This comprehensive inspection was conducted on 29 June 2018 and it was unannounced.

Westmorland Court Nursing and Residential Home (Westmorland Court) is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Westmorland Court provides accommodation for up to 48 adults, who require help with personal and nursing care needs. The home is in a semi-rural setting, a short distance from the village of Arnside. A small car park is available at the front of the building. The home is arranged over three floors with communal bathing and toilet facilities being appropriately located throughout the building. There are stairwells in the home for access to the upper floors, although a passenger lift is also installed for people who live there and visitors to use. At the time of the inspection there were 34 people living in the home.

A new registered manager was in post following the completion of their registration with CQC in April 2018. 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. A clinical lead nurse was also in post to support the registered manager and oversee clinical matters. Staff we spoke with felt supported by the management team.

At our last comprehensive inspection,18 January 2018, the service was rated overall as Requires Improvement. We found that there were five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to; need for consent; safe care and treatment; safeguarding service users from abuse and improper treatment; fit and proper persons employed and good governance. The management of risks within the environment was insufficient and therefore people were at risk of harm. The kitchen was found to be unhygienic and in need of a deep clean. The management of medicines could have been better, so that people who lived at the home could be better protected against poor medicine practices. These findings constituted a breach of regulations 11, 13 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued three warning notices and made two requirements.

Following that inspection, we asked the registered provider to take action to make improvements and complete an action plan to show what they would do and by when they would do this. During this inspection we found that improvements had been made and the registered provider had taken action to improve the quality and safety of the service and the breaches of regulation had been met.

At this inspection on 29 June 2018 people living in the home and their relatives told us they believed the home was a safe place to live. We were told that staff were “cheerful” and “friendly”. We saw occasions when staff displayed empathy and compassion as they comforted people when they became distressed or as helped them around the home. Relatives told us staff responded to people’s needs but that some staff found communication with people living there difficult at times. This was being addressed through an ongoing programme of training and support for overseas staff.

We found that improvements to the processes used when employing people had been made and the recruitment of staff was robust. The checks on the suitability of staff required by regulation had been completed for staff in the home.

The quality assurance and monitoring systems being used to assess the quality of the service provided had been developed to be more effective and quality monitoring visits by the provider and area manager were taking place and were rec

Westmorland Court Nursing and Residential Home (Westmorland Court) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Westmorland Court provides accommodation for up to 48 adults, who require help with personal and nursing care needs. The home is located in a semi- rural setting, a short distance from the picturesque village of Arnside. A small car park is available at the front of the building. The home is arranged over three floors with communal bathing and toilet facilities being appropriately located throughout the building. A number of stairwells are available for access to the upper floors, although a passenger lift is also installed.

Shortly before our inspection the registered manager had left employment. The deputy manager was acting as manager at the time of our visit. She was in the process of applying to the Care Quality Commission to be the registered manager of Westmorland Court. 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.

This comprehensive inspection was conducted on 18 January 2018 and it was unannounced.

Our last comprehensive inspection of this service was conducted over two days on 4 July 2016 and 6 July 2016 when we found the provider was failing to provide safe care and treatment by the proper and safe management of medicines. This was a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore, we issued a warning notice for the unsafe management of medicines. We subsequently conducted two focussed inspections on 7 November 2016 and 11 January 2017 in order to monitor if improvements had been made around the management of medicines. The warning notice in relation to medicines was found to have been met at the inspection conducted on 11 January 2017.

During the inspection on 4 July 2016 and 6 July 2016 we also found the quality monitoring systems were not fully effective in identifying risks. This was a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore, we issued a warning notice for ineffective governance. We subsequently conducted two focussed inspections on 7 November 2016 and 11 January 2017 in order to monitor if improvements had been made around the monitoring of risk. The warning notice in relation to governance was found to be met at the inspection conducted on 11 January 2017.

During the inspection on 4 July 2016 and 6 July 2016 we also found a breach of the regulations in relation to person centred care. At that time people who lived at Westmorland Court were not consistently receiving care or treatment, which had been planned and personalised specifically for their individual needs. Therefore, a requirement notice was issued for regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we looked at how the service provided person centred care. Records showed that people’s needs had been properly assessed and the plans of care we saw were well written, person centred documents. The service demonstrated appropriate systems to assess health care risks for people who lived at Westmorland Court and robust systems were in place for the formulation of individuals care plans. Therefore, the previous breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was met on this occasion. However, person centred care and infection control practices could have been further promoted by peop

We carried out this unannounced focused inspection at Westmorland Court on 11 January 2017. This was to assess the progress being made by the service to meet warning notices to improve had been issued after an unannounced comprehensive inspection of this service on 4 and 6 July 2016.

The warning notices were in relation to a continuation of breaches of two regulations. These were Regulation 17 (Good Governance), as the quality monitoring systems were still not being effective in identifying all relevant risks to people. The second warning notice was issued for Regulation 12 (Safe care and treatment) because the registered provider had not protected people against the risks associated with the safe management of medication

Following the July 2016 inspection, we completed another unannounced focused inspection on 7 November 2016 to monitor progress with meeting the warning notices. At that inspection, we found that some action had been taken to achieve the improvements stated in the action plan regarding medicines management and governance. Following the focused inspection in November the service rating overall remained Requires Improvement

We, the Care Quality Commission, (CQC) needed to be confident that the registered provider could demonstrate a consistent level of improved practice over time. The registered provider had voluntarily suspended admissions to the home for an agreed period, while the work needed to meet the warning notices was completed. They had kept us informed of their progress during that time.

At this focused inspection on 11 January 2017, we found that the new manager and registered provider had met the breaches of the regulations and the issues outstanding from our previous inspection. At this inspection, we found that all medicines were being administered by qualified nurses. The manager had completed regular audits and competency assessments to assess safe medicines handling in accordance with the home’s medicines policies. Disciplinary action had also been taken with staff where necessary to address poor practices.

This report only covers our findings in relation to breaches identified within the warning notices. We will review our regulatory response and our ratings for safe and well led at the next comprehensive inspection. The service rating overall remains Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk’

Westmorland Court Nursing and Residential Care Home (Westmorland Court) is registered to provide personal and nursing care for up to 48 people. The home is in a residential area and within walking distance of the centre of the coastal village of Arnside. There is parking available for visitors and a garden area for people living there to use. At the time of the inspection there were 24 people living in the home, 15 of whom were receiving nursing care.

The service did not have a registered manager in post at this 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 and associated Regulations about how the service is run.

At the time of the inspection in July 2016, there was not a registered manager in post. A new manager had been recruited by the registered provider. They had been in post since October 2016. The new manager had not yet registered with CQC as required under regulation. They were aware they must do so.

At our inspection in November 2016, we found some issues remained to be addressed to protect people from the risk of harm due to poor medicines management. This was because nurses did not always make clear records of medicines handling and administration and some people had missed doses of medicines because there was none in stock to ad

We carried out an unannounced focused inspection at Westmorland Court on 7 November 2016. This was to assess the progress being made by the service to meet two warning notices to improve had been issued after an unannounced comprehensive inspection of this service on 4 and 6 July 2016.

The warning notices were in relation to a continuation of breaches of two regulations where requirement notices had been issued at an inspection in September 2015. This was in respect of Regulation 17 (Good Governance) as the quality monitoring systems were still not being fully effective in identifying risks. It was also in respect of Regulation 12 (Safe care and treatment) because the registered provider had not protected people against the risks associated with the safe management of medication.

We also found at the inspection in September 2015 incidents that had occurred within the home that might affect people’s safety had not been appropriately referred to the local authority safeguarding team or notified to CQC. We found that the registered provider had also not always acted in accordance with the requirements of the Mental Capacity Act 2005 (MCA). In addition, care plan assessments had not always reflected a person-centred approach to managing people’s care needs.

Following the comprehensive inspection in September 2015 and July 2016 the registered provider wrote to us and sent us an action plan saying how and when they intended to make the improvements needed to meet the regulations.

At the inspection in July 2016, we found that action had been taken to comply with the breaches of regulations with the exception of Regulation 12 (Safe care and treatment) because the registered provider had not protected people against the risks associated with the safe management of medication. Also in respect of Regulation 17 (Good Governance) as the quality monitoring systems were still not being fully effective in identifying risks

At the focused inspection on 7 November 2016 we found that some further actions had been taken to make the improvements stated in the action plan regarding medicines management and governance. However, the breaches of the two regulations had not been met in full. Although some breaches of the requirements of the regulations have been addressed, some remain. The service rating overall remains Requires Improvement.

The service did not have a registered manager in post at this 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 and associated Regulations about how the service is run. At the time of the inspection in July 2016, there was a new manager in post but had not yet completed the process to register as a manager with CQC. They had left the post before our inspection on 7 November 2016 without completing registration.

A new manager has now been recruited and had been working in the home for a month when we inspected. We could see from audits and action plans the new manager had done that they were reviewing all that had been done so far to comply with the regulations and what still needed to be completed and embedded with staff. They demonstrated a clear understanding of the areas that must be addressed straight away and we could see that improvement work was underway. We saw that the lack of consistent and effective management during the time since the inspection in July 2016 had had a significant effect upon the service’s ability to implement and monitor improvements and to embed new practices and awareness with staff.

Westmorland Court Nursing and Residential Care Home (Westmorland Court) provides personal and nursing care for up to 48 people. Set in National Trust owned land the home is a short walk from the centre of the village of Arnside. There is parking available

This unannounced inspection took place on 4 and 6 July 2016. We last inspected Westmorland Court on 29 September 2015. At that inspection we found the service was not meeting all the regulations we looked at.

Following the inspection on 29 September 2015 we issued four requirement notices. These were in relation to the management of medicines and the procedures in use that did not reflect current national guidance for the safe management of medicines. Also the registered provider could not demonstrate that effective monitoring and communication systems were in operation to help identify and assess potential risks to people and their welfare. The registered provider had not made sure that all aspects of service provision and record keeping were being regularly monitored for effectiveness.

We also found that incidents that had occurred within the home that might affect people’s safety had not been appropriately referred to the local authority safeguarding team or notified to CQC.

We found at the last inspection that the registered provider had also not always acted in accordance with the requirements of the Mental Capacity Act 2005 (MCA). Also care plan assessments had not always reflected a person-centred approach to managing people’s care needs.

Following the inspection in September 2015 the registered provider wrote to us and sent us an action plan saying how and when they intended to make the improvements needed to meet the regulations.

At this inspection on 4 and 6 July 2016 there was a continuation of breaches of two regulations where requirement notices had been issued at the last inspection in September 2015. This was in respect of Regulation 17 (Good Governance) as the quality monitoring systems were still not being fully effective in identifying risks. It was also in respect of Regulation 12 (Safe care and treatment) because the registered provider had not protected people against the risks associated with the safe management of medication.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Following this inspection 4 and 6 July we asked for further information from the registered provider and manager and to provide reassurances on the immediate actions they were taking in regard to a safeguarding concern and the safe handling of medicines. This was to prevent any repetition of the concerns we had found and to mitigate any risks associated with the medicines management. This information was provided and on the second day of our inspection we saw that appropriate action had been taken to mitigate the immediate risks to people.

During this inspection we found a breach of Regulation 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This shortfall was because people who used this service were not consistently having care or treatment that had been planned specifically for them.

We found during this comprehensive inspection that the home had made some improvements since the inspection in September 2015 in aspects of quality monitoring and had introduced an audit system. Improvements had been made to the care planning systems and an electronic care management system had been introduced to help consistency. The system was aimed at making care planning more person centred.

The registered provider now has procedures in place and staff were acting in accordance with the MCA. We found that consultation had taken place with people living at the home and relatives about the use of CCTV in communal areas. We saw that a private room had been made available for relatives if people wanted more privacy. Surveys and residents meetings were being used to get people’s feedback about the services being provided. Actions had been taken in response to feedback received. Appropriate policies and procedures had been developed regarding the use of CCTV in the

Westmorland Court Nursing and Residential Home provides support to older people and to people who have dementia. The service provides personal and nursing care.

We spoke with people who lived in the home in their rooms and in the communal areas of the building. We also spoke to a relative, staff who were on duty and a community nurse in private. Some of the people who lived in the home were not easily able to tell us their views about the home and the support they received. We used the Short Observation Framework for Inspection to assess how well the service met their needs.

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?

This is a summary of what we found -

Is the service safe?

People were safe living at Westmorland Court Nursing and Residential Home. The staff in the home were knowledgeable about the support people needed and had the skills to deliver the care they required. Care staff we spoke with showed that they had a good understanding of their responsibility to protect people who lived in the home.

Risks to people’s safety and wellbeing had been identified and assessed and appropriate controls had been put in place to protect them.

The home had a range of equipment to support the people who lived there. We saw that all the equipment was serviced and checked regularly to ensure it was safe for people to use.

Robust systems were used when recruiting new staff to ensure they were suitable to be employed in the home.

The home had appropriate policies and procedures regarding The Mental Capacity Act 2005 deprivation of liberty safeguards. The manager of the home was knowledgeable about the Mental Capacity Act 2005 and the Mental Capacity Act Codes of Practice. This meant people could be confident that their rights would be protected.

Is the service effective?

People told us they received a good quality of care at Westmorland Court Nursing and Residential Home. They said the staff in the home knew the support they needed and how they wanted this to be provided.

We saw that the staff in the home treated people with respect. People were supported to carry out as much of their care as they could themselves, with the care staff assisting them with tasks they couldn't manage on their own. This supported people to maintain their independence and control over their lives.

Where people had been identified as at higher risk due to complex needs, appropriate specialist services had been contacted for advice and support.

The home had appropriate equipment to support people and to protect them from the risk of infection.

A member of the local community nursing service told us they had no concerns about how people were cared for at Westmorland Court Nursing and Residential Home. They said the staff in the home contacted them in a timely manner if a person required support and acted on any advice they gave.

We saw that there were sufficient staff to provide the care that people required. However we saw, and staff in the home told us, that there were occasions when the care staff did not have enough time to engage with people. The manager of the home had also identified a need for more staff and was recruiting additional staff to increase the number on duty at busy times.

Is the service caring?

Everyone we spoke with made positive comments about the staff employed at this home. One person told us, “The staff are lovely” and another person said, “The staff are very caring”. A visitor to the home told us, “I think it’s excellent here” and said, “I’ve been very pleased, the home is better than I ever expected”.

We saw that the staff were kind and considerate in how they treated people. People were given choices about their lives and the support they received. We observed friendly and respectful interactions between the staff and people in the home.

Is the service responsive?

We saw that people were treated with respect and given choices about their daily lives. The staff were knowledgeable about people in the home and the support they needed. People received the support they required to meet their needs.

Some people needed small items of equipment to assist them to maintain their independence. The staff in the home knew the equipment individuals required and ensured this was provided as they needed it.

Thorough needs assessments were completed before people were offered accommodation in the home. This ensured that people were not offered accommodation unless the facilities and support provided were suitable to meet their needs.

Some care records had not been reviewed as detailed in the provider’s policies. The manager of the home had identified that there were areas within the care records which required improvement. They were reviewing care planning procedures and had introduced more checks to ensure all the information in people’s care plans was accurate and up to date.

Is the service well-led?

Formal systems were in place to audit the quality of the service provided. The manager of the home held meetings with people who lived there, their families and the staff employed, to gather their views about the service. We saw that action had been taken in response to the feedback given at these meetings.

The manager had been in post for five months at the time of our inspection. We saw that they had carried out a range of checks to assess the quality of the service provided. They had identified a number of areas which needed to be improved and had developed plans for how each issue was to be addressed. We saw that they had started to make the required improvements, giving priority to those areas important to maintain the standard of care and safety of people in the home.

Care staff we spoke with said the manager was committed to improving the quality of the service. One person said, “I have faith in the manager” and another staff member said, “The manager sets high expectations”.

The provider was required to have a registered manager in post, responsible for the day to day management of the home. The manager was in the process of applying to be registered.

People's care was planned very well and assessments were thorough and included personal information about people’s care and welfare needs. People had a named advocate to act in their best interest if needed, for example a relative.

People commented, "I am well looked after, no complaints, the staff are really good". "I generally do most things myself, but I need to a little bit of help my personal care. There are plenty of activities to do but staff respect I don’t want to join in them all”. A family member told us, "They always discuss his care with me, the least little problem. I would not move him anywhere else”.

People had care plans that promoted a person centred approach to their care. Staff were attentive to peoples' request for assistance and were respectful. Staff knew how to care for people at risk of falling, developing pressure ulcers or who may not eat enough.

People lived in a safe environment. They said they were comfortable and had everything they needed. There was sufficient staff on duty to make sure people had the attention they needed.

People were consulted in matters relating to their care and welfare. Quality assurance monitoring showed an overall satisfaction with the service provided, the staff team and the environment.

People who lived at the home told us that they were well treated and looked after, they said that:

"Everyone does a wonderful job here."

" Whatever I need they give me, night or day."

We spoke to health and social care professionals about the home, they told us that:

"Everything's fine."

We found that the staff at the home always asked people for their consent before they did anything. We observed people being spoken to and cared for in a professional and courteous manner. The home ensured that people were free from harm and protected from abuse. We found that there was enough staff to meet people's needs and that the home had systems in place for monitoring the quality and standard of the service it delivered.

Most people we spoke to were very happy with the standards at Westmorland Court. Relatives were made very welcome. Staff were praised as caring and friendly.

This unannounced inspection of Westmorland Court Nursing and Residential Care Home [Westmorland Court] took place on 29 September 2015. We last inspected this service May 2014. At that inspection we found the service was meeting all the five essential standards that we assessed.

The home provides care for up to 48 people. It is set in National Trust owned land and the home is a short walk from the centre of the village of Arnside with access to the local shops and amenities. There is parking available for visitors and a garden area for people living there to use. The home provides accommodation on two floors that are both accessible by a passenger lift and bedrooms are for single occupancy. At the time of our visit there were 34 people living in the home.

The service had 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.

At this inspection 29 September 2015 we found there were breaches of regulation that could have a negative impact upon people using the service. We found that assessments of people’s care, treatment and support needs were not always in place, up to date or in sufficient detail to support person centred care. Care plans did not reflect individual choice and did not always include all a person’s needs and all the risks that needed to be managed. The management of medicines and the procedures in use in the home did not reflect current national guidance for the safe management of medicines. This could put people at risk of receiving unsafe care and treatments.

The registered provider had installed CCTV in communal lounges. They had not done everything reasonably practicable to make sure they had consulted with people fully and in an open way and taking into account people’s views on this and their ability to give consent to this surveillance. Systems and processes were not always in place to identify and assess risks to people’s privacy, safety and welfare in the running of the home. People were not being consistently consulted on the running of the home.

The registered provider had not always acted in accordance with the requirements of the Mental Capacity Act 2005 to ensure that all those using the service, and those who could lawfully act on their behalf, had given consent.

The registered provider had not ensured that CQC had been notified of incidents and accidents in the home that they were required to inform CQC of under the regulations. They had not made sure that suspected or alleged abuse had been acted upon quickly and in line with local safeguarding arrangements to keep people safe and allow for an enquiry into the events. The registered provider did not have effective quality monitoring systems in place to monitor and evaluate service provision.

The Care Quality Commission (Registration) Regulations 2009 require that the registered provider notifies the Commission without delay of allegations of abuse and accidents or incidents that had involved injury to people who used this service. This is so that CQC can monitor services responses to help make sure appropriate action is taken and also to carry out our regulatory responsibilities. The sample of people’s records that we looked at showed examples of incidents and accidents that had occurred that should have been reported to CQC. Our systems showed that we had not received these notifications. The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with people who lived at Westmorland Court and they told us that staff were “kind” and “helpful” and helped them to do things for themselves. We saw that the staff on duty approached people in a respectful way. We spent time with people on both floors and saw that the staff offered people assistance and took the time to speak with people.

We found that there was sufficient staff on duty to provide support to people to meet individual personal care needs. Staff had received training for their work and were supported by the registered manager and the deputy manager. The home had effective systems when new staff were recruited and all staff had appropriate security checks before starting work. The staff we spoke with were aware of their responsibilities to protect people from harm or abuse.

There was a complaints procedure although not all those we spoke with who lived there were aware of how to make a complaint. All the staff we spoke with told us that they had regular meetings, formal supervision and felt they were supported in their work.

All of the care plans we looked at contained a nutritional assessment and a regular check was being done on people’s weight for changes. People told us the food in the home was “good” and that they had a choice of food and drinks.

We found that there were some organised activities going on in the home and planned for future dates and musical events. The home is visited by the churches in the area and the people have the opportunity to take part or have their spiritual needs are met by their own ministers if they wanted.

Training records indicated that care and nursing staff had received training on safeguarding people at risk of abuse. The staff we spoke with were aware of the need to report incidents to their manager or the nurse in charge for action to be taken.

We have made recommendations that advice and information be sought about supporting people to express their views and involving them, their families and representatives in decisions within the home. We also recommended that the registered provider took advice on using surveillance to monitor aspects of the service and the key issues they need to consider when using it.

We recommended the registered provider sought guidance and advice upon how to make sure there was an easily accessible system for raising a complaint and verbal complaints available in the home. We recommended that the registered manager finds out more about training for nursing staff, based upon best practice, in relation to end of life and palliative care.