We inspected Westergate House on 23 October 2018, in light of information of concern that we had received in respect to people’s care. However, at this inspection we found that these concerns were unfounded. Westergate House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Westergate House is registered to accommodate up to 76 people, some of whom were living with dementia and other chronic conditions. Westergate House is comprised of main house connected to a newer building known as the annex. There were 69 people living at the service during our inspection.

A registered manager was 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 and associated Regulations about how the service is run.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both supervision meetings with their manager, and formal personal development plans were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, bingo, exercise, quizzes and themed events, such as reminiscence sessions and visits from external entertainers People were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the pr

We inspected Westergate House on 25 July 2017. This was an unannounced inspection. Westergate House provides accommodation and nursing care for up to 76 people. The home is set in gardens and consists of a main ‘house’ connected to a newer building, known as the annex. The annex, is home to the ‘memory lane community’ which cares for people living with dementia. The ‘memory lane community’ was divided into two communities, known as ‘Fontwell’ and ‘Goodwood.’ On the day of the inspection, care and support was provided to 62 people living at Westergate House.

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.

At the last inspection undertaken on the 2 June 2015 we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the principles of the Mental Capacity Act 2005 (MCA) not being adhered to. The provider sent us an action plan stating they would have addressed all of these concerns by July 2015. At this inspection we found the provider had made improvements and was now meeting the requirements of the regulation.

Staff demonstrated good knowledge and understanding of the Mental Capacity Act (MCA 2005). Decision specific mental capacity assessments were now in place which considered a range of decisions. Documentation reflected where best interest decisions had been made. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people's consent before they helped them.

People were supported to maintain their nutrition and hydration. People felt that they had enough food and drink and observations confirmed that drinks and snacks were offered throughout the day. People could choose what they had to eat and drink and felt that the food was good. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received drink supplements. Foods (where required) were fortified with cream, milk and cheese to increase their calorie intake. People's dining experiences throughout the home was mostly positive . Staff supported most people to have a positive dining experience. They were supported in a sensitive and respectful way according to their needs.

People had access to relevant health professionals to maintain good health. Records confirmed that external health professionals had been consulted to ensure that people were being provided with safe and effective care. People's clinical needs were assessed and met. People received good health care to maintain their health and well-being.

Systems were in place for the safe storage, administration and disposal of medicines. People told us they received their medicines on time and in their preferred manner. We identified minor concerns regarding two people’s medicine regime and lack of access to prescribed medicines. The provider was responsive to our concerns and took action. In response, they also completed a clinical incident analysis to explore why the incidences had occurred.

Arrangements were in place for the provision of meaningful activities and stimulation. The provider employed two dedicated activity coordinators and was in the process of recruiting a third activity coordinator. There was a homely, friendly and relaxed atmosphere within the home. Staff and the registered manager was committed to enabling people’s voices to be heard and listened to. Community meetings were held monthly and every month a range of actions were taken based

The inspection took place on 2 June 2015 and was an unannounced inspection.

Westergate House provides accommodation and nursing care for up to 76 people. The home is set in gardens and consists of a main house connected to a newer building, known as the annex. The annex, is home to the ‘memory lane community’ which cares for people living with dementia. At the time of our visit there were 68 people living at the service. The home also offers respite care.

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.

Where people lacked capacity to make decisions, records did not clearly evidence the process that had been followed. As a result the service was unable to demonstrate that people’s rights under the Mental Capacity Act had been respected. Where people may have been deprived of their liberty, proper processes had been followed that met the requirements of the Deprivation of Liberty Safeguards.

There was a sense of community at the home, complete with three dogs as people were able to move to the home with their pets. There was a regular staff team who knew people well. New employees spent a minimum of two weeks shadowing experienced staff so that they could get to know people and the service opted for their own staff working additional shifts rather than using agency staff. One staff member said, “Staff are good, care is good, and teamwork is good. We are working our level best for the residents here”.

People felt safe at the home. One said, “My daughter and son think it is lovely here too. They don’t worry about me, they know I’m happy here”. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely and at the right time.

Staff received training and support to deliver effective care to people. Every member of staff working at the home had attended dementia awareness training. The home had its own trainer who was rolling out a further eight week programme to staff. Staff felt supported and were able to approach their seniors for advice or guidance. There was a system of supervision and appraisal in place where staff could discuss professional development and training needs.

The service was caring. Staff were available and were quick to anticipate people’s needs and wishes. Staff engaged with people on an individual basis. They shared positive relationships, based on friendship and respect.

Mealtimes were a sociable experience and people spoke highly of the food. The chef provided a choice of menu and was clear on people’s dietary needs and preferences. People received support and staff ensured that they received enough to eat and drink.

People were involved in planning their care and were supported to be as independent as they were able. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This included the involvement of healthcare professionals, such as the GP, Dietician, Community Psychiatric Nurse (CPN) or Tissue Viability Nurse (TVN).

The home was well-led. The registered manager had a system to monitor and review the quality of care delivered and was supported by monthly visits from a representative of the provider. The registered manager received regular feedback from people, their relatives, staff and visitors. They took prompt action to address any concerns. Where improvements had been identified, action plans were in place and used effectively

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We spoke with six people and five visitors who told us that people were treated as individuals and that they were given information and choices in relation to their care. One person said “it is such a lovely place and the staff are always here to talk to you”. Another told us “they try to keep you occupied and there is always something to do”. People, who could, told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations. A visitor told us “I would not hesitate to recommend it to anyone” and another said “they take them out in the mini bus to various interesting places”.

We spoke with staff who told us they felt confident in their role. They said that they had regular training and felt very supported by the manager. During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

We spoke with one person and with three relatives who were visiting the service. They told us about their experiences when they were admitted to Westergate House. They confirmed that someone visited them in order to discuss their needs and how they would be met.

They told us about the care and treatment provided. They confirmed that they had given consent to the care and treatment they had received and were very satisfied. One person told us, “The home is very friendly and has been well run.” A relative commented, “On the whole I think the home is very good and people are well looked after.”

We also asked people if they knew how to make a complaint. They confirmed that they would take up any concerns they had with the manager. We were informed they found the manager was approachable and people we spoke with believed their concerns would be taken seriously.

We spoke to some people who live at Westergate House. They were unable to answer our questions due to impaired memory. However, we spent some time with them observing the care they received from staff.

We spoke to the relatives of two people who live at Westergate House. They confirmed that their relatives’ needs had been assessed prior to admission. They also confirmed that care plans had been discussed with them, but not in detail.

We also spoke to three members of staff who were on duty. They told us about the level of care they provide to people at Westergate House. They also told us about the support and training they have received to enable them to provide good quality care.

We spoke to the manager about the systems that were in place to assess and review the needs of each person. We also spoke to the manager about how the quality of service provision is assessed and monitored.

When we arrived we advised the manager that we are visiting as a result of information we have received which includes an allegation of abuse. We informed the manager that the purpose of our visit was to ensure Westergate House is compliant with the essential standards and not as part of the ongoing investigation being conducted by the West Sussex safeguarding team into the allegations made.