We carried out an urgent unannounced inspection of this home on 13, 14 February and 6 March 2018. At that inspection we found serious concerns about the safety and welfare of people. The registered provider had failed to; identify the risks associated with people’s care needs, ensure people were safeguarded from harm by sufficient staff who understood how to meet their needs; ensure people consented to their care and were not unlawfully deprived of their liberty; provide person centred care in line with people’s needs and preferences; ensure people were treated with dignity and respect at all times; respond to complaints in a timely and effective manner; provide effective leadership and overall management of the home. The overall rating for this service was ‘Inadequate’ and the service was therefore placed into ‘special measures.

At this inspection we found the registered provider had made substantial improvements in the standard of care provided at the home. They were compliant with the fundamental standards set out by law although further actions were required to embed good working practices in the home. The home has now been removed from ‘special measures’.

The home provides accommodation and personal care for up to 55 older people, some of whom live with mental health problems or dementia. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 33 people lived at the home.

Whilst a registered manager was in post they were planning to deregister and return to their previous role of finance manager for the home. The general manager had made an application to CQC to take on the role of registered manager for the home. 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 management team in the home promoted and open and transparent culture. This meant people, their relatives and staff felt supported and had a good understanding of the concerns which had been raised about the home and how these were being addressed.

Staff had a good understanding of their roles and responsibilities in maintaining the safety and welfare of people who lived in the home.

There were sufficient staff deployed in the home to meet the needs of people. Immediate staff training needs had been met to ensure people received safe care and a further training programme had been identified to ensure staff had all the required skills to meet people’s needs.

Risk assessments had been completed to support staff in mitigating the risks associated with people’s care. Care records held information on people’s needs and preferences although further work was required to ensure these were fully person centred. This work was in progress and included seeking the involvement of people and their relatives.

Systems were in place to support staff in recognising and reporting signs of abuse and these had been used effectively by staff.

People were valued and respected as individuals. Staff knew people well and could demonstrate how to meet people’s individualised needs. Most care staff cared for people in a kind and empathetic way, and staff were prepared to challenge other staff if they observed poor care.

The level of activities available had improved however we have made a recommendation about the introduction of more dementia friendly activities in the home.

Where people could not consent to their care, staff had sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

There was a robust system of audit in the home to monitor and review the quality and effectiveness of the service provided at the home.

We carried out an urgent unannounced inspection of this home on 13, 14 February and 6 March 2018. Before the inspection we had received nine whistleblowing concerns about unsafe practices at the home which were allegedly putting people at very high risk of harm. At this inspection we found serious concerns about the safety and welfare of people.

The registered provider had failed to; identify the risks associated with people’s care needs, ensure people were safeguarded from harm by sufficient staff who understood how to meet their needs; ensure people consented to their care and were not unlawfully deprived of their liberty; provide person centred care in line with people’s needs and preferences; ensure people were treated with dignity and respect at all times; respond to complaints in a timely and effective manner; provide effective leadership and overall management of the home.

The registered provider had failed to be compliant with all of the fundamental standards set out by law. You will find further information on the breaches of regulation we found in the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home provides accommodation and personal care for up to 55 older people, some of whom live with mental health problems or dementia. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 43 people lived at the home.

At the time of our inspection a new registered manager had been in post since January 2018. The previous registered manager remained working in the home but in the role of clinical manager. The clinical manager left the home on the second day of our 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.

On the first day of our inspection a new general manager had been in post for two weeks and told us they were planning to become the registered manager for the home. The current registered manager was planning to deregister and return to their previous role of finance manager. During our inspection we found there was a serious lack of guidance and leadership in the home to ens

This inspection took place on the 5 October 2016. The inspection was unannounced.

Westacre Nursing Home is a care home that is registered to provide care with nursing for up to 55 people. The people they support have varying needs and live with dementia. At the time of our visit, 38 people were using the services. The home is a detached modernised Edwardian property situated within a quiet residential area of Winchester. People had their own bedrooms and use of communal areas that included enclosed private gardens.

The home does not have a registered manager, but has two managers who work full-time. They have applied to the Care Quality Commission to become the registered managers of the service. 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 safety was promoted within the home. There were robust processes in place to monitor safety when giving people their medicine. The recruitment and selection process helped to ensure staff of good character supported people. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse. The provider’s whistleblowing policy was being reviewed. This was to be more user friendly and accessible for staff. There were risk assessments that identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising any risks.

Westacre had refurbishment plans in place to improve the environment. Some improvements had already taken place, which included the replacement of a lift to the first and second floors. The managers on reflection during our visit to the service were reviewing the environment to enhance the lifestyle and independence of people who live with dementia.

People were provided with effective care from a dedicated staff team who had received regular supervision to identify their development needs. Staff induction and training was provided by external sources and electronic processes. This made sure staff were supported to receive the training and development they needed to meet people’s individual needs and to pursue further learning and development opportunities.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people and their care.

Staff were held in high esteem by people and their families. They treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

Meals were nutritious and varied to meet individual needs and were being reviewed to promote choice.

People were encouraged to live a fulfilled life with activities of their choosing that were structured around their needs and individual to each person. People told us that they were very happy with the care and support they received. They benefitted from living at a service that had an open and friendly culture. There were opportunities for people to be involved in decisions about the home through formal methods such as surveys and reviews. The provider had an effective system to regularly assess and monitor the quality of service that people received.

There were 46 people living at Westacre when we visited, all of who had been assessed as having some degree of dementia.

We spoke with four people who lived at Westacre and with six relatives during our visit. We also received written feedback from seven visitors after our inspection. People and their relatives were happy with the care, treatment and support received. People we spoke with were satisfied with their care. Nearly all relatives and visitors gave positive feedback about the service. Representative comments were "attention given to my wife is of a high standard," "excellent in all respects" and "my mother is very content at Westacre and the carers are attentive to all residents' needs". We observed many positive interactions between staff and people who lived at the home during our visit.

We found that people received good personalised care, treatment and support. The service cooperated well with other providers to ensure that people who had dementia had their health and care needs met. There were clear systems in place to ensure that the service was monitored effectively.

There was 48 people living in the home on the day of the visit. We spoke to visitors and observed how care was being provided to help us understand the experiences of people using the service.

Our observations told us that people's individual wishes were considered and through observation and discussion we saw that people were respected and supported to make choices in their care.

From talking to people, their relatives and observing care we found that people were happy with the care that they received and that staff were friendly, caring and respectful and they liked the way the home was organised. We saw people receive effective and appropriate care, treatment and support.

People we spoke with said that they felt safe in the home and that they would "have no problem" to speak to a member of staff if they felt concerned. Staff were knowledgeable on safeguarding matters and recognised that many of the people they cared for were vulnerable and relied on them to protect them.

Care was delivered by sufficient number of skilled staff that understood and were trained to care for people with a variety of nursing and care needs including dementia. Relatives told us that they felt “staffing was more settled."

Systems and procedures were in place to monitor the quality of the care. People told us that although their views of the service were not formally requested they would be happy to raise concerns.

Some of the people at Westacre Nursing Home had dementia and were not able to tell us about their experiences, so we also observed care. From talking to people and observing care we found that people liked living at the home because the staff were friendly, caring and respectful and they liked the way the home was organised. They said they felt safe, their health needs were attended to and that they could access a range of activities if that was their choice.