Westbank Care Home provides accommodation along with nursing and personal care for up to 40 older people. The service is divided into four wings Bluebell, Evergreen, Rose and Daffodil. The daffodil wing provides ten beds for people requiring step down care from hospital and is part of a new project operated in partnership with the Clinical Commissioning Group (CCG). There were thirteen people living with dementia who were using the service.

This inspection was carried out on 19 April 2017 and was unannounced.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 experienced flexible and responsive care that met their needs and wishes. The registered manager had developed a creative approach to promoting engagement with the local community. Spending time with children, people from the local community and animals promoted people's emotional wellbeing.

There were sufficient numbers of staff to meet people’s needs effectively and keep them safe. Staff were recruited following robust procedures to ensure they were suitable.

People were protected from abuse and harm by staff who had received safeguarding training and who understood the procedures for reporting any concerns. Most risks to their wellbeing were assessed and appropriately managed, but we made a recommendation about checking pressure relieving mattresses.

People were asked for their consent and were enabled to make their own decisions about their care. Staff understood and followed the principles of the Mental Capacity Act 2005. People were not deprived of their liberty unlawfully. Staff encouraged and enabled people to maintain their independence in daily life.

People were supported to manage their medicines safely. People had their health needs identified in their care plan and met. People were supported to access external health care professionals to meet specific health needs. People had a varied and balanced diet and had enough to eat and drink. Staff provided sensitive and well planned care for people who were at the end of their life.

The risk of infection in the service was minimised due to safe practices and good standards of cleanliness. The premises had been recently refurbished to a high standard. They were well maintained and met people’s needs. Ongoing improvements were underway to develop a dementia friendly environment.

People were supported by a team of care and nursing staff that were skilled and competent in meeting their needs. Staff were supported in their roles and received appropriate training and development opportunities.

People and their relatives told us that the staff were kind and caring and attentive to their needs. The staff knew people well and interacted in a positive way with them that demonstrated respect for them as individuals. Staff were sensitive to people’s emotional and spiritual needs. People received care that was personalised to reflect their wishes and their needs. They were supported to take part in activities of interest to them and to continue with their hobbies.

People were regularly asked for their feedback about the service and they told us their views were listened to. People knew how to make a complaint about the service if they needed to and were confident to do so.

The registered manager provided strong and effective leadership that promoted the person centred principles of the service. Some excellent projects had been implemented recently to support people to engage with their local community and to raise awareness of the service. There were some strong plans in place to taking the service forward in the area of end of life care and with th

Westbank Care Home provides accommodation along with nursing and personal care for up to 40 older people. One wing of the service was closed for refurbishment at the time of the inspection. This inspection was carried out on 9 May 2016. It was an unannounced inspection. There were 21 people using the service at the time of our inspection.

There was not a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. A manager had been appointed to the service in March 2016. They had not yet applied to CQC to be registered.

At the last inspection on 29 January and 1 February 2016, we issued warning notices for breaches of regulation in relation to person centred care, dignity and respect, safe care and treatment, safeguarding people from abuse and improper treatment, staffing and good governance. We also found the provider was not notifying the Commission of significant events that affect people’s welfare.

At this inspection we found that the registered provider had made the improvements required by the warning notices and the requirement notice.

People were safeguarded from abuse and improper treatment. Staff were clear about how to recognise and report any signs of abuse and they were confident to do so. Staff were aware of the risks that related to each person and the plan in place to manage these.

Care and nursing staff were clear about when to raise concerns with the GP about health concerns. Staff had clear guidance in place to support people with their individual needs. People were protected by effective systems for ensuring they received the medicines they needed at the right time and in a safe way.

There were sufficient numbers of experienced and qualified staff on duty to provide the care people needed. The registered provider followed robust procedures for the recruitment of new staff. This ensured people and their relatives could be assured that staff were of good character and fit to carry out their duties. Staff had been provided with the training and supervision they needed to carry out their roles safely and effectively.

Staff spoke respectfully with, and about people. They were discreet when discussing people’s personal care needs. Individualised care plans about each aspect of people’s care had been developed. Staff were clear about people’s needs and how to meet these. However we recommend that the registered provider review the arrangements for personal care to ensure it reflects people’s wishes. People were supported to have sufficient amounts of food and drink to meet their needs. However, we found that people were not always referred appropriately to the speech and language therapists when they required support with swallowing. We recommend that that the registered provider ensure appropriate advice is sought from health professionals before decisions are made about the consistency of people’s food.

Some people who were living with dementia did not have clear plans for how staff should support them with memory loss or confusion. We recommend that the registered provider implement clear plans to inform staff how to support people to manage memory loss and confusion.

Improvements were underway to the range of activities that were provided to meet people’s social needs.

People and their relatives told us that there had been improvements to the management of the service since our last inspection. We recommend that the registered provider fully embed the improvements made to ensure a personalised service is delivered consistently to people. Audits were effective and ensured that improvements were identified and made. Where shortfalls had been identified action had been

Westbank Care Home provides accommodation along with nursing and personal care for up to 40 older people. One wing of the service was closed for refurbishment at the time of the inspection. This inspection was carried out on 29 January and 1 February 2016. It was an unannounced inspection. There were 24 people using the service.

We had received information of concern about the service from a number of sources prior to the inspection.

There was not a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. A manager had been appointed to the service in December 2015, but they had not yet applied to CQC to be registered.

At the last inspection on 24 March 2015, we asked the provider to take action to make improvements in respect of dignity, consent, governance, records and staffing. An action plan was not sent to us by the date we required when we published the final report. An action plan was submitted in July 2015 when we requested this again. The final date the registered provider had set for compliance with the breached regulations was 30 September 2015.

At this inspection we found that the registered provider had failed to make or sustain the required improvements they had outlined in their action plan.

People had not always been safeguarded from abuse or harm whilst using the service. Systems in place to reduce the risk of harm had not been effective. The risks to the welfare of people and the safety of staff had not been appropriately managed or reduced. People were at risk of developing pressure wounds and dehydration due to a lack of effective systems for reducing these risks. One person was at risk of choking and guidance to minimise this risk had not been followed.

There were insufficient numbers of suitably skilled and experienced staff deployed in the service to meet people’s needs. This meant that people waited unreasonable lengths of time for care and for their meals. Staffing numbers on occasions during December 2015 were seriously below the number required to keep people safe in the service.

Staff did not receive adequate induction or training to ensure they were competent in providing safe and effective care to people. The registered provider had not ensured that systems for the regular supervision of staff were effective to ensure they were meeting people’s needs.

Whilst we saw some examples of caring and compassionate staff we found that people were not always treated with respect or their dignity and privacy maintained. Staff were unclear how to respond appropriately to people who were confused or had memory loss.

People did not always receive a personalised service that reflected their needs and preferences. People were not supported to get up at a time they wanted. A lack of directive care planning meant that people’s needs were not always met.

There was a lack of effective leadership of the service. Audits and quality monitoring systems had not identified shortfalls in the provision of safe and effective care and plans to make improvements, following our last inspection, had not been successful.

People did not consistently have their nutrition and hydration needs met. People did not always have their health needs met in a timely way. People did not have care plans in place to enable them to improve their mobility and independence. We have made a recommendation about this.

Recruitment procedures were robust to ensure that people were suitable to work in the service.

People were provided with information about the service provided and were signposted to other services available to them.

People’s medicines were managed safely. A policy for the manageme

This inspection took place on 24 March 2015 and was unannounced.

Westbank is a care home that provides personal and nursing care to up to 40 older people. This includes people with a physical disability and some people living with dementia. There were 35 people using the service at the time of the inspection. The last inspection was carried out on 17 March 2014 when we found the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were met.

Westbank Care home is required to have 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. There was no registered manager at the service. The service had been without a registered manager since 6 March 2015. The provider had acted swiftly to appoint another manager who was yet to make an application to the Commission for registration. A registered manager from another service and the area manager had been overseeing the running of the service. They were continuing to work in the service to support the new manager.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

There were insufficient numbers of suitably qualified, skilled and experienced staff to meet people’s needs. Agency staff were regularly used to cover staff vacancies and they did not always have a full understanding of people’s needs and the care they required. Staff had not received the training, supervision and support they needed to effectively and safely care for people. Staff were not organised in a way that ensured people received care and support at the right time. People were often left waiting for unreasonable lengths of times for their meals.

Where people needed to make a decision about whether to receive a potentially lifesaving treatment, the correct process had not been followed to comply with the Mental Capacity Act 2005 to protect people’s rights.

People were not consistently treated with dignity and respect. Staff talked over people’s heads and some staff did not engage with them in a respectful way during mealtimes. There were also examples of staff treating people with kindness and compassion, for example listening to them, showing warmth and providing care at an appropriate pace. However, this was not consistent and staff did not have time to spend engaging with people in a positive way.

The service had a set of vision and values that promoted person centred care, but these were not consistently delivered by staff. The registered provider had not ensured that there were effective systems in place to monitor the quality of care and identify where the vision and values were not delivered. The registered provider had developed an action plan for improving other areas of the service and was working on completion of this.

Record keeping was inconsistent, which meant the registered provider could not check that people had received the care they needed.

People felt safe in the service and staff knew how to recognise and respond to signs of abuse. Staff were confident to “blow the whistle” on poor practice and knew how to do so.

Risks to people’s safety had been assessed and minimised. Staff knew the procedures to follow in the event of an emergency. Equipment was serviced and tested regularly to ensure it was working well.

People received their prescribed medicines when they needed them and in a safe way. The storage of medicines was cluttered and nurses were sometimes interrupted by other staff when administering medicines. We have made a recommendation about the management of medicines.

The service was kept clean and hygienic. Steps had been taken to reduce the risk of infection spreading in the service.

Staff had not received sufficient appropriate training in dementia to ensure they were confident in communicating effectively with people and meeting their needs. The environment had not been assessed to ensure it met the needs of people with living with dementia. People living with dementia had not been supported in a person centred way to take part in activities of interest to them to avoid the risk of social isolation and boredom. We have made some recommendations about the care of people living with dementia.

The registered provider and managers understood the requirements of the Deprivation of Liberty Safeguards (DoLS) and had made applications to the relevant authority where people needed to be deprived of their liberty to ensure their safety.

People enjoyed their meals and had a variety of foods and drinks to choose from. People were provided with sufficient amounts of food and drink to meet their needs.

People had their health needs met and their health and welfare monitored. Staff reported concerns to the nurses on duty who contacted other health professionals as needed.

People had been involved in planning their care when they moved to the service, but had not always been aware of changes to their plan. The new manager had begun reviewing people’s care plans with people and their families. People had been asked about what was important to them, but this information had not been used to plan their care. This meant that people did not always receive person centred care.

People knew how to make a complaint if they needed to and felt confident to do so. The complaints procedure was available in written format only. We have made a recommendation about the complaints procedure.

We found that appropriate checks had been made of staff members before they began working in the service to ensure their suitability and to reduce the risks to people using the service.

We spoke with four people that used the service, who told us they felt safe in the service and were happy with the care they were receiving. One person said “They treat me very well” and another said “I’m quite happy really”. There was a policy in place for reducing the risk of abuse to people using the service and we found that staff understood this policy and knew how to report any concerns. The provider demonstrated that they worked effectively with the local safeguarding team at Kent County Council to ensure any allegation of abuse was swiftly investigated.

Effective systems were in place for checking the suitability of staff employed to work in the service. The provider had ensured all employees had a police check and that references were checked before they started working in the service. All staff had been required to undergo an interview and to provide information about their previous employment and their qualifications.

The provider and the registered manager sought feedback from people that used the service and staff regularly. Both staff and people using the service told us they knew who they could talk to if they felt there was a problem or if they had a suggestion for how the service could be improved. The service was well led, with decisions about people’s care being made by qualified nursing staff and the clinical manager.

There were 38 people using the service at the time of our inspection. We found that people had their needs assessed and a plan put in place to meet their needs in a safe and effective way. People told us they were happy with their care. One person said “I’m very happy and the food is lovely” and a relative told us “X is very lucky to be here”. The service responded quickly to people’s health needs and ensured that people received the nursing care they needed.

Although there had been some recent difficulties providing the numbers of staff required to care for people this had been addressed and there were sufficient numbers of staff to ensure people were cared for effectively. We saw that staff were caring and patient when supporting people, however, some staff used over-familiar terms when addressing people which the manager said she would raise with the team.

The service was provided within safe and well maintained premises. The manager and the provider of the service carried out a range of quality and safety checks to ensure that people were receiving quality care and that their health and welfare were maintained.

We spoke with seven people who were using the service. Some people living there were not able to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. For example observations, reading records and speaking with relatives.

People we spoke with told us they liked living at Westbank and were involved in making decisions about their care and support. They said they were given choices about their daily routines such as when to get up and go to bed, what to eat and what to do each day.

People told us that staff were kind, polite and respectful. They said staff respected their dignity and independence. One person said “I do a lot myself, I can wash and dress, but I need help to shower”. Another person said “Staff are always there if you need them”.

Relatives told us “We are very happy with this place “and “We have got to know staff well, and they are helpful”.

People said they were comfortable living at Westbank Care Home. They said they had been involved in discussions about the help they needed and their preferred day to day routines. People said there were a range of different activities to do and that they could join in with activities if they wanted to. They said that the staff supported them as needed and looked after them well. People said they liked the food, there was a choice of menu and that they chose where to eat. They said that the home was always kept clean. People said they knew who to speak to should they have any concerns.