We carried out an unannounced inspection of the service on 19 and 21 September 2017. Westcliffe Care Home is a care home in Radcliffe-on-Trent in Nottinghamshire which provides accommodation for up to 19 older people. On the day of our inspection 17 people were using the service and there was a registered manager in place.

At the last inspection, in September 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to feel safe and there were systems in place to reduce the risks to people’s health and safety. There were sufficient numbers of staff to meet people’s needs in a timely manner and systems were in place to support people to take their medicines.

Staff received relevant training and felt supported. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make certain decisions. People were supported to eat and drink enough to maintain good health and when people’s health changed staff made referrals to external health professionals.

Positive and caring relationships had developed between people who used the service and the staff who supported them. Staff promoted people’s choices and valued their privacy and dignity.

People’s needs were responded to by staff who had a clear understanding of people’s current support needs. Care plans were in place which provided information about the care people required. People felt confident to raise concerns and felt these would be acted on.

There was an open and transparent culture which empowered people and staff to speak up and make suggestions for improvement if they wished to. The management team provided leadership and direction to staff. There were systems in place to monitor the quality and safety of the service.

Further information is in the detailed findings.

We carried out an unannounced inspection of the service on 1 September 2015.

Westcliffe Care Home provides care and support for up to 19 older adults with a variety of needs.

At the time of our inspection there were 17 people using the service.

Westcliffe Care Home is required to have 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. At the time of the inspection a registered manager was in post.

At our last inspection in November 2013 we found the provider was in breach of one Regulation of the Health and Social Care Act 2008. This was in relation to the management of medicines. The provider sent us an action plan detailing what action they would take to become compliant with this Regulation. At this inspection we found the provider had made the required improvements.

At this inspection people told us that staff provided a safe service and risks were managed appropriately. Staff were aware of the safeguarding procedures and had received appropriate training. There were safe management and administration of medicines processes. Safe recruitment practices meant as far as possible only people suitable to work for the service were employed.

Accidents and incidents were recorded and appropriate action was taken to reduce further risks. Risks plans were in place for people’s needs that were regularly monitored and reviewed. Additionally, the environment and equipment had safety checks in place.

People told us that there were sufficient staff to meet their needs. Additionally they said staff had time to spend with them and requests for assistance were met in a timely manner. People’s dependency needs were reviewed on a regular basis and staffing levels amended to meet people’s changing needs.

CQC is required by law to monitor the operation of the Mental capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This is legislation that protects people who are unable to make specific decisions about their care and treatment. It ensures best interest decisions are made correctly and a person’s liberty and freedom is not unlawfully restricted. People’s rights were protected because staff were aware of their responsibilities and had adhered to this legislation.

People told us that they received sufficient to eat and drink. They were positive about the choice, quality and quantity of food and drinks available. People received appropriate support to eat and drink and independence was promoted.

Relatives and people that used the service said that care staff were knowledgeable about their needs. Additionally, they told us that support to access healthcare services to maintain their health was provided. People’s healthcare needs had been assessed and were regularly monitored.

Staff were appropriately supported. This consisted of formal and informal meetings to discuss and review their learning and development needs. Staff additionally received an induction and ongoing training.

People and relatives we spoke with were positive about the care and approach of staff. We found the staff were caring, compassionate and knowledgeable about people’s needs. People’s preferences, routines and what was important to them had been assessed. Support was provided to enable people to pursue their interests and hobbies.

The provider supported people to be actively involved in the development and review of the care and support they received. This included regular discussions with people and formal meetings.

People told us they knew how to make a complaint and information was available for people with this information. Confidentiality was maintained and there were no restrictions on visitors.

The provider had checks in place that monitored the quality and safety of the service. This included enabling people and their relatives and representatives, to give feedback about their experience of the service.

Some people at the service were living with dementia. The provider supported staff to access training and resources in dementia care that ensured best practice and person centred care was provided.

We visited the location to check that the provider was compliant with the regulation about which we had set a compliance action at our previous inspection on 27 June 2013.

We spoke with three people using the service. They told us staff looked after their medication for them and they were happy with the arrangements for their medication. They told us they got it on time and had no concerns.

We also spoke with a relative. They told us they had no concerns with the medication arrangements for their family member.

We spent 30 minutes in the dining room during the morning and observed a staff member administering medication. We saw they checked the medication against the information on the MAR charts before giving people their medication. We saw that the staff member waited with people until they had taken their medication.

However, we found that people were not fully protected against the risks associated with medicines. We looked at the medication administration record (MAR) charts for eighteen people from 18 November 2013 until 25 November 2013. MAR charts are used to record when people have or have not taken their medication. We found some gaps on the MAR charts for ten people. We also found gaps on the topical medication administration record (TMAR) charts that staff used to record when creams were applied to people’s skin.

We also found that the fridge containing medication was not locked. This meant medication had not been kept securely.

We spoke with three people using the service. They told us their needs were met and they received good care. One person said, “[Staff are] very good to me.”

We spent 45 minutes in the dining room in the morning. We saw that the atmosphere was relaxed and we observed positive interactions between staff and people using the service. We saw staff spoke with people in a warm and kind way and asked them about their food and drink preferences. We saw that staff provided the support people needed.

People using the service who we spoke with told us they felt safe with staff and would inform staff or the manager if they were worried about anything.

People told us staff looked after their medication for them, they were happy with the arrangements and they always got their medication on time. However, we found some gaps in the medication records.

We found that people were protected against the risks associated with unsafe or unsuitable premises.

We found that staff received inductions, training, supervision and appraisals.

People using the service who we spoke with told us they felt the service was good. One person said, “Well I think it’s very good”. We found that the provider had systems in place to monitor the quality of the service provided.

We spoke with three people using the service. They told us staff asked them about their preferences and provided support that met their needs. They told us staff helped them to maintain their dignity. One person said, “They make you feel comfortable, not embarrassed.” They told us there were enough social activities. One person said, “[The provider] is always thinking of things to do.”

We found care plans were person-centred and described the care needed to meet people's needs.

People using the service told us they felt safe at Westcliffe Care Home and felt their finances and belongings were protected. However, we found gaps in safeguarding training. This meant there was a risk staff did not have up-to-date knowledge about how to recognise and to respond to abuse appropriately.

We found medicines were not always safely administered. We also saw there were gaps in recording. This meant there was a risk creams and ointments were not being applied in accordance with doctor’s instructions.

We found staff received an induction, supervision and appraisals. However, we found gaps in training. This meant there was a risk staff did not have appropriate knowledge to provide safe care.

We found people were made aware of the complaints system. We saw the complaints policy on display on the wall in the reception area. The provider also showed us a comments, compliments, concerns and complaints book.

Residents were positive about how they were treated by staff. One resident told us, “I like it here…they look after you.” They all felt that the quality of care they received was of a good standard, including attention to their personal preferences. The residents were pleased with the range of stimulating activities that were offered. They felt safe living at the home and considered that staff were very competent at their job. Residents felt the service considered their needs and they felt listened to.