The inspection visit at Westfield was undertaken on 13 June 2017 and was unannounced.

Westfield Rest Home is situated in a residential area of Blackpool close to a main road, shops and leisure facilities with a good transport network. The home is registered for 13 people. The home is a corner property and has recently undergone building work to extend the communal space and add more bedrooms. Communal areas include two lounges and a dining area. There are garden areas to the side and front of the home and a rear yard area for people to sit out in. There were 13 people living at the home at the time of the visit.

There was a registered manager in place. 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.

We looked at safeguarding procedures at Westfield and discussed safeguarding individuals from abuse or harm. Staff were knowledgeable about related principles. People who lived at the home told us they felt safe whilst living at Westfield. The registered manager had risk assessments to maintain their safety and welfare.

We found recruitment checks were carried out to ensure suitable staff were employed to work at the home and there were sufficient staff to meet people’s needs. This was confirmed by talking with staff members.

We observed a member of staff administered medicines safely by concentrating on one person at a time. They recorded in each person’s records afterwards to evidence they had taken their medication. The registered manager completed audits to assure safe procedures were maintained.

Staff supported people to eat their meals where required to do so. People chose where they wanted to eat their meals. People who lived at the home told us they enjoyed the food provided at the home and the quality, choice and quantity was good. One person said, “Yes very good choice of food here.”

The registered manager had a programme of training for staff to further their skills and keep up with current practice. Staff confirmed training courses and access to them was very good. One staff member said, “Don’t mention training there is loads of it and it does help.”

The registered manager and staff had received training in the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). We found care records contained people or relatives’ consent prior to care and support. Throughout our inspection visit, we observed staff did not limit people in any way and they moved around the building freely.

Care plans were in place detailing how people wished to be supported. People who received support or where appropriate their relatives were involved in decisions and consented to their care.

People who lived at the home told us the best aspects of living at Westfield were the compassion, and caring attitude of staff. They also praised the staff for the way they supported them during the day. One person said about the caring attitude of staff, “They do care and that makes me feel better.”

We found people had access to healthcare professionals and their healthcare needs were met.

People who lived at Westfield and relatives knew how to raise a concern or to make a complaint. The complaints procedure was available in documentation provided to people and their relatives.

Staff updated care plans on a regular basis to check support continued to meet people’s changing needs. The registered manager completed life histories of each person and checked their wishes in relation to, how they preferred to be known as, their hobbies and meals.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, relative surveys and staff/resident meetings to seek their vie

We carried out an unannounced comprehensive inspection of Westfield on 27 January 2016. At which breaches of legal requirements were found. This was because the provider did not have effective auditing and oversight systems, as well as suitable deployment of staff at mealtimes. Recruitment, training and environmental safety monitoring failed to pick up concerns we found. Additionally, the provider failed to carry out their required duty to notify the Commission about incidents that affect people’s health, safety and welfare.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 08 November 2016 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Westfield Rest Home’ on our website at www.cqc.org.uk.

Westfield provides care and support for a maximum of 13 older people who may be living with dementia or a mental health condition. At the time of our inspection, there were 13 people who lived at the home. Westfield is situated in a residential area of Blackpool close to local shops and leisure facilities. Communal areas include two lounges, a dining area and gardens to the side and front of the home. A passenger lift offers ease of access for wheelchair users between floors.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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.

During this inspection, we found the registered manager had notified CQC about incidents that affect people’s health, safety and welfare. They understood their responsibility and the deputy manager was in the process of completing related training to submit notifications in their absence. The registered manager had also introduced new audits and systems to assess quality assurance, maintain people’s safety and gain effective oversight of Westfield.

A new, intensive training programme had been implemented over the last few months, which staff had or were in the process of completing. The registered manager had developed the training matrix to gain better oversight. Staff told us they felt the new training had enhanced their skills and given them insight into care and support.

We observed lunchtime and found staff were deployed effectively to ensure they could complete all tasks. This included a new mealtime system to provide quality time and social support to meet people’s nutritional requirements.

We could not improve the rating for well-led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This inspection took place on 27 January 2016 and was an unannounced inspection.

Westfield Rest Home is a small home situated in a residential area of Blackpool close to a main road. There are shops and leisure facilities with a good transport network. The home is a corner property and has recently undergone building work to extend the communal space and add more bedrooms. Building work was still on going within the home. Communal areas included one lounge with a second combined lounge and dining area. There are garden areas to the side and front of the home and a rear yard area.

The home is registered to provide care and accommodation for up to twelve people who have learning disabilities, dementia or a mental health condition. Twelve people were living in the home at the time of the inspection.

There was a registered manager in place. 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 last inspection was in August 2014 and was a responsive inspection due to information of concern received at that time. The service was meeting the requirements of the regulations that were inspected at that time.

During this inspection, we spoke with relatives to gain an insight into how their relatives were care for and supported. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. Relatives told us staff were friendly and caring and this was observed during our inspection. We found members of the staff team were welcoming and there was a friendly atmosphere in the home. Relatives were encouraged to visit and be involved in people’s care.

Relatives were encouraged to give feedback regarding the service people received through formal and informal means. We found aids and adaptations in people`s rooms were available. This helped people to maintain their independence and manage their conditions.

Since the last inspection there had been an increase in the numbers of people who lived at Westfield Rest Home. Previously seven people lived at the home, and this had now increased to twelve people. Due to the increased number of people living at the home, the management team had recruited two additional staff. Although the staffing levels had improved, we found the deployment of staff at lunchtime was not always managed for the benefit of people who lived at the home.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). We found when restrictions had been made, these had been applied for and authorised by the local authority.

We found there were good systems in place for the safe administration of people`s medicines. We spoke with relatives regarding the support people received to take their prescribed medication safely. One relative said there were high levels of care provided with regard to medication management.

A member of the senior management team had introduced nutritional health screening tool into their care planning. We found weight monitoring and reviews of care plan records were regularly evaluated. Staff worked well with a range of health care providers for advice and guidance. This helped to keep people safe and well.

Although there were a range of quality monitoring systems in place they were not always effective. We found inconsistencies in the management of recruitment of staff, staff training and supervision. The registered manager had failed to submit a notification regarding a safeguarding incident and when deprivation of liberty safeguards had been authorised. We found the risk management for people in relation to their environment was not well managed. We fou

Summary

We considered our inspection findings to answer questions we always ask: -

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People were comfortable and relaxed during our inspection. We observed care being provided in a dignified and supportive manner. People told us they felt safe and respected. One person told us, “They keep my dignity at all times. I feel very well respected”.

Our discussions with staff confirmed they understood the needs of the people in their care. This matched the information we found in people's care records. This meant the provider had protected people from unsafe care by ensuring care planning and risk assessment was appropriate.

During our discussions with staff we noted they had a good understanding of safe administration and recording of medication. Appropriate training had been provided to underpin this. One person confirmed, “The staff look after my medication, which is great. It keeps me safe”. This demonstrated people were protected against unsafe medication practices because the manager had ensured effective systems were in place.

Is the service effective?

People told us they felt the home was effective in meeting their needs. One person said, “The manager is great and she’s very supportive with my needs”.

Documents we reviewed showed support plans and risk assessments were individualised and regularly updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

People were supported with their nutrition and hydration needs. Care records we reviewed held documents that assessed people’s requirements and monitored their weight and general progress. Menu options were available and service users commented they enjoyed their meals. This demonstrated Westfield appropriately supported people to maintain their nutritional needs. A relative said, ''My mum loves her food. The meals are great here''.

We noted that staff had received annual appraisals and team meetings. Staff told us they felt supported by the managers. Staff had received formal supervision. However, two staff files we reviewed had no recorded supervision since September 2013. This meant staff were not always fully supported because formal supervision was not provided on a regular and consistent basis. We were assured this would be addressed as a priority.

Is the service caring?

People consistently stated that the home delivered a caring and supportive service. One person told us, “I have always found the staff to be polite and respectful. We can have a laugh”.

People were comfortable and relaxed during our inspection. Staff engaged with people in their care in a friendly, supportive and appropriate manner. One staff member said, “It’s important to interact with people as a way of improving their quality of life. I treat people as I would like to be treated”.

Is the service responsive?

One person told us, “The staff discuss my care with me and if anything needs to change”. A relative added, “When my mum’s been unwell, they always let us know and ring the GP straight away”. This demonstrated the home checked and responded to people’s changing needs.

Westfield had undertaken annual satisfaction surveys and regular resident and staff meetings were held. We were told that any negative feedback was responded to. This showed the home was proactive in seeking people’s views about the quality of care delivery.

Is the service well-led?

Westfield had quality audits in place to monitor service delivery. Other regular processes underpinned this, such as satisfaction surveys and resident and team meetings. This meant people were protected against inappropriate support because the manager had systems to check the quality of care. A relative told us, “They ask me for feedback regularly. I did this recently online. If I had any issues I’m certain they would deal with these safely and promptly”.

Care delivery was well-led and there were clear lines of responsibility. Care planning was in-depth and personalised. This was reflected in our observations during our inspection. This meant Westfield delivered appropriate and safe care because the home was well-led.

We spoke with a range of people about the home. They included the registered manager, staff members and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Westfield.

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved relatives, where possible to ensure people received the right care and support.

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with people about the care and support they received. They said they were happy living at the home and said that staff were polite and kind.

The home has recently undergone building work to extend the property. This has now been completed and existing bedrooms are currently being renovated on a rolling basis to update the fixtures, fittings and décor. People we spoke with said that they were happy with the current arrangements.

We spoke with a range of people about the home. They included the registered provider, home manager, staff members and people who lived at the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced.

This home cares for people with a range of dementia conditions and conversation with most residents was limited due to their dementia condition. We therefore spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people’s care and support was being managed.

We observed staff assisting people who required care and support. Staff treated people with respect and provided support or attention as people requested it. We spoke with one person about the care and support they received. They said “I am happy living here,” and “I always feel looked after.”

The home is currently undergoing building work to extend the property. This meant that the communal area for the people living at the home was temporarily limited. The provider also notified us that the lift was out of use. There is plan to install a new passenger lift by mid 2013. This meant that people could only be accommodated on the first floor if they could manage the stairs unaided. The statement of purpose has been updated to reflect this. People we spoke with said that they were happy with the current arrangements.