We inspected this service on 21 February 2017. This was an unannounced inspection.

Westgate House nursing home is registered to provide accommodation for up to 61 older people some living with dementia who require personal or nursing care. The home is divided into three units namely Kingfisher, Skylark and Nightingale. At the time of the inspection there were 59 people living at the service.

There was 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. The registered manager worked closely with the deputy manager as well as the area operations manager.

We were welcomed by the registered manager and head of care who were clearly happy to see us.

People who lived at Westgate House felt safe. Some people living with dementia were not able to tell us their experiences. We saw those people sought reassurance from staff and were relaxed with them. This showed they felt comfortable and safe with staff. Relatives told us they felt their family members were safe living at the home. Staff had a clear understanding of how to safeguard people and protect their health and well-being. People’s medicines were stored and administered safely.

The provider followed safe recruitment procedures and people were involved in the recruitment of staff. There were enough suitably qualified and experienced staff to meet people's needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

People were supported to express their views and were involved in making decisions about their care and were offered day to day choices. Staff sought people's consent for care and treatment and ensured they were supported to make as many decisions as possible. The registered manager and staff had a good understanding of the Mental Capacity Act 2005. Where people were thought to lack capacity, assessments in relation to their capacity had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions

People received effective care from well trained staff. Staff demonstrated high levels of knowledge and understanding required to be able to positively impact on people’s wellbeing. People received care from staff that understood the needs of people living with dementia. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.

People's mealtimes were positive and sociable experiences. Staff were innovative in the ways they supported people who were living with dementia to eat and drink and this improved their health and wellbeing. People were given choices and received their meals in timely manner. People were supported with meals in line with their care plans.

There was a calm, warm and friendly atmosphere in the home. Staff we spoke with were motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these influenced the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People had access to meaningful activities and stimulation at the home. Activities were structured to people's interests. Staff knew how to best support people and what activities and furt

We visited Westgate house on 25 February 2015. It was an unannounced inspection. We previously inspected the service on 26 August 2014. The service was meeting the requirements of the regulations at that time.

The service provides accommodation for up to 61 people and is divided into three units called Kingfisher, Skylark and Nightingale. Each unit is designed to meet the needs of people living with dementia, people who require nursing care and people who have personal care requirements.

Prior to this inspection we had received some concerns about how people’s medicine was administered, the staffing levels on Kingfisher unit and the cleanliness of the home.

Medicines on Kingfisher unit were sometimes left with people without staff making sure they had been taken. This did not follow the homes policy on the safe administration of medicines.

Although people’s needs were met on the Kingfisher unit, staff were busy and had their breaks interrupted to answer call bells. They were not always available in communal areas to support people. The manager had identified more staff were needed on this unit and had made a business case to the provider to increase staffing levels.

The home was clean and tidy and staff followed best practice in infection control but had not all attended update training in infection control.

There were plans to keep people safe in the event of an emergency. However, some staff had not attended fire extinguisher or fire evacuation refresher training in line with the providers training schedule.

People liked living at the home. They told us they felt safe and staff were kind and caring.

People

were cared for in a respectful way. People were supported to maintain their health and were referred for specialist advice as required. People were involved in their care planning. They were provided with person-centred care which encouraged choice and independence. Staff knew people well, understood their individual preferences.

People were supported to have their nutritional needs met. People liked the food, regular snacks and drinks were offered and mealtimes were relaxed and sociable. People who had lost weight had a plan in place to manage their weight loss and were referred for specialist advice.

People felt supported by competent staff. Staff felt motivated and supported to improve the quality of care provided to people and benefitted from regular supervision, team meetings and training in areas such as dementia awareness.

People told us they enjoyed the many and varied activities. People who were living with dementia benefitted from an interesting and stimulating environment.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. People, relatives and staff were complimentary about the registered manager and the management team. The registered manager sought feedback from people and their relatives and was continually striving to improve the quality of the service. There was an open culture where people and staff were confident they could raise any concerns and these would be dealt with promptly.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see the action we took and what action we told the provider to take at the back of the full version of the report.

We saw evidence in individual care plans and notes of group meetings that the provider respected and involved people. We observed people were treated with respect. People told us "everybody is good to you" and "we don't need to worry about anything".

We found that there was a variety of activities available. The provider provided personalised care, treatment and support. Peoples needs were assessed with appropriate plans drawn up and implemented. We found that people were supported in a manner that was consistent with these plans.

There was guidance in the home on safeguarding people from abuse. Staff members knew how to report concerns regarding abuse. The provider had responded appropriately to allegations of abuse. People told us they felt they would be listened to if they had any concerns regarding the way they were treated.

Through looking at staffing levels, training records and speaking with the provider we found that there was sufficient qualified, skilled and experienced staff to provide care and support for people. We were told by one staff member that "the teamwork is good".

We found the provider sought the views of people and their family representatives and made changes as a result. The provider told us they tried to be open and transparent so that they could learn and improve. We found the provider had a comprehensive system in place for assessing the quality of the service provided to people and had a system for continually trying to improve.

We observed staff interacting with people in a kind, calm and professional manner. Staff spoken with were knowledgable about their role and the needs of people who use the service.

People told us "l feel very fortunate to be in this home, staff are very helpful and give me plenty of time","brilliant staff, if I have to be in a home then this is where I want to live","the food is very good","always plenty to do, we have an excellent activities person" and "never needed to complain as this is like living in a five star hotel".

The home had a copy of the Oxfordshire Safeguarding Adults procedure, available for staff to refer to. Staff we spoke with were clear about the procedure to take if they suspected that abuse had taken place. People and their relatives told us that if they had concerns or complaints they would speak to their key worker or senior member of staff.

Medication administration was given by a RN on the nursing unit. On the other two units, medication was administered by care leaders, who had received appropriate management of medication training and had successfully demonstrated their competence.

We were told that staff turnover was low, as most staff felt the home was a good place to work.

We saw evidence that regular audits were carried out each month by a senior manager of the Trust. We examined a sample of audits completed. The audits and action plans were detailed and well documented.