Woodview House Nursing Home is registered to provide accommodation and personal care for a maximum of 24 older people with a diagnosis of dementia and/or mental health needs. At the time of our inspection, there were 17 people living at the home. Our inspection took place on 8 March 2017 and was unannounced.

At our last inspection in February 2016 we identified that improvement in a number of areas in all the key questions was required. The provider was also in breach of the regulations as they had failed to notify us of Deprivation of Liberties Safeguards authorisations. We found on this our most recent inspection; the provider had made the necessary improvements.

There was a manager in post at the time of our inspection and we saw that they were in the process of registering with us. 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's medicines were administered as prescribed. Electronic and paper copies of medicine administration records in use did not match in relation to people’s prescribed medicines. Guidance for staff in relation to ‘as required’ medicines needed to be more robust. There were sufficient numbers of staff available to keep people safe and meet their needs. Staff had received training in keeping people safe and understood their responsibility to report any observed or suspected abuse. Staff were knowledgeable about the risks associated with people’s care and support; risk assessments and management plans were in place to manage any identified risks.

Staff received a good level of training and a comprehensive induction to ensure they were effective in their roles. The principles of the Mental Capacity Act (MCA) 2005 were being followed as the provider was ensuring that when people lacked mental capacity they were being appropriately supported to consent to their care. People were supported to access food and drinks of their liking and were offered choices. People were referred to other health care agencies for support and advice if they became unwell or their needs changed.

Staff were kind, caring and engaged well with people. Interactions and communication between people and staff demonstrated that they knew people well and were able to reassure them when they were in need of reassurance. Relatives spoke positively about the care and support received by their family member. Staff respected people's privacy and encouraged them to be as independent as they were able. People were supported to maintain relationships with people that were important to them.

Care was personalised and met people's individual needs and preferences. People and their relatives were involved in the assessment and planning of care. The provider had a complaints procedure and people told us they felt they could approach the management with concerns and they would be dealt with.

The provider had acted appropriately to address areas requiring improvement in relation to issues raised with them. Staff were well supported in their role and demonstrated a clear passion for their work. Management of the service provided staff with the support required for them to deliver effective care. Staff benefitted from regular supervision and meetings. People and relatives were actively encouraged to provide suggestions and opinions about the service, this included through regular meetings and surveys supplied to them for their completion. Staff could make suggestions and give their opinions openly to the manager.

Woodview House Nursing Home is registered to provide accommodation and personal care for a maximum of 24 older people with a diagnosis of Dementia or mental health needs. At the time of our inspection, there were 23 people living at the home.

Our inspection took place on 3 and 4 February 2016 and was unannounced. Our last inspection took place in April 2014 and the provider was compliant in all areas inspected.

There was no registered manager in place at the time of our inspection. However, there was a manager registered for the service. As part of the conditions of their registration, the provider is required to have 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. We saw that recruitment was on-going to find a new registered manager.

The provider has a legal responsibility to notify us when someone is being deprived of their liberty but had not notified us of a number of Deprivation of Liberty authorisations. This meant that the provider was not meeting the legal requirements of their registration. You can see what action we told the provider to take at the back of the full version of the report.

People were not always supported in a safe way as information about the risks posed to people were not always communicated to staff effectively.

We saw that staff were able to identify types of abuse and knew the actions to take if they suspected someone was at risk of harm.

There were errors in the recording of what medication had been given to people which meant the provider was unable to evidence that medication had been given as prescribed.

Staff were not always aware that people had Deprivation of Liberty Safeguards in place and so were not able to demonstrate how they support people in line with their DoLS authorisations.

People were not always given choice at mealtimes. Details of the meals people could choose from were not displayed in a way that would support people to understand their choices.

Staff were not always caring in their interactions with people. We saw that that there were long periods of time where staff could have been interacting with people but did not.

We saw that there were a lack of activities available for people. Staff told us that the activities that were available were not appropriate for the abilities of the people living at the home. We saw that staff responsible for doing activities were often completing other tasks.

Quality assurance audits completed by the manager did not always identify areas for improvement and where issues had been identified; action had not been taken to reduce the risk.

We saw that there were sufficient amounts of staff available to meet people’s needs. Where staff shortages were identified, there were systems in place to ensure temporary staff were used.

Staff were supported in their role as they received an induction and training to give them the knowledge required to support people. However, the training was not implemented effectively to ensure staff had the skills needed to support people in a way that kept them safe.

People were supported to maintain their health and well-being by having access to healthcare professionals when required.

People were encouraged to make decisions about their care. If they were unable to their relatives were involved in how their care was planned and delivered.

People knew how to make complaints. Where a complaint had been made, this was investigated and resolved by the manager.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what relatives of people using the service and staff told us, what we observed and the records we looked at. At the time of our inspection we were not able to speak to people who lived there and instead spoke to staff and relatives and spent time observing people in their living environment and interactions with staff.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. A relative told us "I'm really happy. Staff are wonderful."

Staff records demonstrated that mandatory training was up to date and that staff were trained sufficiently to meet the needs of people who lived there. Staff were trained in caring for people with challenging behaviour and managers and team leaders were trained in Deprivation of Liberty Safeguards. Where authorisation had been granted for a Deprivation of Liberty Safeguard, the registered manager was able to explain how this was in the best interests of the person and how the person's relatives or next of kin had been involved alongside specialists in agreeing to the application.

Is the service effective?

Relatives told us that they were happy with the care that was delivered and that people's needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home. The home had provision to use agency staff who were trained to the same standard as permanent staff and who regularly worked at the home to maintain consistency.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff took into account the complex needs of people when planning activities and the home had three activity coordinators. A relative told us "Staff don't give up. They keep going even when the person can't show their appreciation." Staff said that they were very happy with the level of professional and emotional support they received from the management team.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences and interests and life maps were used to help staff understand each person's personality and emotional state. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and robust quality assurance processes were in place. A relative told us "For the first time in years I can sleep at night. I feel safe leaving my relative here." Food was supplied by a specialist caterer who was able to meet the complex nutritional needs of people. Staff told us that they were clear about their roles and responsibilities and that management support was of a high standard and helped them to do their job effectively.

There were 18 people living at the home at the time of our inspection. We spoke with four relatives, five staff, and the deputy manager. We did speak to people who lived at this home, but due to their complex support needs we were not able to use their comments.

Relatives we spoke with were happy with the care provided. One relative told us, “I have peace of mind that my relative is cared for and is safe”. Another relative told us, “Care here is great, very gentle and supportive. The staff include me in the reviews of the care package”.

We saw that improvements have been made with the way staff engaged with people. We observed staff explaining to people about the personal care tasks that they were going to undertake, and they offered reassurance when this was needed.

Staff knew about the needs of the people they were caring for. We looked at care records for three people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

We found that arrangements were in place to ensure that people were safeguarded from harm.

We found that a training plan was in place to ensure staff had access to the required training to enable them to deliver care to an appropriate standard.

The relatives we spoke with confirmed they knew how to make a complaint if they needed to. This meant systems were in place to enable people or their relatives to raise any concerns they may have.

There were 20 people living at the home at the time of our inspection. We spoke with four relatives, four staff, and the deputy manager. The safe handling of medicines was assessed by a pharmacist inspector. They spoke with three members of staff, looked at the storage of medicines and 20 people’s medicine records.

We saw times when staff engaged positively with people as well as times when they did not. We observed times when people’s dignity was not always being respected by the way staff supported them with tasks. This means that people did not always receive support that was respectful and promoted their dignity.

We saw that people’s needs were assessed, and care plans were in place. This ensures they receive support in a way they prefer.

Relatives we spoke with were happy with the care provided. One relative told us “I think my relative is well looked after, I couldn’t ask for more”. Another relative told us “The care is excellent; I think the staff are good, I have no concerns”.

We found that the medication systems in place ensured people received their medication as required.

We found there was enough staff available to meet people’s needs.

We found gaps in the training records which meant that staff may not have all of the required skills and knowledge to meet people’s needs.

We found that there were some systems in place to monitor the quality of the services, and make improvements where required.