Westlands provides accommodation and personal care for up to 41 older people who may live with dementia. Thirty-three people were living at the home at the time of our inspection visit. At the last inspection, the service was rated Good overall and Outstanding in well-led. At this inspection we found the service has maintained the same ratings and continues to be rated Good overall and Outstanding in well-led.

There were two registered managers for this service at the time of our inspection visit. 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.

One registered manager had recently retired, but had not yet deregistered from the service. The new registered manager had been in post since April 2017 and had been registered as the manager at this home since May 2017. The new registered manager was already registered with us as a manager at another of the homes in the provider’s group, which had been rated Good under their leadership. The provider had notified us of these changes.

People were at the heart of the service. Staff and the management team shared and demonstrated the provider’s philosophy that, ‘every day should be a day well lived’. Staff received training in the provider’s values, which included, ‘play, make their day, be there and choose your attitude’. People were supported to maintain their purpose and pleasure in life independently or with the support of staff and volunteers.

People and their relatives were encouraged to share their opinions about the quality of the service, which ensured planned improvements were beneficial to the people who lived at the home. The provider continued to use external agencies and recognised methods to understand how people who lived with dementia experienced care, to drive improvements in the service. Changes to the premises had improved people’s enjoyment of their environment.

The provider was innovative and creative and strived to improve the quality of people’s lives. They had researched and reflected on how an internationally recognised provider of excellence in dementia care provided care. They had implemented an electronic care planning system that ensured staff and management had access to the most up-to-date information at the press of a button and enabled relatives to be fully informed and involved in their relations’ care.

The provider planned to implement an acoustic monitoring system at night, which was already in operation at some other homes in the group, where people had agreed they would like it. People will benefit from the technology because they will not be disturbed by regular night checks and staff will have more time to care for them.

People continued to have freedom of choice and were supported by staff who had the skills and training to meet their needs. People were supported with their dietary and health needs and were encouraged to maintain their independence by following their preferred and familiar routines and habits.

People were involved in planning their care with the support of their relatives and staff, to make sure their care plans met their individual needs, abilities and preferences. Staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.

People were protected from the risks of harm, because staff understood their responsibilities to protect people from harm. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. Medicines were stored, administered and m

The five people we spoke with told us they like living at the home. People told us, “The carers are very good, very helpful” and “I have a call bell and staff come when I ring it.” Both relatives we spoke with were happy with the care and support their relative received. One relative said, “The staff are marvellous. They all chat to us. I feel welcome and that is very important.”

The provider assessed people's needs and abilities before they moved into the home. Everyone had a own care plan, which minimised risks and promoted their independence. In the five care plans we looked at, we saw that people or their relatives signed to say they agreed with the plan and consented to staff acting on their behalf for specific aspects of their care.

People were protected from the risks associated with medicines because staff followed the provider's policy, procedures and guidance. We saw that senior staff checked that accurate records were kept when medicines were obtained and administered.

Care staff we spoke with told us they were supported by the provider to deliver the care and support that people needed. We saw records of staff’s individual meetings with the manager. A member of care staff told us, “I love it here I love working here.”

The provider's quality assurance process included regular checks that people and their relatives were happy with the service they received. One person we spoke with told us, “If I had any concerns, I would go to the manager.”

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional.

Many of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed. We talked with seven staff and relatives, looked at the care plans for five people who lived at the home to see how their needs should be met and we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People appeared to be relaxed and confident in staff’s company. We saw that staff treated people with kindness and understood people’s moods and behaviours. We found that staff encouraged people to take an interest in their surroundings and to make choices about what to eat. One person who lived at the home said, “It’s lovely here, the staff really look after me.”

We found that staff knew people’s preferences, likes and dislikes very well, and these had all been recorded in people’s care plans when they moved into the home. A relative we spoke with said, “We are really pleased we chose this home, the friendliness, not only for X, but for us too, we feel welcome.”

The inspection took place on 5 and 6 May 2015 and was unannounced. The service was meeting the regulations at our previous inspection in July 2013. We were confident the provider continued to meet the regulations because they had kept us informed of changes and important events and had responded to our requests for information promptly and effectively.

The home provides accommodation and personal care for up to 41 older people, or older people living with dementia. Thirty five people lived at the home at the time of our inspection. Each of the three floors of the home was organised as a separate household, which meant people had access to communal rooms and facilities of a size many people would be familiar with.

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.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks.

There were enough staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored and administered safely.

Staff understood people’s needs and abilities because they read the care plans and shadowed experienced staff until they knew people well. Staff received training and support that ensured people’s needs were met effectively. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, to improve people’s experience of care.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one was subject to a DoLS at the time of our inspection. The manager ensured that best interest decisions, for people who lacked capacity, were made after discussions with their representatives or families and other health professionals.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and staff understood the importance of helping people to maintain a balanced diet.

Staff were attentive to people’s moods and behaviour and understood when to implement different strategies to minimise people’s anxiety. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health or when their needs changed.

People and their relatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences and care plans were regularly reviewed.

The provider’s quality monitoring system included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

People who lived at the home, their relatives and other health professionals were encouraged to share their opinions about the quality of the service. The provider and registered manager took account of others’ opinions to make sure planned improvements focused on people’s experience. The provider worked with partner agencies, who were specialists in the field of dementia care, to ensure people received the best possible care and support.

The provider had implemented innovative technologies to minimise medicine errors and obtain prompt health care advice. People could access a virtual health advice service, which reduced the time it took to relieve any anxiety about their health.

The provider’s philosophy, vision and values were understood and shared across the staff team and resulted in a culture which ensured people were supported to maintain their purpose and pleasure in life.