Westlands is a service which provides accommodation for up to 30 people who require nursing or personal care. The home supports older people some of who live with dementia and physical disabilities. At the time of the inspection there were 19 people using the service.

Following our previous comprehensive inspection in June 2016, we gave this location an overall rating of 'Requires Improvement’.

At that inspection we found that people’s risk assessments were not robust enough and the staffing levels were not sufficient to ensure people's needs were safely met. We also found the service was not always safe because people's medicines were not managed effectively. In addition to this we found some of the areas of the home and furniture were dirty and this exposed people to the risk of acquired infections. People were also exposed to hazards because cupboards with cleaning detergents were not always locked.

The service offered to people who lived at the home was not always effective because the requirements of the Mental Capacity Act 2005 were not met. We also found people were not always involved in decision making around their meals and meal times. From our observations, we found that care plans lacked involvement from the people who received care and did not take into account their wants, needs and were not person centred. People were bored and spent much of the time just sitting throughout the day which was punctuated by mealtimes or tasks delivering their personal care. People also told us they were not able to take part activities and hobbies that were of interest to them because there wasn't enough staff.

We found there was an area of concern whereby the lift had broken down, but this was not reported to the Care Quality Commission (CQC) as an event that stopped the service from operating as normal. You can read the report from this comprehensive inspection by selecting the 'all reports' link for Westlands on our website at www.cqc.org.uk.

The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have them met by. At the last inspection in June 2016 we asked the provider to take action to make improvements to the above issues and during this unannounced comprehensive inspection on 14 June 2017, we found that these actions had been completed

There was a registered manager 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 2008 and associated Regulations about how the service is run.

There was not strong leadership in the service and we found that people were unsure who the registered manager was. Quality monitoring systems were however in place. A variety of audits were carried out and used to drive improvement.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent. There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed. Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

The service was clean and there were no malodours. Cleaning products were locked away.

Staff received an induction process and on-going training. They had attended a variety of training to ensure th

This inspection took place on 3 and 7 June 2016 and was unannounced. This was our first inspection of this service.

Westlands is a residential care home in Leighton Buzzard, providing accommodation and support for up to thirty older people. The home operates over three floors. The first and second floors are accessed by stairs and a lift. At the time of our inspection there were twenty-five people living at the home, some of whom were living with dementia.

The home had a registered manager in post at the time of our inspection. 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.

People who lived at the home were not always safe because the staffing levels were not sufficient to meet their care and support needs. Their medicines were administered as prescribed but there were unexplained gaps in medicines administration records and their risk assessments did not always provide adequate guidance to staff on keeping them safe. Risk assessments that related to the safe running of the home had not been reviewed since 2013. Staff were trained on safeguarding people and they understood the process they needed to follow, if there were concerns about people’s safety.

Some of the areas of the home and furniture were dirty and this exposed people to the risk of acquired infections. People were also exposed to hazards because cupboards with cleaning detergents were not always locked.

People’s care was not always effective because regular use of agency staff meant that they did not always receive consistent care. The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were not always met, and people were not involved in menu planning. Although staff were trained in areas that were relevant to their job roles, we found that the training was not always effective in meeting people’s care needs. People were supported to access other health and care services when required.

The service was not always caring because the interactions between staff and the people who lived at the home were mainly task led. People were advocated for by their relatives or social care professionals where needed but there was no evidence that showed people had support from independent advocacy services if required. Staff were spoke with people appropriately and called them by their preferred names. People’s privacy and dignity was observed.

Improvements were also required in the responsiveness of the service because people and their relatives were not fully involved in the assessment and planning of people’s care. People were not always supported by staff to take part in activities that were of interest to them.

There was an effective system in place for handling complaints, but improvements were required in senior management’s oversight of this home and the frequency of audits so that any issues could be addressed quickly.

The provider was not meeting the regulations in relation to consent, safe care and treatment, the safety of the premises and equipment, staffing, person-centred care, good governance and notification of other incidents. You can see what action we told the provider to take at the back of the full version of the report.