The inspection took place on 18 July 2018 and was unannounced.

Westlands Retirement Home 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. Westlands Retirement Home accommodates up to 51 people some of whom may be living with dementia, across two linked units. On the day of the inspection, 49 people were accommodated.

The service had 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.

People were kept safe from the risk of abuse as staff had undertaken relevant training and understood their responsibilities to protect people. Risks to people both as individuals and from their environment had been identified, assessed and managed safely. There were sufficient staff to provide people’s care. The provider followed safe staff recruitment practices. People’s medicines were safely managed within the service by trained staff who followed good practice guidance. Staff followed infection control guidance to ensure people were kept safe from the risk of acquiring an infection. Learning took place following incidents and processes were in place to identify any trends that needed to be addressed for people.

People’s care needs were assessed prior to their admission. The planning of their care considered good practice guidance, to ensure it was effective. Staff were supported in their role through the provision of an induction, on-going training, supervision and professional development. People were supported to eat and drink sufficient amounts for their needs. Risks to people from dehydration and malnutrition were assessed and managed effectively. Processes were in place to promote effective working both within the team and with other services. People were supported to access healthcare professionals as required and staff had undertaken relevant training to support them in recognising promptly if people’s health was deteriorating. Parts of the service were being refurbished and enhanced for people’s use and enjoyment. 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.

We observed care and support was given to people throughout the day, in a kindly manner. Staff supported people to be involved in making decisions about their care where possible. People were treated with dignity and respect by the staff who provided their care.

People received care that was responsive to their needs. People and their families were involved in their care planning, which reflected their care needs and preferences. Staff had undertaken relevant training to enable them to be responsive to the needs of people whose behaviours could be challenging. People were provided with daily activities to stimulate them and could have visitors when they wished. People’s concerns and complaints had been used to improve the quality of the care provided. Staff had completed training and were undertaking further training to enable them to support people appropriately at the end of their life.

People told us the service was well-led. The new registered manager had fostered a positive culture within the service, with staff feeling pride and commitment to their work. The registered manager had submitted notifications as legally required. People’s views on the service were sought and used to improve the service. Processes were in place to assess and monitor the quality of the service provided. The service had good working rela

The inspection took place on 5 February 2018 and was unannounced.

Westlands Retirement Home 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. Westlands Retirement Home accommodates up to 51 people some of whom may be living with dementia across two linked units. On the day of the inspection, 42 people were accommodated.

We carried out an unannounced comprehensive inspection of this service on 12, 13 and 14 July 2017. Breaches of legal requirements were found. 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 this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westlands Retirement Home on our website at www.cqc.org.uk.

At the last inspection on 12,13 and 14 July 2017, we asked the provider to take action to make improvements in relation to safe care and treatment, medicines, premises and equipment and governance, and these actions had been completed.

This is the second time the service has been rated Requires Improvement. Although the requirements of the breaches had been met, we were unable to change the ratings for the key questions of safe and well-led to good as further work had to be completed and changes embedded within staffs practice. The manager had already undertaken a number of actions in areas such as medicines, but was aware that it would take further time for all of the required improvements to be completed.

The provider had appointed a new manager, who had applied to the Care Quality Commission to become the registered manager for the service. 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.

Processes were in place to ensure staff could recognise when to alert healthcare services about potential risks to people. People’s fluid requirements were identified, their intake monitored and appropriate action taken to prevent dehydration. Equipment safety checks had been completed.

Staff’s competency to administer medicines had been assessed and relevant guidance was in place. The dating of topical creams and drinks thickeners by staff upon opening required improvement. People were receiving their medicines safely, but further time was required for the improvements the manager was making in this area to become consistent staff practice.

Processes were in place to monitor and improve the service and feedback from professionals had been acted upon. However, some audits required further improvement in order to make them fully effective such as the infection control and staff file audits. More time was needed for the manager to be able to demonstrate that audits had driven consistent improvements in the service over time.

People were safeguarded from the risk of abuse. The manager understood their responsibilities and took the correct action to safeguard people.

Sufficient staff were deployed to provide people’s care. Pre-employment checks had been completed, but this area required improvement to ensure all information was available and verified.

Aspects of the cleanliness of the service required attention. The manager took action following the inspection to address this and they were recruiting additional cleaning and maintenance staff. More time was needed for the provider to be able to d

The inspection took place on 12, 13 and 14 July 2017 and was unannounced. Westlands Retirement Home is registered to provide accommodation and support to 51 people some of whom were living with dementia; they are not registered to provide nursing care. At the time of the inspection there were 48 people living there.

The service had 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 told us they received their care safely. Although most risks to people were well managed staff did not consistently recognise or proactively respond to some potential risks to people. We found staff had not acted to sufficiently reduce potential risks for two people. Staff were not always provided with sufficiently detailed guidance with regards to people’s individual care needs to enable them to manage potential risks safely.

Not all required safety checks on the environment had been completed to ensure peoples’ safety. People told us the service was clean and the communal areas, bathrooms and people’s bedrooms were seen to be clean. A new kitchen was due to be fitted however; the current kitchen had not been cleaned or maintained to the required standard to ensure safe food preparation. During the course of the inspection the provider took immediate action to ensure the kitchen was cleaned to the required standard.

The providers told us that following a medicines safe incident actions had been taken to improve medicines safety and people confirmed they had seen improvements. However, we still found some aspects of medicines management were not being managed safely for people.

Audits were not consistently completed in accordance with the provider’s audit schedule nor were they fully effective; they had not identified or fully addressed all of the issues we found. The providers did not always take prompt action in relation to issues identified either internally through their own audits or through external feedback or audits. People’s records were not always kept fully up to date as required. Robust processes were in place to document and analyse incidents.

During the course of the inspection the providers started to take action on the issues we identified. Following the inspection they submitted an initial action plan based on the written feedback provided at the end of the inspection. This set out the actions they had started to take or planned to undertake, this has served to lower the level of the above risks identified.

Staff had undertaken relevant safeguarding training and understood their role and responsibilities. However, further improvements are required to ensure that actions taken in response to safeguarding alerts are fully effective in preventing the risk of reoccurrence for people.

Although not all people felt there were enough staff we found there were sufficient staff deployed to meet people’s needs. Staffing requirements for the service were kept under regular review and adjusted accordingly. Relevant checks had been made in relation to staff’s suitability for their role.

At our previous inspection of the service we found the providers had failed to follow the requirements of the Mental Capacity Act prior to making an application to deprive people of their liberty or when determining if the use of bed rails was in their best interests. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found this legal requirement had been met. 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.

The inspection took place on 01 and 02 August 2016 and was unannounced. Westlands Retirement Home is registered to provide accommodation and support without nursing for up to 51 people. The service expanded in June 2014, when an extension was added to the original building. The original building known as the ‘green’ wing accommodates 35 people whilst the extension known as the ‘purple’ wing accommodates a further 16 people. At the time of the inspection there were 48 people living there.

The service had 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.

At our last inspection of this service on 13 and 14 July 2015 we found two breaches of legal requirements in relation to safe care and treatment and governance and record keeping. Following the inspection the providers wrote and told us they planned to meet the requirements of these regulations by the end of November 2015. At this inspection we found the requirements of these regulations had been met.

Risks to people had been assessed; staff had written guidance about how to manage identified risks to people. Risks to people from falling had been assessed and relevant action taken to manage these risks safely for people. People who had diabetes had a care plan to provide staff with written guidance about how to support them to manage their condition.

Various aspects of the service had been audited and action had been taken to improve the service for people. People’s records were found to be accurate, reflected the care they had received and were stored securely.

The providers did not always follow procedures to ensure people’s rights were upheld in line with the Mental Capacity Act (MCA) 2005. There was a lack of written evidence to demonstrate that either people had consented to the use of bed rails or that they had been assessed as lacking the capacity to consent to their use and a best interest decision had been made in consultation with relevant parties. Deprivation of Liberty Safeguard (DoLS) applications had been made on people’s behalf. However, there was a lack of written evidence to demonstrate legal requirements had been met in relation to the requirements of the MCA prior to the applications being submitted. The providers had not carried out mental capacity assessments and best interest decisions where people’s freedom of movement was restricted.

People were safe as staff understood their roles and responsibilities in relation to safeguarding. Safeguarding alerts had been made to the relevant authorities as required to ensure people were safeguarded against the risk of abuse.

People, their relatives, staff and professionals provided mixed feedback about staffing levels. Staffing levels had been increased in response to staff feedback even though people’s assessed needs had actually decreased. Records demonstrated that the registered manager regularly assessed and kept under review people’s staffing requirements. Staff had been required to undertake appropriate pre-employment checks to ensure their suitability to work with people.

Staff who administered people’s medicines had undergone appropriate training and had their competency assessed. Improvements were required to ensure staff administering medicines were not distracted for people’s safety. The providers took measures during the inspection to ensure people’s medicines were stored at a safe temperature. Processes were being introduced to improve record keeping in relation to people’s topical creams. However, it will take time for these changes to become embedded within staff practice.

Staff received an induction to their role and were supported to undertake professional development. Not all staff

During our inspection on 25 October 2013, we found that people had not been protected against the risks of inappropriate care by means of the assessment, planning and delivery of care. We found that whilst the service had a menu which included a choice of nutritious food and hydration, people had not always been provided with adequate support to eat and drink sufficient quantities. In addition, we found that the systems in place to monitor the quality of care records had not been effective and that the care records contained out of date or conflicting information and were not always accurate.

Following the inspection, the provider sent us an action plan, telling us what actions they were taking to address the areas of non-compliance. On the 04 March 2014 we carried out a further inspection to assess whether the home was now compliant.

At the time of our inspection in March 2014, Westland’s Retirement Home was providing care to 32 people. We spoke with the registered manager, six care workers, the activities co-ordinator and the chef. We looked at four peoples care records.

We spoke with five people who used the service who told us about their experiences of the care they received. One person said, “I am very happy here…I like to be independent and I can do what I want”. Another person told us, “The staff are all kind and caring”. A relative told us that they had looked at a number of homes but, “This one was the best”.

We found that the provider had made improvements to the way in which people’s needs were assessed and care planned and delivered. The service had put in place arrangements to ensure that people received adequate food and nutrition and we saw that people were supported to eat and drink in a relaxed and supportive manner.

The service had made improvements to their systems for assessing and monitoring the quality of care plans to ensure that care records were accurate and up to date. However, these improvements will need to be embedded in practice and sustained over time.

During our visit we spoke with the relatives of four people who told us that they were kept informed of their family member’s changing needs. The relatives we spoke with all confirmed that their family member was treated with respect and dignity. One said: “I am here a lot and watching I can see they treat all people with dignity and respect”. Another commented: “All people’s individual traits are recognised and dealt with here”.

We observed staff supporting people in a manner that was respectful, sensitive and considerate. However we had some concerns staff did not have sufficient guidance to provide appropriate support. We found that specific assessments of people’s care and support needs had not always been made.

We observed the midday meal, which was uncoordinated and resulted in a disjointed mealtime experience. Some people were not adequately supported to eat their meal. Staff stood at tables to assist people, they did not sit with them or wait until people had finished their meal before moving away.

The care records at the home were not clear or contained inconsistencies. These issues had not been identified through the audit process. This meant that the auditing of care records was not effective in identifying the shortfalls of the care records.

Two of the staff we spoke with told us that they felt the care plans were a good source of information but felt they could be more person centred. One member of staff said that they were sometimes unsure of the support people needed as the information in care plans was not consistent.

The inspection took place on 13 and 14 July 2015 and was unannounced. Westlands Retirement Home is registered to provide accommodation without nursing for up to 51 people many of whom experience dementia. At the time of the inspection there were 49 people accommodated.

The service had recently appointed a new manager; they understood the need to submit an application to become the registered manager and planned to do this shortly. 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 expanded in June 2014, when an extension was added to the original building. The original building accommodates 35 people whilst the extension accommodates a further 16 people. The service provides both long term care and short-term respite care to people. The original building and the extension both contain a lounge and dining area in addition to people’s bedrooms.

Staff had not identified all potential risks to people or put care plans in place to manage these risks. People with diabetes did not have diabetes care plans to provide staff with written guidance about how to manage their condition safely. Staff had not informed the GP when people had fallen in all cases that they should have. Staff had not always reviewed people’s written care plans following incidents, to ensure any required updates were made, to manage risks to people.

People’s daily records did not always reflect the actual care they had received. The manager had taken action to improve staff record keeping. However this issue had not been fully addressed to ensure people had accurate daily records of their care. The manager reviewed incidents but there was a lack of robust trends analysis to identify potential areas of risk to people. The manager produced a monthly quality assurance report for the provider but this process was not sufficiently in-depth to fully assess and monitor the quality of the service people received.

Some relatives and staff provided negative feedback on staffing levels but people themselves, and the majority of relatives and staff felt staffing was sufficient. Staffing levels were observed to be sufficient to meet people’s needs.

The provider operated safe staff recruitment practices. Staff had completed an induction to their role and were required to undertake regular training and supervision. People were supported by suitable staff who felt sufficiently supported in their role.

People were safeguarded from the risk of abuse. Staff had completed relevant training and understood what action they should take to safeguard people. Safeguarding incidents had been reported by the manager to the relevant authorities to keep people safe.

Staff who administered medicine had received training. Learning had taken place following a medicines incident and changes implemented. People’s medicines were managed safely.

People were protected from the risk of infection. Staff had received relevant training and had ready access to equipment to prevent the spread of infection. The service was clean.

The manager had identified areas for improvement in relation to the quality of the lunch time experience for people who lived with dementia. Some changes had already been implemented but further improvements were required to meet people’s needs effectively at lunchtime.

A programme of renovation was planned for the original building and this was due to commence once quotations had been obtained. The provider planned to use improvements to the internal environment to improve the appearance of the service for people.

People were weighed regularly and action was taken if they were assessed as at risk from malnutrition. Where required, people had been referred to the dietician and their food and fluid intake had been monitored. People’s pressure ulcers were managed effectively. Staff had sought relevant advice from the district nurses and used equipment appropriately to manage people’s pressure ulcers.

Where people lacked the mental capacity to make specific decisions staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLs applications had been submitted for people to ensure restrictions on their liberty, to keep them safe, were legally authorised.

People’s relatives provided mixed feedback about how caring staff were. They told us the long-term staff were very caring but that some of the new care staff did not interact consistently with people. Some care staff chatted with people positively and warmly whilst others were observed to focus on providing people’s care. People experienced inconsistency in the level of social interaction from some staff.

People’s records provided staff with clear documentation in relation to their personal preferences about their care. People were involved in making decisions about their care where possible and their choices were respected. Staff treated people with dignity. They spoke with people respectfully and ensured their privacy was upheld.

People’s care needs were thoroughly assessed prior to them being accommodated. The provider ensured they only agreed to accommodate people whose needs staff could meet. People had clear care plans which they or their families had been consulted about. Their care plans were reviewed regularly to ensure they remained relevant. Staff read people’s care plans and understood their care needs.

Some relatives felt there had been a reduction in the amount and quality of activities. People were able to access a range of activities during the week, however, they were not all publicised to ensure people knew what was taking place and where.

People and their relatives had accessed the provider’s complaints process. The manager had responded to complaints received at an individual level. They had also taken action when a trend in complaints about laundry had been identified in order to improve people’s experience of the laundry service. People’s views of the service were sought and recorded during their monthly review where possible. People’s views were also sought through the annual quality survey and meetings. People’s views had been sought and action taken in response to issues raised.

There had been a recent change in management and growth in the size of the service. Although staff felt supported by the management, some people’s relatives felt management should be more visible on the floor. There were processes in place to ensure information was shared between staff on the floor and the manager, however, these were not always fully effective. The provider was reviewing how to make the team leader role more robust in order to provide a stronger level of direct management of care staff on the floor for people.

The new manager was working to create an open and transparent culture. Staff told us they felt supported and able to speak up about any concerns they might have. People were cared for by staff who felt able to speak out about issues.

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