working in silos and we could not how the services in the new part of the building were monitored.

At this inspection we focused on the deployment of night staff as concerns had been raised. We found that for 96 people who used the service up until 9pm there were 12 staff members on duty and overnight there were 11 staff members.

The Maple Suite which is for Dementia nursing is staffed with one nurse and two care staff, at the time of the inspection there were 14 residents. The Sycamore Suite had one staff member on duty as at the time of the inspection there were 8 people living on the suite. Staff told us they could ask for assistance off the Maple Suite but normally found the staff were unable to provide assistance. Of the other residential suites each are staffed by two staff. Chestnut Suite which is for people with learning disabilities is staffed by two and nine people used this unit.

As found at the last inspection the staff worked as individual teams operating into each unit, which meant that staff could be working on their own with over 8 people to support. We found that many people had complex needs and the staffing levels overnight failed to ensure their needs could be met in a timely fashion.

The management team told us that the registered provider had developed a new dependency tool and they were using this to determine staffing levels. Although we asked the manager for information about how and who had developed it, the guidance for staff to follow and the underpinning mechanism for calculating the staffing levels this was not provided. In light of this lack of information we

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were protected from the risks of inadequate nutrition and dehydration and were cared for, or supported by, suitably qualified, skilled and experienced staff.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People we spoke with spoke very positively about the service. They said, "I am happy here, very happy" and "They are a great bunch, do anything for me."

In our scheduled inspection, carried out 2 May 2012, we set a compliance action in relation to outcome 21, Records. We carried out our inspection on 30 November 2012 to follow up on this compliance action and determine what improvements had been made.

We found that the Home had taken reasonable steps to improve the quality of the care records maintained for the people who used the service. We found that care records were accurate, fit for purpose and reflected the current needs of the people who used the service. We also found that records we requested were kept securely and were located promptly when needed.

One person who lived at the Home told us, "It is tops here, it really is and that is the honest truth of it, my family never thought I would settle and they are amazed at how I have."

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke to several people who live at Woodside Grange. On the whole they confirmed that they made their own decisions and had a range of choices. One person said, “Everything is hunky dory.” Another person said, “I make my own decisions, I decide my own time for getting up and going to bed. I prefer to stay in my room."

Another person said, “You do have choices at mealtimes and it is written on the notice board. Sometimes there is too much, I can’t eat it all.”

People who use the service said that they were very happy with all aspects of the service provided at Woodside Grange Care Home. They liked the welcoming atmosphere and the friendly, caring practices of staff. They felt they were well respected by staff who acknowledged and understood their individual needs and wishes. They felt safe and found that they could talk easily to staff about any concerns. They described the home as being well run. They liked the range of activities and social events on offer. They enjoyed the meals and felt happy with the quality of the catering and choices available. They were confident that their health care needs were being well met, including the arrangements for their medications and access to healthcare professionals/services. They felt they were consulted about all important matters. They felt the home was well run.

We inspected Woodside Grange Care Home on 5, 11, and 20 August 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

At the last inspection on 6 December 2013 we found the Woodside Grange Care Home was meeting the requirements of five regulations.

Woodside Grange Care Home is a purpose built care home for up to 121 people, which provides nursing and personal care for both older people with dementia and younger people with mental health needs. There are three floors to the building, each connected by two vertical passenger lifts. All bedrooms are lockable, spacious single rooms, with en-suite facilities. The building is surrounded with private grounds and has on site car parking facilities.

The home has not had a registered manager in post since June 2015. 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 provider has employed a new manager and they came into post in June 2015. At the time of the inspection the new manager was on holiday but the director of care confirmed the new manager intended to become the registered manager. To date the new manager has not yet to successfully completed an application to be the registered manager.

Not having a registered manager is a breach of the provider’s registration conditions and we are dealing this matter with outside of the inspection process.

Albeit the provider had systems for monitoring and assessing the service over the last year these had been reviewed and changed. We found that staff struggled to implement these consistently and the system did not support staff to identify when actions such as notifying CQC of incidents should be taken. We made the provider aware that failure to notify CQC of incidents is a breach of the Care Quality Commission registration regulations. Subsequently the provider has sent us all of the relevant notifications.

The system also failed to identify that staff were working in silo so not using the resources effectively. Staff told us that manager and a separate team were responsible for the operation of the nursing service. We found that the units in the newly built nursing provisions were run as completely separate services and staff within the residential unit took no note of the service. Also we found that each floor of the home was run as a separate unit and staff could not tell us what happened on other units. We found that all of the information the management staff referred to such as staff rotas, staff training, safeguarding incidents, audits only dealt with what occurred in the residential service. Staff who worked in the nursing services could not produce information management documents for their service. Therefore it was unclear as to what systematic oversight was given to the nursing service.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. People who used the service and their relatives found the staff worked very hard and were always busy supporting people. However, people did note that there had been a marked turnover of staff in recent months and found this disconcerting. We visited from the early hours of the morning and spent time with people in each of the units. We found that people required varying levels of support and to some extent the staffing levels reflected the different needs but at the time of the inspection there were staff shortages.

The home had a system in place for ordering, administering and obtaining medicines. However some improvements were needed in the way the staff managed medicines. We saw three people had been waiting to have a urine sample sent off for analysis with a suspected urine infection but as the home had run out of ‘top hats’ (the equipment needed for obtaining urine samples). Staff had waited until they arrived rather than asking community nurses to assist them or contacting the GP. Once these samples had been sent it was confirmed that the people had infections and antibiotics were prescribed for the three people. We looked at the care file for one person to determine when the antibiotics had been received but the daily notes only went up to mid-July 2015 and staff confirmed that no other information was available to confirm receipt.

Checks of the building and maintenance systems were undertaken. However we found that these checks had not ensured that cleaning materials were stored securely or that staff developed mechanisms to ensure all areas of the home were deep cleaned.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that people’s preferences were catered for and people were supported to manage their weight and nutritional needs. We found that the provider was in the process of reviewing the catering budget and menu, as they had found these could be improved.

People we met were able to tell us their experiences of the service. They were complementary about the staff and found that the home met their needs. People told us that they felt the staff had their best interests at heart and if they ever had a problem staff helped them to sort this out. They told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.

People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. Relatives discussed incidents whereby they had raised concerns and felt that initially the management staff had been slow to respond but once these concerns had been taken to the director of care the issues were resolved.

We saw there were systems and processes in place to protect people from the risk of harm. Safeguarding alerts were appropriately sent to the local authority safeguarding team and fully investigated. However, in recent months the associated notifications had not been sent to CQC. We raised this matter with the director of care and they ensured this was rectified.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. The director of care ensured that concerns were thoroughly investigated. People we spoke with told us that they knew how to complain and although they were unclear about the identity of the new manager they felt the director of care would respond and take action to support them. People were extremely complimentary about the support the director of care provided and told us that they were always accessible and available to discuss any issues at the home.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were detailed. They contained person specific actions to reduce or prevent the highlighted risk.

People told us that they made their own choices and decisions, which were respected by staff. We observed that staff had developed positive relationships with the people who used the service. Where people had difficulty making decisions we saw that staff gently worked with them to find out what they felt was best.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and clearly understood the requirements of the Act which meant they were working within the law to support people who may lack capacity to make their own decisions. We found that action was taken to ensure the requirements of the act were adopted by the staff. The provider recognised that staff needed additional support to ensure they had the skills and knowledge to consistently work with the Mental Capacity Code of Practice.

The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia and Parkinson’s disease. We found that the provider not only ensured staff received refresher training on all training on an annual basis but routinely checked that staff understood how to put this training into practice.

Regular surveys, resident and relative meetings were held and we found that the information from these interactions were used to inform developments in the home such as the change in menus.

We found the provider was breaching one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the governance arrangements. You can see what action we took at the back of the full version of this report.