Westerham Place 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. Westerham Place provides care and accommodation to a maximum of 33 older people with varying levels of need, including those living with dementia, mobility issues, frailty and diabetes. There were 24 people living there at the time of our inspection.

At the last inspection in November 2015 the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People were protected from abuse. Risks to people were assessed and minimised. There were sufficient numbers of staff in place to keep people safe and meet their needs. People received their medicines safely. People were protected by the prevention and control of infection where possible. Accidents and incidents were managed effectively.

People’s needs and choices had been assessed when they started using the service. Staff were trained and their skills and competencies checked by the registered manager. People were supported to maintain a balanced diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were seen to be kind and compassionate towards people. People and their relatives were involved with making decisions about care and support. People were treated with privacy and dignity.

People received care that was personalised to their needs. People were supported to take part in meaningful activities and to engage with the local community. People were encouraged to raise concerns or complaints.

There was an inclusive, open and transparent nature to the service. The registered manager understood the legal requirements of their role. The service had an effective system of checks in place which were used to assess the quality of care provided by staff. The service worked in partnership with other agencies to ensure care was provided in a joined up way.

Further information is in the detailed findings below

The inspection was carried out on 29 September 2015 by two inspectors and an expert by experience. It was an unannounced inspection. The home provides personal care and accommodation for a maximum of 31 older people. There were 28 people living there at the time of our inspection. All the people living in the home were able to express themselves verbally and one person preferred to use body language.

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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

All fire protection equipment was serviced and maintained.

People’s bedrooms were personalised to reflect their individual tastes and personalities.

Staff knew each person well and understood how to meet their support needs. Staff told us, “Sometimes it is the little details that matter the most, but whatever it is we respect what is important to our residents.”

Staff received essential training and had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal. This ensured they were supporting people to the expected standards.

The Care Quality Commission (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 were considered as per the Mental Capacity Act 2005 requirements.

Staff sought and obtained people’s consent before they helped them.

The service provided meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect.

People were satisfied about how their care and treatment was delivered. They told us, “The staff look after me very well, they know what I need” and, “The staff know me so well and they help me every way they can.”

People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to contribute.

Clear information about the home, the facilities, and how to complain was provided to people and visitors. The activities programme was provided for people in a suitable format which made them easy to read.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed monthly with their participation and updated when their needs changed.

People were involved in the planning of activities and told us they were satisfied with the activities provided.

The service took account of people’s feedback, comments and suggestions. People’s views were sought and acted on. The registered manager sent annual satisfaction questionnaires to people’s relatives or representatives, analysed the results and acted upon them. Staff told us they felt valued under the registered manager’s leadership.

The registered manager notified the Care Quality Commission of any significant events that affected people or the service. The registered manager kept up to date with any changes in legislation that may affect the service and carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

During our inspection we talked with seven people who used the service or their relatives. People told us that staff responded to the nurse call alarms in good time, (nurse call alarms are fitted to bedrooms and bathrooms and enable people who live at the service who require support to trigger an alarm that staff respond to.) One person told us “I am very well cared for and I am supported to make choices about what I eat and my daily routine” another said “The care is good, staff are respectful and they respond to our needs.” People told us that they felt safe and that staff were professional and competent.

We found that the provider had made a number of improvements after we inspected in May 2013. The service had recently reviewed its policies around safeguarding and whistleblowing. These reviewed policies and procedures gave clear instructions to staff about the protection of vulnerable adults (safeguarding). We saw that the registered manager had introduced a new system for making staff aware of key policies. We saw that the homes policy about safeguarding and whistleblowing had been displayed for staff to read in the staff room.

People told us that their needs were met and that staff responded to them effectively if they required support; staff told us that there were enough staff at the home to meet people’s needs. Some people we spoke with had concerns about the number of staff on shift at night. The registered manager told us that they were reviewing staffing levels and looking at the feasibility of introducing another post into their team structure.

We found that the registered manager had reviewed the staff supervision and appraisal system which had become more effective. We looked at five staff files including two for staff who had started recently. We saw that in the files there were records showing that staff had received supervisions and the registered manager told us that staff appraisals were booked for the next supervision meetings; supervision records were signed by the supervisor and the staff member.

People who used the service, their representatives and staff were asked for their views about their care and treatment and the provider responded to people’s views in a positive way.

We found that the home had a pre assessment process for people who may want to live at the home.

We asked to see the records of meetings involving people who used the service or their relatives, but none were available.

We looked at five care plan files for people who used the service. We saw that care plans were being reviewed on a monthly basis and that they showed evidence that they had been changed to meet a person’s needs. However, there were no associated risk assessments that would inform staff of how they should safely meet the person’s needs.

We spoke to four people who used the service and they did not have any concerns about their safety.

Staff we spoke to had not read the providers whistleblowing policy. This means that people who used the home could not be confident that staff would know how to whistleblow.

We talked with three staff and they told us that they were confident that they were meeting people’s needs, but none of them had read the key policies they need to be aware of in order to carry out their roles safely.

We asked to see the records of meetings involving people who used the service or their relatives, but none were available.

We saw that the provider had an accident book, but there was no record of actions taken or analysis.

We asked to see the results of surveys, but there were no available records to see. This meant that the provider and manager were not regularly assessing and monitoring the quality of the service provided.

The inspection visit was carried out by one inspector over three hours. During this time, we (i.e. CQC) talked with five people living in the home, two relatives, two visiting health professionals, and two care staff. The manager and deputy manager were present throughout the visit.

All of the people that we spoke to were very positive about the home and the standards of care being given.

Comments from people living in the home included:

“It is lovely here; the staff are all very caring.”

“They look after us beautifully; I would say we get 100% good care.”

“The staff are very kind and help us with everything, whatever we ask for they are there to help.”

“The food is excellent; the staff look after us well, and I am very happy here.”

We visited the home on two separate days. This was because the registered manager was absent on the first day and staff on duty were unable to access some documentation which we needed to see.

During the course of the two visits, we talked with eleven people living in the home, one relative, and six staff, as well as one of the Providers.

People living in the home said they felt well cared for.

Comments included:

“It’s very nice here. My daughter chose the home for me. I am very comfortable, and I like it very much.”

“They look after us wonderfully well. They are all very kind and caring.”

“The staff are excellent.”

“It’s a beautiful home, very good. I am very happy here.”

“Full marks!”

The staff answer bells instantly. They are all good, and are very attentive.”