This inspection took place on 14 March 2018 and was unannounced.

West View Integrated Care Centre 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.

West View Integrated Care Centre accommodates up to 60 people in one purpose built building. The service is split into four units. One of the units specialises in providing care to people living with dementia. The remaining three units accommodate people with people on respite breaks and people in receipt of rehabilitation.

At the time of our inspection a registered manager was not in place. The previous registered manager had left their post in November 2017. 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 day to day running of the service was overseen by an acting manager.

People told us they felt safe at the service. However, we found that there were not always enough staff to meet people’s needs. Risks to people had not been assessed in a timely fashion, this led to people having accidents and serious injuries before plans had been put in place to mitigate risks. Systems to learn from incidents had not been effective making people safer. New systems had been put in place but these were too new to be assessed for effectiveness. People’s medicines were managed safely, however guidance for ‘as and when’ required medicines was not always available. We made a recommendation about this.

People’s needs had not always been assessed before they entered the service. People’s care plans had some person-centred elements. However, information was not recorded consistently and was stored in a number of folders which not all staff could access. Different systems were used across the units at the service leading to people being at risk of inconsistencies in support. We made a recommendation about this.

People took part in a range of activities. However, these could be restricted by staffing levels and would benefit from being expanded to include one to one activities for people.

The lack of a registered manager for a period of time had led to a lack of stable leadership. This had impacted the culture and oversight of the service. Audits of the quality or care delivered had been completed infrequently and these has not been effective in identifying shortfalls. Feedback from people was sought in a limited way, this could be expanded to encourage people to give their views of the service. Systems to drive improvement at the service had not been effective and had not identified issues which were impacting people’s safety and quality of support.

People were supported by staff who treated them with kindness and compassion. People’s dignity and privacy was respected by staff. Staff took the time to encourage people to eat and drink a balanced diet. People were supported to access health care support when required. When people were at the service for a short period of time there were clear goals set for them to progress. Staff worked in partnership with other agencies to meet people’s needs and to support them to return home when appropriate.

People were supported to express themselves and staff used a range of communication tools to support this. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this. Visitors were welcomed and people were supported and encouraged to maintain relationships with loved ones. When people expressed concerns or made complaints these were respon

The inspection took place on 18 May 2017. The inspection was unannounced.

At the last Care Quality Commission (CQC) inspection on 15 April 2015, the service was rated as Good in all of the domains and had an overall Good rating.

At this inspection we found the registered manager and provider had consistently monitored the quality of their service to maintain a rating of Good.

A registered manager was in post and present on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

West View Integrated Care Centre provides both adult social care and health care on the same site for up to 60 people. There were 43 people at the service at the time of the inspection. The ground floor provided accommodation and personal care for up to 30 older people, some of whom may be living with dementia. The service had been split into two units, Linden and Wittersham, to promote care consistency. Both respite stays and longer term placements for people were provided. The care was delivered in a modern environment that had been designed to enhance people’s care experience and provide flexibility in order to meet people’s longer term needs. On the first floor there are two units which each have 15 beds, Benenden East, and Benenden West. These units provide rehabilitation for around six weeks, for people who need help to enable them to return to their own home after illness, injury or self-neglect. Staffing was provided by Kent County Council (KCC) throughout the service, with the addition of NHS employees who are nurses or health care assistants, in the rehabilitation service.

The premises are a Private Finance Initiative (PFI), owned by Integrated Care Solution (East Kent Limited). Management of the premises, maintenance, laundry, domestic and catering services are sub-contracted to Shaw Healthcare.

There were enough nursing and care staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises and equipment were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

All staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans. The service was clean and a team of staff were enthusiastic in their role of ensuring practices at the service minimised the spread of any infection.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and staff supported people to maintain a balanced diet.

Staff training continued to be that matched to people’s needs effectively and nursing staff were supported with clinical supervision and with maintaining their skills and their professional registrations.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff were consistently kind, caring and compassionate, and treated people with dignity and respect. Care was personalised and staff had positive relationships with people who were actively involved in making decisions that affected their daily lives.

People’s care, treatment and support needs were assessed and guidance was in place for staff to follow to meet people’s needs.

A range of appropriate activities were available and in

The inspection visit was carried out on 15 April 2015 and was unannounced. The previous inspection was carried out in January 2014, and there were no concerns.

West View Integrated Care Centre provides both adult social care and health care on the same site. There is a residential care service with two units on the ground floor. Linden unit has 15 beds for older people requiring permanent or respite residential care; and Wittersham unit has 15 beds for older people living with dementia who require permanent or respite residential care. On the first floor there are two units which each have 15 beds, Benenden East, and Benenden West. These units provide rehabilitation for patients who need help to enable them to return to their own home after illness or injury. The residential care service on the ground floor is staffed by employees of Kent County Council (KCC), whilst the rehabilitation service on the first floor is staffed by employees of KCC, and NHS employees who are nurses and other health professionals.

The premises are a Private Finance Initiative (PFI), owned by Integrated Care Solution (East Kent Limited). Management of the premises, maintenance, laundry, domestic and catering services are sub-contracted to Shaw Healthcare.

The service is run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.

The registered manager worked closely with the manager for Shaw Healthcare to ensure that the services provided were fully integrated and benefitted the people receiving care and support.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. One application and authorisation had been made to the DoLS department for depriving people of their liberty for their own safety, and CQC had been notified about this.

Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager, or with outside agencies if they needed to do so.

The service had systems in place for on-going monitoring of the environment and facilities. This included maintenance checks, and health and safety checks. Emergency plans and personal emergency evacuation procedures (PEEPs) for people receiving support were in place. Fire evacuation procedures and the fire risk assessment were reviewed and updated yearly by both managers. Accidents and incidents were reported, and systems were in place for following these up for all people and staff using the building, so that there was a co-ordinated approach to identifying any patterns occurring, and if any risks could be lessened.

The registered manager kept staffing numbers under review for care staff and nursing staff; and the Shaw Healthcare manager reviewed the numbers of ancillary staff in discussion with the registered manager. There were sufficient numbers of staff to run the service efficiently, and people were confident that there were suitable numbers of all staff to provide them with the care and support they needed. They said they felt safe and secure in the home, and were never rushed by the staff. People and their relatives said that the home was “Always kept clean” and that the building was “Well maintained”. The service followed required infection control procedures.

There were robust staff recruitment procedures by the registered manager and Shaw Healthcare to check that staff had required checks completed, and were suitable for their job roles. Records of on-going staff training, supervision and appraisals confirmed that staff were working to appropriate standards and were supported by their line managers. All staff were encouraged to attend meetings, and to take their part in the development of the service.

Nursing and care staff ensured that medicines were stored and administered to people using safe practices. These included nursing staff on the first floor, and senior care staff on the ground floor. People told us they received their medicines on time.

People and their relatives said that they were fully engaged in discussing their care planning and formally consented to their care plans. This included discussing changes in people’s progress with rehabilitation; and any changes in people’s care or health needs who were receiving respite care. Staff showed an understanding of assessing people’s mental capacity, and when they could make decisions for themselves; and when they may need support in making more difficult decisions. Staff contacted people’s family members, health professionals and social care professionals for ‘best interest’ meetings when these were needed to support people with appropriate decision-making.

The food was well presented and a variety of dishes were provided at each meal to give people choice. All the people that we spoke to were happy with the quality of food they received and the choices given. The chefs were familiar with people’s different dietary needs and their likes and dislikes; and spoke to people to obtain their feedback about the food.

People’s health needs were assessed by nursing and care staff in the different units. Health professionals such as occupational therapists, physiotherapists and a geriatrician were involved in people’s on-going assessments to ensure that they had the maximum support possible to assist them with making progress with their health needs. Referrals were made to doctors as needed. The service contained suitable equipment to support people with their health needs, and this was serviced and maintained for safety.

Staff treated people with respect and dignity, and maintained their privacy. People were supported to sit in communal areas or to stay in their own rooms as they wished. They were able to get up and go to bed as they wished, and were encouraged to maintain their independence. This was especially noticeable on the first floor units, where people had agreed to take part in their rehabilitation and were committed to developing their mobility and dexterity, and their general health, to enable them to regain more daily living skills and increase their independence.

People’s life histories were documented in their care plans and staff were well informed about people’s previous lifestyles and the subjects that interested them. There was a programme of entertainment and activities throughout the day, which was especially helpful for people living with dementia who needed support with following their interests.

People said they would have no hesitation in raising any concerns with the staff, health professionals or the registered manager, and were confident that any concerns or complaints would be addressed. People were provided with a complaints leaflet when they were admitted to the home, and these leaflets were easily available in reception and communal areas.

People were invited to express their views every day about how they were feeling and how they felt their needs were being met. People who were admitted for short term respite care or rehabilitation were asked to complete a quality assurance questionnaire before leaving. Results from the quality assurance questionnaires were analysed and made available for people to read, and included any action taken in response to people’s comments. People receiving long term care were asked for their views on a regular basis. This included attending residents and relatives meetings. People spoke very positively about the service with remarks such as, “I am very impressed with everything, especially the staff and the environment. Both are excellent”.

Records were neatly and accurately maintained, and were up to date and correctly signed and dated. The registered manager and staff maintained a culture of continuous improvement, and several staff told us they were “Proud to work here”. Staff were informed of the ethos of the service in ensuring that people received the support they needed, and in working together for the on-going development of the service.

The residential care service was staffed by employees of Kent County Council (KCC) whilst the rehabilitation service was staffed by NHS employees and employees of KCC. We talked with six people who used the service and three visitors.

People were pleased with the quality of the care that they received. Comments we heard included, “absolutely marvellous … the kindness of the ladies (staff) almost without exception”, “they have time to understand you” and “I had heard about this place but I did not know it was as good as it is”. Visitors of people on the dementia unit were happy with the care that their friends or relatives were receiving.

People received adequate food and fluid. They were impressed with the quality of the food. “Plenty of choice”, “the food is always hot” and “it looks lovely” were comments we received from three different people.

People received the right medicines at the right time.

There were systems in place to monitor the quality of the care that was provided. Records were accurate, available and kept securely.

The residential care service was staffed by employees of Kent County Council (KCC) whilst the rehabilitation service was staffed by NHS employees who were seconded to KCC for the duration of their work.

People wanted to be at the care service. Comments included, “I love it here” and “if you want anything they get it for you”.

People consented to their care and treatment. They understood why they were at the rehabilitation service and what goals they were trying to achieve during their stay.

People were very pleased with their care. They said, “the staff are wonderful”, “very responsible and responsive care” and “staff are very careful and attentive”.

We saw that the premises were clean. People also said so, for example, “very clean, mopped daily” and “yes, very clean and tidy”.

We saw that staff were well supported and trained to carry out the tasks appointed to them.

There was an effective complaints procedure.

People told us that they liked being at the home, they said staff were caring, attentive and treated them with respect. They said staff responded quickly when they needed help with anything.

People told us they could make choices, for instance they could get up and go to bed when they chose, had choice of meals, could stay in their rooms or socialise, and were offered a variety of activities.

Overall they liked the meals, they said they were tasty and there was plenty to eat.

People told us the home was clean and hygienic and they were happy with their rooms. They liked the views over the surrounding countryside.

Everyone we spoke with was complimentary about staff and the care and support they received. People who were receiving recuperative care appreciated the input they were given to help them to regain independence.

Some comments from people were,

“Excellent, you can’t complain about anything”

“I wouldn’t go anywhere else”

“Staff take us out for walks in good weather”

“I feel safe here”

“I don’t want to go home, I want to move in and am on the waiting list”

“I feel a lot better than I did now”

“They are extremely kind”

“ I can’t grumble about the meals”