An unannounced comprehensive inspection took place on 18 June and 22 June 2018.

Westdene House is registered to provide accommodation for up to 14 older people that may require personal care. Some people at the home were living with dementia. The home provides short term/respite stays. On the inspection there were 12 people residing at the home.

Westdene House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in place. 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. On the day of our inspection the registered manager was away so we spoke to the person in charge who oversaw the day to day running of the home.

At our last inspection on 15 March 2016, the service was rated as ‘Good’ overall with the key questions of ‘Safe’ being rated as ‘Requires improvement’, as concerns were identified relating to the safe management of medicines. At this inspection medicines were being stored, managed and administered safely but other concerns around people’s safety were identified.

Staff did not always know people well enough to support them safely or to evacuate people safely in the event of an emergency. Evacuation plans were not up to date for people. People’s risks were assessed and documented but records were not always up to date and did not accurately reflect the needs of the person. Staff were given training and were trained in moving people safely but an instance of staff practice was observed to be unsafe. Records were not always accurate, for example care plans did not provide staff with clear or up to date information. If someone’s needs had changed plans did not always reflect this. Staff carried out a range of audits but these did not have clear actions to improve the service.

There were policies and procedures to safeguard people from abuse but staff did not always understand safeguarding processes. Records showed that staff did not arrange immediate or timely access to healthcare following incidents such as a fall where injuries may have been sustained. Staff told us that if a person fell staff did not immediately seek healthcare help to assess what care they needed. People’s health care needs were not always monitored however staff did liaise with health care and mental health services such as referrals for people.

People were not always protected from the risks of infection control and prevention and some areas of the home were not well maintained. People’s rooms and areas of the home were not always clean and there were unpleasant odours in certain areas throughout the inspection. We have recommended that there is a review of the frequency and effectiveness of the carpet shampooing regime at the home.

Records showed that people's capacity to consent to care and treatment was not always assessed in line with best practice guidance and procedures to make best interest decisions were not in place. People were not encouraged to express themselves or to be involved in their own care. Staff had basic awareness of the principles as set out in the Mental Capacity Act 2005 Code of Practice and Deprivation of Liberty Safeguards (DoLS) but records and staff’s understanding showed principles were not put into practice.

People were not always treated in a caring or respectful way by staff but some kind interactions were observed. People told us they were not supported to participate in activities of their choice or pursue hobbies and people did not receive support that was responsive to their individual

The inspection took place on the 15 and 17 March and it was unannounced.

Westdene Rest Home is registered to provide accommodation for up to 14 older people that may require personal care. At the time of the inspection 7 people were living at the home this included two people who were receiving respite care. Some people were living with dementia.

A registered manager was in post who was also the provider owner of 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.

Westdene Rest Home is at the end of a close near the seafront in Worthing. Communal areas included a dining room and a conservatory which led onto a court yard garden area. All bedrooms were single occupancy apart from one which was shared. All bedrooms had en-suite facilities.

We found the home to be clean and tidy and maintained to a high standard. Home furnishings such as pictures, flowers and ornaments decorated communal areas. The ambience of the home was warm and inviting.

Medicines were not always managed safely for people. The records and our observations did not demonstrate that all people had received their medicines as prescribed. This was fed back to the registered manager who had recognised this was an issue.

People and their relatives felt that Westdene Rest Home was a safe environment. There was sufficient staff who had been trained in how to recognise signs of potential abuse and protected people from harm. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. The service followed safe staff recruitment practices and provided a thorough induction process to prepare new staff for their new role.

Staff demonstrated how they would implement the training they received in core subject areas by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager.

Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. They also understood the associated legislation under Deprivation of Liberty Safeguards and restrictions to people’s freedom.

Additional drinks and snacks were observed being offered in between meals and staff knew people’s preferences and choices of where and what they liked to eat.

Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach.

People received personalised care. Care plans reflected information relevant to each individual and provided clear guidance to staff on how to meet people’s needs. There was a complaints policy in place. All complaints were treated seriously and were managed in line with the complaints policy.

People and staff told us they were happy with the activities that had been organised. During the inspection we observed staff sat talking to people about topics of interest to them.

People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and treatment. Relatives were also encouraged to give their feedback on how they viewed the service and where necessary support with the reviewing of the care plans alongside more senior staff.

The registered manager was open to feedback and promoted a positive culture in the home.

A range of quality audit processes overseen by the registered manager were in place to measure the overall quality of the service provided

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulati