This inspection took place on 4 May 2017 and was unannounced.

Westside Care Home is registered to provide nursing and residential care for up to 26 older people, some living with dementia. At the time of our inspection there were 23 people using the service. The service is a converted residential property which provides accommodation on the ground and first floor. Access to the first floor is via a stairwell or passenger lift. The service is located within a residential area and has an accessible garden to the rear of the property.

The previous comprehensive inspection of 6 May 2015 found a breach of a legal requirement. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement. At this inspection, we found the service to be compliant with the regulation.

Westside Care Home had a registered manager in post. However they no longer had managerial responsibility for the service and confirmed they would be submitting an application to CQC to cancel their registration as manager. A manager had been appointed and had worked at the service for three months at the time of our inspection visit. The manager informed us of their intention so submit an application to CQC to be registered as the 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 felt safe and staff were trained in safeguarding (protecting people who use care services from abuse). Where people were at risk, assessments had been undertaken, however we found improvements were needed to ensure these fully documented the actions required by staff to promote and maintain people’s health and welfare.

People said there were enough staff on duty to meet their needs. Throughout the inspection we observed staff had the time they needed to support people safely. If people needed assistance this was provided promptly. Medicines were managed safely.

People were supported by staff that understood their needs and had received training. People using the service spoke positively about the attitude and approach of staff in involving them in the day to day decisions about their care. The manager was aware DoLS applications for some people needed to be made and plans were in place for their submission. The manager was liaising with health care professionals in the best interests of people, to ensure their needs could be met.

The support and care people required was outlined within their care plans and we found by speaking with staff they had a good understanding of people’s needs. However we found improvements to the quality of information about people’s individual care would assist staff in the provision of individualised, consistent quality care based on good practice. We found information within people’s care plans to be judgemental when referring to specific aspects of people’s care and showed a lack of understanding and empathy in recognising people’s health, care and support needs.

People we spoke with were complimentary about the meals provided at the service. Where people were at risk of poor nutrition, advice from healthcare professionals was sought and their recommendations followed. Individual dietary needs were catered for.

Our observations and comments from people we spoke with and their visitors told us they had good access to healthcare. Records showed people were referred to the appropriate healthcare professionals when necessary and that their advice was acted upon.

People spoke positively about the staff, referring to them as caring and kind and that they respected their privacy and dignity. People trusted staff and were at ease with them and happy in their company. People told us they were happy

The inspection was carried out by an inspector for adult social care. We set out to answer five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a short summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service, and relatives and representatives of these people, told us that they felt they were well looked after at Westside Care Home and had confidence in the staff who supported them.

Risk assessments had been used to consider the possibility of any risks to each person’s health or wellbeing, and plans then put in place to explain how any identified risks were to be managed.

The provider carried out checks on any new staff to ensure that they had the right skills, qualifications and were of good character.

Medicines were not being managed safely enough which meant people may not always receive their prescribed medicines when they should do.

Is the service effective?

Each person had an individual care plan to explain their specific needs and plans were in place to explain how their support was to be delivered. This included information about any specialist equipment which was needed to meet their needs.

Records were kept to confirm that people’s care was delivered reliably and that people received the support they needed.

Is the service caring?

Staff were attentive and engaged in a positive way with the people they supported. It was evident from our observations that staff were familiar with the needs, interests and personalities of the people they supported.

There was information recorded in each person’s care plan about their life histories and interests, which helped staff to get to know the people they supported.

Is the service responsive?

Social and recreational activities were arranged and people were supported to take part in these.

People told us that their views had been taken into account when their care plans had been put together.

There was information available to explain to people how they could complain about the service, should they need to do so. Visitors we spoke with told us that staff made them aware of any changes or concerns in relation to their relative’s health or wellbeing

Is the service well led?

There were systems in place to help the provider check whether the service was operating well. Some of these were working reliably but those aimed at checking the reliability of medication arrangements had not been effective.

People’s personal care records, and other records kept in the home, were accurate and kept safely.

As part of this inspection we spoke to four members of staff including the manager. We also spoke with eight people who used the service and three relatives. We also spoke with the local authority and Derbyshire Fire Service.

People we spoke with told us they were happy with the care provided. Comments included: “it’s such a nice atmosphere”, “they have boosted my confidence” and “it’s alright”.

We found that one person out four we looked at did not have a care plan in place, not all risk assessments had been completed and that there was a lack of guidance for staff about what action to take following risk assessments.

Staff we spoke with felt that staffing levels were sufficient for them to meet people’s needs.

We found that medication was not always being administered safely and that relevant protocols were not in place. Not all medication was being stored correctly.

The provider had quality assurance systems in place to help monitor the quality of the service. We found that not all of the audits carried out were effective.

We found that not all care records were accurately maintained.

This was a follow up inspection. Please see our previous inspection report for full comments.

Although the provider had made improvements in both outcomes we looked at, there were still some concerns.

On the day of the inspection the home had 25 people residing there. We spoke with five people who used the service, four relatives and four members of staff. The manager has been in place since the end April 2012. We also spoke with two health professionals who were visiting the home on the day we inspected.

One person we spoke with stated that their relative “does get looked after very well”. Another person told us that they received “very good treatment”.

One person we spoke with stated that “staff are excellent”. A person who used the service stated “there could be more staff on in the mornings”. A health professional stated “there is always some one to help and they are willing to help”.

A relative we spoke with stated “they want for nothing whilst in here”. A health professional stated “people seem to be happy”.

One person stated “the owners are very keen on keeping it right”.

People told us their views about whether there were enough care workers on duty to meet their needs. One person told us, “I need someone to walk with me, sometimes I have to wait because I need two, but that’s ok, they always check on me through the night.” Another person told us that there should be four care workers on duty in a morning. They said, “They are short of staff, sometimes there are only three and sometimes two. They are rushing around.”

Another person told us, “I don’t need much help but they are always around, there’s no problem with that. They are all very nice.” Relatives spoken with told us, “There is always plenty of staff around, at least two or three. We have had no problems at all since she has been here; we have been very satisfied with everything."

This inspection took place on the 6 May and was unannounced. We returned on the 8 May 2015 announced.

Westside Care Home is registered to provide nursing and residential care for up to 26 older people. At the time of our inspection there were 26 people using the service. The service is a converted residential property which provides accommodation on the ground and first floor. Access to the first floor is via a stairwell or passenger lift. The service is located within a residential area and has an accessible garden to the rear of the property.

A registered manager was 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.

The inspection was facilitated by the acting manager. We were told by the acting manager that they will be submitting an application the CQC to become the registered manager, and that the current registered manager will apply to cancel their registration with CQC as they now work at the service as the deputy manager.

At the last inspection of the 15 April 2014 we asked the provider to take action. We asked them to make improvements in the management of people’s medicines and the system for assessing and monitoring the quality of the service people received. We received an action plan from the provider which outlined the action they were going to take which advised us of their plan to be compliant by 3 June 2014. We found that the provider had taken the appropriate action.

People told us they felt safe and staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. Where people were at risk, staff had the information they needed to help keep them safe.

Staff were able to tell us what action they would take should they believe somebody was being abused and were aware of the provider’s policies and procedures, which included whistleblowing. Records showed staff had received training to support them in recognising potential abuse and this provided them with guidance as to their role in promoting people’s welfare.

People said there were enough staff on duty to meet their needs. Throughout the inspection we observed staff had the time they needed to support people safely. If people needed assistance this was provided promptly. Medicine was managed safely.

The staff were trained and supported people with confidence and skill. The service had received an award for the provision of its ‘End of Life Care’, which was commented on by people’s relatives and staff in a positive way. People told us staff were always caring and kind. People trusted the staff and were at ease with them and happy in their company.

People we spoke with were complimentary about the meals provided at the service. Where people were at risk of poor nutrition, advice from health care professionals was sought and their recommendations followed.

Our observations and comments from people we spoke with and their visitors told us they had good access to healthcare. Records showed people were referred to the appropriate health care professionals when necessary and that their advice was acted upon.

There were open and positive relationships between people who use the service, their relatives who visited and staff. This created a friendly, calm and welcoming environment for people to live in and visit. People were supported by staff who sought to provide companionship and social interaction in a caring manner.

Visitors said they were encouraged to be involved in decisions about their relative’s needs and were provided with opportunities to comment on and influence the care provided.

People who had expressed concerns told us these had been responded to quickly and well. Information about the providers’ complaints procedure was accessible. Complaints records showed complaints had been investigated and responded to consistent with the providers policy and procedure.

The acting manager and staff had a clear view as to the service they wished to provide which focused on promoting people’s rights and choices and good quality health care support. Staff were complimentary about the supported they received from the management team and commented that they led by example.

The acting manager undertook effective audits to check the quality and safety of the service, which included daily, weekly and monthly audits. The service had strong links with health and social care professionals who helped to ensure people were in receipt of quality care.

The provider and registered manager did not notify the CQC in a sufficiently timely manner of ‘notifiable’ events. These are changes, events or incidents that providers must tell us about.

This was a breach 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 this report.