Woodside Grange Care Home

The service had prepared an area as a designated setting which could accommodate up to 17 people with a positive Covid-19 status. The home had previously been able to offer between five and 10 designated setting beds but as demand had recently increased the provider had made changes to the area in order to safely increase capacity.

We found the following examples of good practice.

All visitors to the home, including visiting professionals, were asked for evidence of a recent lateral flow test. Evidence of vaccination in the form of COVID passports were also requested and temperatures taken to screen for symptoms.

The home had been successfully managing a designated setting and had demonstrated the knowledge and skills to keep people safe and avoid cross contamination. Careful thought had gone into the best way to increase bed capacity without compromising safety.

The entrance to the red zone (an area where people were COVID positive) was to be moved in order to extend the area but was still secure as there was a keypad lock on the door to prevent people from accessing it accidentally. Signs on these doors made it very clear that it was the entrance to a red zone and what that meant..

There was an entrance specifically for people arriving into the red zone of the home from hospital to avoid them passing through any other area of the home. This had been used successfully since the home first offered designated setting beds and admissions had been running very smoothly. The registered manager had built a good relationship with the hospital discharge team and no one was moved to the home without a full handover. The hospital always called ahead to let the home know when a person was being transported so staff at the home could manage their arrival safely.

The staff room and changing facilities were being relocated to maximise bed space but these were still within the red zone of the designated setting. Staff also had access to a shower within the designated setting.

The home was very clean and tidy. Enhanced cleaning schedules were in place which included regular cleaning of touch areas such as handrails and door handles to reduce the risk of cross infection. Staff working on the red zone were responsible for cleaning this area to avoid domestic staff moving between zones and keep the number of staff entering the area to a minimum.

There was a detailed infection prevention and control policy in place and regular checks were completed. Staff had received training in the appropriate use of Personal Protective Equipment (PPE) and infection prevention and control training. Information was displayed throughout the home to remind staff how to use PPE correctly and how to prevent the spread of infection.

There was a plentiful supply of PPE and additional PPE stations had been placed in the red zone to ensure staff had safe and easy access. Clinical waste bins were in place for the safe disposal of used PPE.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

The service had prepared an area as a designated setting which could accommodate up to ten people with a positive Covid-19 status. This area had previously been used as a designated setting but when demand for beds in the area reduced it was closed.

We found the following examples of good practice.

The environment had been specially adapted in order to meet the needs of a designated setting. A lot of thought had gone in to the way the unit would be safely separated from the rest of the home to minimise any risk of cross contamination to other areas. The home had been arranged into zones to avoid cross-contamination and there was clear signage to alert staff they were about to enter a ‘red zone’ (an area where people were COVID positive). There was an entrance specifically for people arriving into the red zone of the home from hospital to avoid them passing through any other area of the home.

The provider and manager had put robust plans in place to ensure people admitted to the service with COVID-19 were cared for safely. Careful thought had gone in to how food would be safely transported and how contaminated laundry would be handled. Colour coded bedding, towels and crockery had been purchased for the ‘red zone’ to avoid the risk of these items being used in any other area of the home. Equipment such as food trollies which were being moved from the red zone were cleaned and disinfected in a neutral area between zones.

There was a separate staff room, staff changing facilities and a shower for staff to use, all located within the designated setting.

The home was very clean and tidy. Enhanced cleaning schedules were in place which included regular cleaning of touch areas such as handrails and door handles to reduce the risk of cross infection. Staff working on the red zone were responsible for cleaning this area to avoid domestic staff moving between zones and keep the number of staff entering the area to a minimum.

Visits were permitted to the ‘red zone’ in exceptional circumstances, for example a relative of a person receiving end of life care. In line with government guidance essential care givers were also permitted to visit. Visitors would be required to complete a COVID-19 lateral flow test before visiting the home and appropriate levels of PPE (personal protective equipment) was provided. Alternatives such as video calls would be arranged for families who could not visit.

There was a detailed infection prevention and control policy in place and regular checks were completed. Staff had received training in the appropriate use of PPE and infection prevention and control training. Information was displayed throughout the home to remind staff how to use PPE correctly and how to prevent the spread of infection.

There was a plentiful supply of PPE and additional PPE stations had been placed in the ‘red zone’ to ensure staff had safe and easy access. Clinical waste bins were in place for the safe disposal of used PPE.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

The service had prepared an area as a designated setting which could accommodate up to ten people with a positive Covid-19 status.

We found the following examples of good practice.

The provider and manager had made changes to the environment so people who were discharged from hospital could enter the home separately. They had arranged the home into zones to avoid cross-contamination and put up clear signage to alert staff they were about to enter a ‘red zone’ (an area where people were COVID positive).

The provider and manager had put robust plans in place to ensure people admitted to the service with COVID-19 were cared for safely. Careful thought had gone in to how food would be safely transported and how contaminated laundry would be handled. Colour coded bedding, towels and crockery had been purchased for the ‘red zone’ to avoid the risk of these items being used in any other area of the home.

The home was very clean and tidy. Enhanced cleaning schedules were in place which included regular cleaning of touch areas such as handrails and door handles to reduce the risk of cross infection.

Only essential visits would be taking place in the ‘red zone’, for example a relative of a person receiving end of life care. Visitors would be required to complete a health questionnaire before visiting the home. Temperature checks were to be completed on arrival and PPE (personal protective equipment) was available for all visitors. Alternatives such as video calls would be arranged for families who could not visit.

There was a detailed infection prevention and control policy in place and regular checks were completed. Staff had received training in the appropriate use of PPE and infection prevention and control training. Information was displayed throughout the home to remind staff how to use PPE correctly and how to prevent the spread of infection.

There was a plentiful supply of PPE and additional PPE stations had been placed in the ‘red zone’ to ensure staff had safe and easy access. Clinical waste bins were in place for the safe disposal of used PPE.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Woodside Grange Care Home is a residential care home providing personal and nursing care for up to 121 people. The home supported people with varied needs in six areas, spread across three floors in a purpose-built building. This included older people, people living with a dementia and people with a learning disability or autism. Eighty-five people were using the service when we inspected.

People’s experience of using this service and what we found

The people we spoke with were very happy with the care they received at Woodside Grange. One person told us, “I’ve got everything I need here; I can’t think of anywhere else that would be suitable. Nothing could be better in my point of view; everything is here and that suits me. I’m doing well here.” Another person said, “Everything is tickety-boo here.”

People’s relatives were also happy with the home. One relative told us, “We are very pleased with Woodside; I think the home is as good as you are going to get.”

Records had improved since our last inspection. However, we found some areas that still needed more work. We discussed this with the management team and they assured us that further work would be done to make the necessary improvements. Quality checks were taking place regularly. Staff felt well supported and spoke highly of the manager.

The home was clean and tidy and safe infection control procedures were followed. Medicines were administered safely but some improvement was needed in medicines records. Risk assessments were in place to ensure staff had the information necessary to minimise risk to people. There were enough staff on duty to meet people’s needs. Safe recruitment procedures were followed.

A good selection of healthy food options were offered at mealtimes and people enjoyed the food provided. However, people’s special dietary needs were not always correctly recorded. Changes were made following our visit to improve this. The environment was homely with a number of pleasant communal areas for people to spend time and a specially adapted Covid safe visiting space. Staff had received all necessary training. External health professionals were contacted whenever required.

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

Staff treated people with dignity and respected their privacy and independence. We observed positive interactions between staff and people living at the home. One person told us, “You see the same staff and get to know them, you have a bit of a banter.”

People were involved in decisions about their care and detailed care plans reflected people’s preferences. Staff were doing their best to ensure people were kept occupied and entertained despite limits on the activities that could take place during the pandemic. People were supported to keep in touch with loved ones when they were not able to see them. Any complaints received were handled appropriately.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture in the area of the home where people with a learning disability were living. People were supported to have maximum choice and control and their independence was encouraged. People received care and support that was adapted to their individual preferences. The environment was very homely and adapted to reflect people’s likes and dislikes. Bedrooms were decorated in a very personalised way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 January 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this inspection to check the provider had followed their action plan, to confirm they now met legal requirements and see whether improvements had been made since our last inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• Systems were in place to prevent visitors from catching and spreading infections, including screening visitors before they entered the building.

• Staff had undertaken training in infection prevention and control. Staff were seen wearing appropriate personal protective equipment (PPE).

• The home supported people and staff with social distancing.

• The home carefully considered and supported the wellbeing of people and staff. Staff were able to access a number of wellbeing resources.

• Systems were in place to admit people safely into the home.

• People and staff were regularly taking part in the coronavirus testing programme.

Further information is in the detailed findings below.

Woodside Grange Care Home is a residential care home providing personal and nursing care for up to 121 people. At the time of the inspection 93 people were living at the home.

The home supported people with varied needs in six areas, spread across three floors. Each area was aimed at meeting different needs, for example the top floor provided nursing care, the first and ground floors provided residential care to people, some of whom were living with dementia. A separate area on the ground floor specialised in the support of people with a learning disability or autism.

The learning disability area of the service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, therefore the learning disability area did not meet current best practice guidance. However, the size of the building having a negative impact on people was mitigated by the way the area where people with a learning disability lived was kept as a smaller self-contained area within the larger building. This area had a separate entrance and all meals were prepared in a domestic style kitchen.

People’s experience of using this service and what we found

People’s experiences varied depending on the area of the home in which they lived. A new manager had been appointed since our last inspection. They had only been managing the home for seven weeks and had identified a number of areas that needed to be improved. This included finding a way to make sure everyone living at the home received the same standard of care.

People who received nursing care, on the second floor of the service, were not always supported in a kind and compassionate way by staff. Although people’s basic care needs were met, staff did not always take time to speak to people or respond to their requests. People on the ground floor and first floor, some of whom were living with dementia, had more positive relationships with staff.

The learning disability area was overseen by a unit manager who was popular with staff and people using the service. They had worked hard to ensure this area of the service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service in this part of the home reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Food was prepared by the staff in this area of the home. People’s records were accurate and up to date in this area of the home and people were engaged in meaningful activities they enjoyed.

Medicines were not always managed safely at the home. Although people told us they felt safe at the home risk assessments were not always in place and therefore staff did not have all the information necessary to minimise risk.

There were enough staff on duty to meet people’s needs. Staff understood the needs of the people they supported well. Safe recruitment procedures were followed.

People enjoyed the food provided. One person said, “I like the fish and chips. I’m never hungry.” However, people’s special dietary needs were not always well managed and records informing staff of these needs were not always correct.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice but accurate records were not always kept. We have made a recommendation about this.

People's care was delivered around their wishes and preferences however care plans did not always accurately reflect this.

People had access to a variety of activities inside and outside of the home and relatives were always made to feel welcome.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 December 2018). The service remains rated requires improvement. This service has now been rated requires improvement for three consecutive inspections.

At the last inspection there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was now in breach of two regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe management of medicines and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 the inspection we saw numerous examples of kind and caring support being delivered. People’s cultural, spiritual and sexual needs were considered when they moved into the service, and steps taken to maintain and promote them. Policies and procedures were in place to support people to access advocacy services.

People’s support needs and preferences were assessed before they started using the service. Most of the care plans we looked contained detailed information on how people wanted to be supported. Some care plans lacked detail on how people should be supported and the registered manager said action would be taken to address this immediately. People were supported to access information in as accessible a way as possible. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. Nobody was receiving end of life care at the time of our inspection, but policies and procedures were in place to provide these when needed.

Staff spoke positively about the leadership of the registered manager, who they said had improved the service and promoted positive values of care. People and their relatives also spoke positively about the management of the service and changes made by the registered manager. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. Feedback on the service was sought from people, relatives and staff. The registered manager and staff had developed a number of community links that benefited people living at the service.

This is the second time the service has been rated requires improvement.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicines management. You can see what action we took at the back of the full version of this report.

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 other professionals.

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

People and their relatives spoke highly of the care they received.

People had access to a range of activities, which they enjoyed. However, the activity coordinators needed support to ensure people were not socially isolated and due to the service being so large, with a large variety of activity needs. A plan was in place to provide activities on a weekend.

Procedures were in place to support people to access advocacy services should the need arise. The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had.

Care was planned and delivered in way that responded to people’s assessed needs. Plans contained detailed information on people’s past life history.

Feedback was sought from people and relatives assist with the quality of the service. However, we could not see any records of action following the feedback.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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 reflective learning culture in the home, which allowed staff to look at even the smallest of incidents to determine what lessons could be learnt.

The registered manager and staff had a clear understanding of safeguarding. The registered manager acted as a champion for people and would raise complaints and safeguarding matters when this was needed.

Where people had difficulty making decisions we saw that staff worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations.

We reviewed the systems for the management of medicines and found that overall people received their medicines safely.

People told us they were offered plenty to eat and we observed staff assisted individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. The cook provided a home cooked healthy diet and provided a range of fortified meals for people who needed extra calories to ensure they maintained their weight. People were supported to manage their weight and nutritional needs.

People were supported to ensure their health and well-being were promoted. The staff had formed good links with the Consultants, GPs, dieticians, speech and language therapists, tissue viability nurses, community nurses and the falls team.

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. The staff team was stable and a number of the staff had worked at the home for over four years.

The service had a strong leadership presence with a director of operation, a director of care and registered manager who had a clear vision about the direction of the service. They were committed and passionate about the people they supported and were constantly looking for ways to improve. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the safest and most effective way possible.

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 analysed the dependency rating scores and overall staffing calculation against documents showing the each person’s details and the dependency levels rated by the placing team and rotas the manager had supplied.

We found the individual dependency assessment concentrated on people’s physical ability. The tool did not take into account social inclusion or supporting people to deal with distress. Also the way the questions were worded favoured staff concluding that individuals who used the service were rated as having a low dependency level. The home accepts people with complex needs; younger adults with learning disabilities as well as people who required nursing care however the management team provided no information to demonstrate how this was factored into the tool.

When we compared the assessment the staff had reached with that supplied for each person we found it did not match the dependency levels and was significantly lower than the rating on peoples’ information form. We found that the ratings staff arrived at did not match the assessment made by the placing authorities; minimised dependency levels and did not reflect people’s actual needs. Using this tool we found it would be virtually impossible to rate anyone at high or very high level needs. Yet people who used the service did have very high level needs and were receiving one-to-one support because of their needs. This had led to insufficient numbers of staff being deployed at the home.

From the information supplied it was extremely difficult to establish how staffing levels were calculated and we were left unable to determine why staffing levels were set at the figures on the sheet. The staff could not explain how they used the tool to calculate the number of staff needed for the whole home or each unit. Although asked for, the registered provider did not supply any information to demonstrate how their tool had been created or checked to confirm it was accurate.

We saw that the some of the people who used the service had more complex needs and even though an additional 31 people were using the service the tool had determined that less staff were needed now than in August 2015. The management team could not explain why this was the case.

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

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."

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.