This unannounced comprehensive inspection took place on 21 and 26 November 2018

Westholme 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.

The service provides nursing and personal care for up to 74 people, including people living with dementia. The home is located on the outskirts of Winchester town centre and is arranged into three units; residential, nursing and discharge to assessment. Each unit has communal areas, including dining rooms and lounges.

The discharge to assessment unit can accommodate 10 people who require a period of care and treatment on leaving hospital before moving back home or into another supported living setting. At the time of our inspection there were 69 people living in the home.

There was a registered manager in post who had overseen the management of the whole service for many years. 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 service had an open and friendly feel. People commented positively on the home and the care received.

The provider and registered manager had taken action to make improvements identified at the last inspection, ensuring the service provided to people was compliant with the Mental Capacity Act 2005 (MCA).

People were treated with kindness, respect and compassion. Staff respected people’s privacy and promoted their dignity. People and relatives we spoke with told us staff were kind and caring. There were many positive interactions observed with staff showing compassion and understanding when supporting people.

Care staff and managers knew and cared about people who used the service.

Relatives and friends could visit whenever they and the person liked, although the service promoted a ‘protected lunchtime’ to enable people to concentrate on their main meal.

People and, where appropriate, their relatives were involved in regular care planning reviews.

Wherever possible, staff promoted people’s independence.

Staff were attentive, noticing when people looked uncomfortable or upset. They were quick but discreet in offering the care and support needed.

People received care and treatment that met their individual needs. Care was planned and delivered based on people’s individually assessed needs and preferences. Assessments and care plans were reviewed and updated regularly, with the involvement of people and their relatives.

People were supported to eat and drink enough to maintain a balanced diet. They had a choice of meals and drinks. Special dietary needs and preferences were catered for. Where people needed assistance to eat or drink, staff helped them attentively and with sensitivity.

People’s risk of malnutrition was monitored regularly. People were weighed at least monthly, or more frequently if there was concern about weight loss. Prompt action was taken to address weight loss.

People had access to healthcare services and were supported to manage their health.

People had access to activities that made their individual needs and helped them maintain community links.

Staff worked with GPs and district nurses to provide the support people needed at the end of their life, for example ensuring that strong pain-relieving medicines were in place.

People and staff told us there were enough staff to provide the care and support they needed.

Medicines were managed safely and people were administered the medicines prescribed by their GP. Medicines were stored securely.

Recruitment systems were robust and helped ensure only suitable staff were recruited.

Staff had the knowl

This inspection took place on the 16, 17 and 18 May 2016 and was unannounced. The previous inspection of this service was on 24, 25 and 26 of November 2014 when we found one regulatory breach. Following the inspection, the provider wrote to us to say what they would do to meet these legal requirements. During this inspection we checked whether the provider had completed their action plan to address the concerns we had found. We found the provider had made the required improvements, however at this inspection we identified some other improvements were required.

Westholme Care Home provides nursing and personal care for up to 74 people, including those who are living with dementia. This included a discharge to assessment unit for up to 10 people. This unit is for people who require a period of care and treatment on leaving hospital prior to moving back home or into another supported living setting. At the time of our inspection there were 69 people living in the home.

The home is located on the outskirts of Winchester town centre and is arranged into three units; residential, nursing and discharge to assessment. Each unit has communal areas, including dining rooms and lounges.

The home has a registered manager in post. 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.

Our inspection of November 2014 found people were not adequately protected against the risks associated with medicines. At this inspection we found improvements had been made. Appropriate arrangements were in place for the safe storage, disposal, administration and management of people’s medicines.

The provider did not always follow the procedures to ensure people’s rights were upheld in line with the Mental Capacity Act (MCA) 2005. It was not evident that best interest decisions were always carried out when people lacked the capacity to make their own decisions. The provider had identified this concern and was taking action to address this at the time of our inspection. Staff training in the MCA had been planned and the appropriate documents were being implemented to ensure the correct process was followed. Action was being taken to protect people from inappropriate or unlawful decision making but the provider required more time to fully implement and embed this in their practice.

People and their relatives told us that people were safely cared for in the home. Staff we spoke with demonstrated their understanding of how to safeguard people and report their concerns. People were protected from the risk of abuse.

People had risk assessments in place that detailed their individual areas of risk and how these should be managed to keep people safe. Staff were updated daily on people’s changing needs to ensure they had the information they required to provide safe and appropriate care. Plans were in place to guide staff on how to support people safely in an emergency situation such as a fire, loss of utilities or insufficient staffing available to meet people’s needs.

There were sufficient levels of suitably skilled staff available to meet people’s needs. Whilst there were some staff vacancies the provider had ensured staffing levels were maintained. Agency staff were checked for their suitability to work with people and as far as possible the same agency staff were used to provide continuity of care for people.

Staff completed an induction into their role to ensure they were competent to carry out their responsibilities. Staff were supported by managers through regular supervision and an annual appraisal. Staff completed a range of training to develop the skills and knowledge they needed to meet people’s needs.

People were offered choice by staff in their day to day

During this visit we spoke with the manager, three deputy managers, the Practice Development Nurse, a registered nurse and six care staff. We also spoke with three people who use the service and a relative.

Staff we spoke with confirmed that staffing had improved since the last inspection. For example, a member of staff on the nursing unit said they now had “More individual time with residents, rather than being rushed”. Another care worker told us “We now have more time to give the care we want to give”. We observed that people received timely and responsive care to meet their needs. A person’s relative told us “We used to find it difficult to find a member of staff if we wanted to talk to them. Staff now have more time”. They said that it was important that staff spent time with their relative and that they felt more reassured that this was happening now. The Practice Development Nurse told us she felt that “Improved staffing levels and the use of a dependency tool are helping us to organise the day better around the needs of people”. The records we saw, including planned staff rotas and direct care hours provision, further helped to demonstrate that staffing levels were reviewed and had increased.

We spoke with three people who used the service and three relatives, the registered manager, two deputy managers and 11 members of staff. We also met and spoke with the service manager who visited the home during the inspection.

We saw that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. A relative spoke about “the care and the love” at Westholme and said “I could not ask for better care. I recommend the home to people I know”. Another person’s relative also told us “I could not wish for better”. Staff we spoke with were knowledgeable about people’s needs. A person who used the service told us the staff were “so helpful”.

We found, however, that robust arrangements were not in place to ensure that there were enough qualified, skilled and experienced staff to meet the health, safety and welfare needs of people using the service at all times.

People were cared for in a clean, hygienic environment and were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. A relative said “I go to the relatives meetings and they are useful" and commented “I feel that I can raise issues if I there is anything I am worried about”.

During the visit we spoke with four people who used the nursing home service and the relatives of three people. People told us that staff provided the care and support that they needed, although some people said this was not always at the time that they would prefer. People told us that “Staff provide all the care that I need” and “Staff provide the help that I need”. Relatives we spoke with also said staff were “Kind and gentle”, “Staff provide the care that (their relative) needs”.

We received mixed views about the numbers of staff available and whether there were sufficient. Two relatives told us that people sometimes had to wait to receive care. One relative said their relative “Has to wait at times for staff to be able to provide the care she needs”. We were also told that staff “Do their best, but there are sometimes staff shortages”. Other people we spoke with said they thought there were enough staff available and said they responded promptly to the call bell. We found other information which demonstrated that there were not always enough staff available to safeguard the health, safety and welfare of people who use the service. Staff were not always able to provide the care that people had identified as important to them.

The provider had systems for storing records safely; however, records were not always fully completed. This lack of information in the records did not always protect people from the risk of unsafe or inappropriate care and support.

During the visit we spoke with four people who used the service and spent time observing the interactions between staff and people who used the service. People told us they were well treated by staff and that they liked the home. We observed staff supporting people to make decisions, for example, about what drinks and snacks to have and what activities to take part in. Staff took the time to listen to people’s requests and to respond to them.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us staff provided the care and support that they needed. Staff demonstrated a good understanding of people’s needs and communicated with people in different ways.

People told us they felt safe in the home and said they were confident that any concerns they had would be addressed by the manager.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People we spoke with said they were able to raise concerns with the staff or manager and were confident that action would be taken to address the issue.

People said they received the care they needed in the way that they wanted it to be provided. People told us that staff had the right skills and treated them well and said there were enough staff available to meet their needs. One person we spoke with said staff provided support for her to take her medicine at the right time.

During the visit we spoke with eight people who use the service. People said staff provided the care that they needed in the way that they liked. A group of four people we spoke with said they were very happy with the care provided, adding that staff had the right skills and they were treated well.

People said they thought there were sufficient staff available to meet their needs. Examples were given of staff responding quickly to requests for assistance.

People we spoke with said they felt well looked after and that there were sufficient staff working in the home to meet their needs.

This inspection took place on 24, 25 and 26 November 2014 and was unannounced.

Westholme Care Home provides nursing and personal care for up to 67 people, including those who are living with dementia. It also provides reablement treatment for up to six people. Reablment is a way of helping people to remain independent, by giving them the opportunity to relearn or regain some of the skills for daily living that may have been lost as a result of illness, accident or disability. There were 63 people using the service at the time of this inspection.

The service is overseen by 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.

People were complimentary about the service they received. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

Although people told us they felt safe, we found medicines were not always stored, given to people and disposed of in line with good practice. Suitable guidelines were not in place for the administration of pain relief medicines for people.

There were enough staff to meet people’s needs and the registered manager used regular agency staff who were familiar with the people living in the home. Recruitment to fill vacancies was actively taking place and relatives were involved in recruitment interviews.

People and their families were included in the planning of their care and care plans detailed support required and how risks needed to be safely managed. People were treated with dignity and respect and staff knew the people they were supporting. However, we observed several interactions which were focussed on tasks rather than individual needs.

People told us they had sufficient to eat and drink and they had a choice of meals, snacks and drinks. Family and friends were able to visit and told us they were involved in the service and kept informed appropriately.

Staff were aware of their responsibility to protect people from harm or abuse and knew what action to take if they were concerned. They told us they were confident to use the procedures to raise concerns.

Staff involved relevant health professionals and responded quickly to people’s changing health needs. The manager had implemented several approaches to involve people, including relevant professionals in the service and continually seek ideas for improvement. Issues we raised with the manager during the inspection such as some lack of clarity in one of the records were dealt with promptly and followed up with relevant staff.

We identified two areas where the service required improvement. There were a number of missed opportunities for staff to engage and interact with people to enhance the quality of care. There were some inconsistencies with care records putting people at risk of not having their needs responded to appropriately. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.