About the service: Westcliff House is operated by the registered provider Mrs Christine Dodge. It is registered as a care home without nursing to provide accommodation for up to 34 people living with learning disabilities and/or mental health needs. The service is divided into two wings. The Sidborough Wing provides a more traditional care home setting substantially for people with learning disabilities, some of whom are older people who have lived there for many years. The Roborough wing is set up as individual flats for people living with learning disabilities or long term mental health needs. At the time of our visit there were 29 people living at the service.

People’s experience of using this service:

People told us they felt safe living at Westcliff House. People had close and respectful relationships with the staff, registered manager and provider. People’s independence and rights to make choices about their care were respected. People were happy with their accommodation and we saw improvements to the décor and furnishings of the building had been made and these were on-going.

Since the previous inspection, the registered manager and provider had worked with the local authority’s quality assurance and improvement team (QAIT) to address the improvements identified at that inspection. These included improvements to care plans and risk assessments, both individual and environmental, as well the systems used to monitor the quality and safety of the home. The home had developed a service improvement plan and while progress had been made, the required improvements had not been fully completed. Some improvements were still required with risk assessments and care planning as well as how the home monitored one person’s behaviour and how they responded to another person’s health condition.

Staff were able to tell us about people’s care needs; however, some people’s care plans and risk assessments did not describe these needs or provide staff with guidance about how to support people while keeping them safe from harm. The registered manager reported further progress had been made on these since the inspection.

Medicines were managed safely. The home sought guidance from health care specialist such as learning disability, epilepsy and diabetes nurses.

People gave mixed views about the quality of the food provided. Some people said they enjoyed the food and it was very good while others said they felt the quality was poor. Some people asked for the evening meal choice to be reviewed. In response, the registered manager had provided each person with a questionnaire to allow them to give their individual views about the food and what meals they would like to see on the menus.

Recruitment practices were safe and staff received the training they required to undertake their role. Staff were supported through regular supervisions, appraisals and meetings. There were sufficient staff employed to meet people’s care needs, but some people indicated they wished to spend more time with staff in leisure and social activities.

We found one breach of the regulations in relation to safe care and treatment. More information is in the detailed findings below.

Rating at last inspection: Requires improvement. Four of the key questions were rated ‘requires improvement’, with the key question of ‘well-led’ rated ‘inadequate’. The last inspection was undertaken in March and April 2018 and the report was published on 25 June 2018.

Why we inspected: This was a planned, scheduled inspection based on the previous rating.

Enforcement: The provider is required to send us an action plan regarding the breach of regulation and how the home is going to achieve a rating of good.

Follow up: This is the third time Westcliff House has been rated requires improvement. We will meet with the provider after an action plan has been sent to us to discuss the improvements they are going to make.

Westcliff House is operated by the registered provider Mrs Christine Dodge, and is registered as a care home without nursing to provide accommodation to 34 people living with learning disabilities and/or mental health needs. The service was divided into two wings. The Sidborough Wing provides a more traditional care home setting substantially for people with learning disabilities, some of whom are older people who have lived there for many years. The Roborough wing is set up as individual flats for people living with learning disabilities or long term mental health needs. At the time of our visit there were 29 people living at the service.

This inspection took place on 28 March and 4 April 2018 and was unannounced. At our last inspection of the service in January 2017 the service had been in breach of three regulations of the Health and Social Care Act 2014. These were in relation to acting in accordance with the Mental Capacity Act, good governance and staff training and support.

On this inspection we found the service had taken action to meet the breach in relation to staff training and support, but remained in breach of regulations relating to the Mental Capacity Act and good governance. The breach for the regulation regarding staff training was however again breached as we found instances of where there had not been sufficient staff on duty to meet people’s needs. In addition we identified new breaches of regulations relating to safe care and treatment, treating people with dignity and respect, safe staff recruitment, safeguarding and person centred care.

We found the overall rating for the service is requires improvement for the second time.

The service has 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 was not present for the first day of the inspection, but was for the second.

The service was not developed and operated in line with the values that underpin the “Registering the right support” and other best practice guidance as it preceded this guidance being in place. Values identified in the guidance include choice, promotion of independence and inclusion, so that people with learning disabilities using the service can live as ordinary life as any citizen. We have asked the registered manager and provider to consider how their service can be further aligned with these values.

The service was not always well led. We identified a number of new concerns on this inspection that had not been identified in the service’s own quality assurance systems. The service was not always following their own policies and procedures in practice and had not regularly taken actions to assess the quality and safety of the services provided, including regular audits.

People were not always being kept safe because the provider had not ensured systems in place were effectively protecting people from abuse. Policies and procedures were in place to identify and respond to allegations of abuse and staff had received training in how to identify concerns. However, we found that staff and management had acquired a tolerance of behaviour from the people living in the home towards others that was potentially abusive.

Risks to people were not always reduced because staff did not understand people’s health and welfare needs and what actions they needed to take to keep individual people safe. Records were not always in place to support people with risks associated with specific health conditions. Risk assessments did not always contain detailed guidance for staff on how to reduce or manage risks related to people’s behaviours.

Risks associated with the environment had not always been assessed or mitigated. We found

Westcliff House is an old property divided into two wings called Roborough and Sidborough. The Roborough wing is for people who have minimal care needs and the Sidborough wing is for people who need more support. It is registered to provide accommodation and personal care for up to 34 adults of all ages with learning disabilities and / or mental health needs. At the time of our inspection there were 31 people living at the service.

We carried out this inspection on 10 January 2017. The service was last inspected in August 2014 and was found to be meeting the regulations.

There was a registered manager in post who was responsible for the day-to-day running 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 and associated regulations about how the service is run.

Each person was allocated a key worker who knew and understood their care and support needs. However, care records did not reflect the knowledge staff had about people’s needs. Care plans lacked detail about personal history, daily routines and personal preferences. Where people could display behaviour that might be challenging to others there was no information in their care plan to provide guidance for staff. When staff worked with people, they were not so familiar with, information about people’s care needs was mostly communicated to them verbally. This meant there was a risk that staff would not know how to provide the right care for people, if key staff were not available, because care records had insufficient detail.

Staff demonstrated they knew the type of decisions each individual person could make and when they might need support to make decisions. However, where people lacked capacity, there was no documentary evidence that people’s capacity to make particular decisions had been assessed or records of best interest decisions made. Staff were unaware of the Mental Capacity Act (MCA) 2005 and did not understand how the legislation related to the way they provided care and support for people.

Staff were not consistently supervised, supported and trained to carry out their roles. Staff training was not being updated to ensure staff had the skills and knowledge to provide effective care to people. The registered manager and deputy manager were visible in the service and regularly worked alongside staff to provide care and support for people. However, formal individual supervision with staff had not taken place for some time, with some newer members of staff not having had any formal supervision. This meant staff did not have the opportunity to discuss their development and identify any training or support needs they might have.

People told us they felt safe living at Westcliff House and with the staff who supported them. Comments from people included, “I am very happy here, yes it's nice here”, “Yes, I do feel safe.” A relative told us, “[Person’s name] is very happy living here.”

On the day of our inspection there was a relaxed and friendly atmosphere at the service. People were encouraged and felt confident to make decisions about their daily living. We observed people had a good relationship with staff and each other. There was plenty of friendly and respectful chatter between people and with staff. The staff team had developed kind and supportive relationships with people using the service. People commented about staff, “I am happy with the care, everyone here is really nice” and “Really really lovely people here and very caring, nothing seems too much trouble.”

People were supported to access the local community and take part in a range of activities of their choice. People went out shopping and to local attractions and some had paid and volunteering work. Activities were provided for people to take part in within th

One adult social care inspector carried out this inspection. We inspected the home following concerns raised with us about the care and welfare of people living at the home. The focus of the inspection was to answer the key questions of; is the service safe, effective, caring and responsive?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw that a risk assessment had been completed in relation to concerns over one person’s clothing choice. This was because the person’s clothing choices, whilst respecting their individuality, had not protected their dignity or ensured the public were protected from seeing them unsuitably clothed. This had resulted in appropriate action being taken to keep people safe.

Is the service caring?

We saw that care had been taken to ensure people were able to lead the lifestyles they wished.

Is the service effective?

We saw action had been taken to protect people living at the home and respect other people in the community.

Is the service responsive?

Appropriate action had been taken in response to the challenges posed in allowing people to make lifestyle choices whist ensuring they were kept safe and their dignity was maintained.

Westcliff House is registered as a care home for up to 34 adults. It provides accommodation and personal care to people with learning disabilities and/or mental health needs. At the time of the inspection there were 28 people between the ages of 19 and 86, living at the home.

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 and shares the legal responsibility for meeting the requirements of the law with the provider.

The home was divided into two areas. One area, Roborough, provided care to people in self-contained flatlets and bedsits. These people required minimal support from staff. The other part of the home, known as Sidborough, provided care and support for people who were less independent and required a higher level of care.

Throughout the inspection we saw that people were treated with kindness and respect. Everyone we spoke with told us their privacy was respected and they were able to make choices about their day to day lives.

There were policies and procedures in place to make sure people were safe but also to allow people to take risks in line with their wishes.

All areas of the home we saw were maintained to a safe level. We saw that equipment had been put in place to support people to maintain their independence and minimise risks.

Each person who lived at the home had a care plan which was personal to them. The care plans enabled people to set their own goals and record their wishes for how they wanted to be supported. This meant that all staff had access to information which enabled them to provide support in line with the individuals’ wishes and preferences.

We saw how the home monitored people’s health and ensured care was in place to meet changing needs. We saw that one person’s physical health had declined and they required more physical support than previously. The home had contacted healthcare professionals from outside the home and made sure that appropriate equipment was made available to meet the persons’ changing needs. Records seen showed the home continued to closely monitor this persons’ health in line with recommendations from healthcare professionals.

The registered manager and provider carried out regular audits to monitor the quality of the service offered and plan improvements. We saw that where an audit had highlighted shortfalls then action had been taken to address them.

Throughout the day we saw that staff were well motivated and competent in their roles. All appeared to have a good knowledge and understanding of the needs of the people who lived at the home.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. People’s rights were therefore properly recognised, respected and promoted.

At our last visit in March 2013 we found that improvements were needed to the care plans for people who lived at the home. At this visit in August 2013 we found that improvements had been made. For example, care plans had been regularly reviewed.

During this visit we found that people were offered choices and were treated with dignity and respect. We saw that there was a range of activities and outings available to people.

We found that care plans had been updated and gave care workers information on people’s needs and how they liked their needs to be met. Care workers were aware of this information and told us they ensured people’s needs were met as the individual wanted.

Care workers were aware of the procedures to be followed if they suspected abuse had occurred.

People were protected from the risks associated with care workers who may be unsuitable to work with vulnerable people. This was because the provider had effective recruitment procedures in place.

The provider had systems in place to assess and monitor the quality of the service provided.

We were welcomed into Westcliff House and shown around. People were happy to show us their rooms or flats. We saw that staff knew the people who lived in the home well and addressed them by name. People were treated with respect, offered choices and encouraged to maintain their independence. People we spoke with told us that they enjoyed living at Westcliff. They also said “the staff are nice and the food is good”.

We looked at four care and support plans. We found that the person’s assessment of need had not been recently updated. Risk assessments were not clearly up to date so it was not always possible to see what the risks were and how to minimise them.

Domestic staff followed a cleaning schedule and the home was clean and tidy. Cleaning equipment and products were colour coded and clearly labelled. There was an infection control policy which staff had read and signed to state it had been understood.

Staff felt well supported and had opportunities for further training. Staff we spoke with told us “I love my job” and “I really enjoy working here”

Complaints were recorded and investigated. When necessary the provider assisted people who lived in Westcliff House to raise concerns and make a complaint.

When we went to Westcliff House we visited people in their own rooms, and in the lounges. We shared lunch with people in two of the three dining areas. A large and very varied group of people live at the home. Some have their own lounges in a flat they may share with another person.

One person told us they had lived in other care homes, and that this one is the best, because of the friendly atmosphere, and all the staff are nice. People have their own space and privacy, but can choose to be sociable when they want.

One person told us they are looking forward to moving to their own flat, which has been arranged and is due to happen soon. They told us that staff at Westcliff House have helped them get ready to move, but they did not say how. The manager told us that they will have the cooker in their flat connected, so they can have tuition and support with cooking their own meals, but that had not started. Several people have a kettle and microwave, and were pleased to tell us they make their own hot drinks and snacks.

We saw that people had keys to their own door, and some had a key to the back door of the house. Some people are assessed as safe to go out without support. One person currently had a job, while others are seeking employment, with support.

One person told us about their membership of a local club. Another said they would like to go on holiday again. There has been a group holiday each year. People had discussed where they would like to go in a residents’ meeting, and this year the choice was Butlins. Several people mentioned that the previous year’s boat holiday was a great success. Not everyone chooses to go. Some people have been taken on individual days out, for example to the Pantomime.

One person told us they like to help their Mum when they go home, and they speak to her on the phone every day. Another person was pleased to tell us that they would be supported to visit a family member the following day.

We saw that menus had been discussed at the residents’ meetings, which happen two or three times per year, and often there are discussions between people in the house. People told us they were looking forward to fish and chips the following day, but they did not know what they would be having for lunch that day.

The manager told us that when they are recruiting staff, one of the people who lives in the home had shown candidates around after their interview so they could meet the people who live in the house. They gave their impressions of the candidates to the manager, who said that this feedback had been useful.