The inspection visit at Westwards House was undertaken on 08 December 2016 and was unannounced.

Westwards House provides care and support for a maximum of 19 older people. At the time of our inspection there were 16 people living at the home. Westwards House is situated in a residential area of Garstang close to local amenities. Accommodation is on two floors, with a stair lift for access between the floors. There are two lounges, a conservatory, dining room and gardens for people’s use.

A registered manager was in place. 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 the last inspection on 15 and 21 January 2016, we rated the service as Requires Improvement. This was because breaches of legal requirements were found. The provider had failed to submit to the Care Quality Commission (CQC) required notifications. These related to incidents that affect the health, safety and welfare of people who lived at the home. Furthermore, the provider failed to ensure care planning and practices were personalised to remove institutional support. Mental capacity and risk assessments were not completed to protect individuals against inappropriate or unsafe care. Those who lived at the home were not always safeguarded due to lack of appropriate referral to the local authority safeguarding team. We saw staff did not receive regular supervision and appraisal to underpin their skill and knowledge.

We further made recommendations for the provider to improve people’s safety and welfare. These concerned tools to monitor staffing level needs, medication recordkeeping and effective quality assurance auditing.

We have made a recommendation about ensuring effective risk assessment management.

During this inspection, we found the provider had made a number of improvements to ensure they met legal requirements. Folders held in each person’s bedroom contained details about what constituted abuse and who to contact if they suspected this had occurred. Staff demonstrated a good understanding of safeguarding principles and had completed relevant training.

Staff had detailed knowledge about falls risk management and we found care records were detailed in relation to minimising falls. Additionally, the provider was implementing risk assessments to protect people from, for example, fire and environmental safety, infection control and medication.

The management team had improved their medication procedures. For example, guidance provided clear instruction to staff about medicines recordkeeping and we found they followed correct procedures. Consequently, people’s medicines were managed safely.

We found staffing levels were sufficient and deployed well to maintain the different needs of each person who lived at Westwards House. One staff member told us, “Yes, we have enough staff on duty.” The registered manager had developed staff support with more regular and in-depth supervision. To underpin their skills and knowledge, they also received a variety of training.

We found the provider had improved their systems in relation to the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Staff had received training and had a good understanding of related principles. We observed staff explained tasks to people and sought their consent prior to assisting them.

The management team had developed their person-centred approach to care, which was based around people’s preferences. The registered manager introduced guidance in each person’s care file to instruct staff about the importance of personalised care planning. People and relatives we spoke with said their care was based around their individual needs.

We observed staff supported peo

This inspection took place on 15 and 21 January 2016, the first day was unannounced. We arranged to come back on the second date to ensure that the registered manager and owner were present. 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.

We last inspected Westwards House Residential Care Home on 30 July 2014 and the service was judged to be fully compliant with the previous regulatory standards.

Westwards house residential care home is registered to provide personal care for up to 19 people. Accommodation is on two floors with a stair lift for access between the floors. There are two lounges and a large dining room and a large garden for people to use. The home is situated close to shops, buses and the local facilities of Garstang.

There were 17 people at the home on the two days the inspection took place of which four people had been transferred from the organisations sister home in Lostock Hall, near Preston, due to the boiler breaking down. The registered manager was registered for both homes therefore knew the four people well and we saw that all the necessary care documentation was present at Westwards House for them. Due to the issues at the home in Lostock Hall the registered manager and owner were not present during the first day of the inspection. Both were present on the second day of the inspection. The newly appointed Deputy Manager was present on both days of the inspection.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices. However we saw some incidents had occurs that should have been notified as safeguarding issues to the local authority.

Body maps detailing people’s injuries were not completed with any frequency and those we did find were in different locations, some being in people’s care plans and some in a separate file in the office. Body maps we did find did not inform changes to care plans.

Risk assessments that were in place that we reviewed did not have sufficient information within them to be effective.

People told us they felt safe at the home and with the staff who supported them.

We spoke with the deputy manager of the home regarding staffing levels. They were confident that staffing levels were in place at all times to meet the needs of the people in the home. This was observed to be the case during the inspection and the feedback we received from people, their relatives and staff also confirmed staffing levels to be sufficient to meet people’s assessed needs.

We looked at how medicines were ordered, stored, administered and recorded. We spoke with the deputy manager who had responsibility for administering medication on the both days of the inspection and observed medication being given to people on the morning of the second day of our inspection.

We observed a number of recording issues whilst reviewing the controlled drugs records, this was mainly around missed signatures.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We reviewed care plans and associated documentation for people who used the service. We found no records of people’s consent to care and treatment, nor any assessment of people’s capacity to make a decision around consent.

We talked with people who used the service about the quality and variety of food provided. The responses we received were positive and people were seen to enjoy the food on offer. We observed lunch be

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 we spoke with told us they felt safe living at Westwards House and felt able to raise any concerns with staff or the manager. One person who lived at the home said, "I feel safe and well looked after and the staff are all very good". Another person said, "I definitely feel comfortable raising issues with people if I need to".

Is the service effective?

Two of the three members of staff we spoke with confirmed that they had regular supervision sessions and had received a formal annual appraisal. There was evidence of both when we looked at staff files. One member of staff had not been at the home long and had not as yet received a supervision session but they did tell us that they had received an induction and felt able to approach the manager or senior staff with any concerns. All the staff we spoke to felt supported in their role. One person told us, "All staff know who is who and who to go to if they have any problems or concerns".

Is the service caring?

We looked at care plans for four people living at the home. People's needs were assessed and care and support was delivered in line with their individual needs. We saw that care assessments had been carried out and daily notes had been completed. Care plans were easy to follow and it was evident that regular reviews of people's needs were carried out. Risk assessments were in place covering areas such as moving and handling, falls and nutrition.

Is the service responsive?

A key worker system was in place at the home which meant that staff were able to build close relationships with people whom they were key worker for. This arrangement also meant that people living at the home had one key contact person. Staff we spoke with knew who they were key worker for although the provider may wish to note that not all the people living at the home we spoke with were able to name their key worker.

Is the service well-led?

We saw that a number of audits took place at the home. The home's owner undertook a monitoring visit in February 2014 that looked at a number of areas of practice within the service. This included spending time talking to people who lived at the home, reviewing care plans and staff observations. The audit report included some recommendations such as including more detail in care plans and increasing activities, we saw evidence during our inspection that both these issues were being addressed.

At the time of our inspection there were 16 people living at Westwards House Residential Care Home. We spoke to a number of residents, relatives and visiting professional's who visited on the day as well as staff working at the home. People who lived at the home were positive about their experiences and the comments received reflected this. One person living at the home stated, "The staff are lovely and the people are lovely, you usually get one bad penny but there aren't any here".

When we spoke to staff all of them could describe what to do in the event of an emergency, medical or otherwise. The visiting professionals we spoke to were complimentary about the home, the management and the care staff.

Equipment used in the home was stored correctly and well maintained. Staff knew how to use the equipment and confirmed that there was always enough equipment in place to meet the needs of the people in the home.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

Records showed care assessments had been carried out. However much of the information within the care plans was missing or lacking in detail. We have asked the provider to tell us how they will ensure that records are kept up to date and reflect the needs of all the people living at the home.

People said that routines in the home were flexible and they were encouraged to make their own decisions about their daily routine. Staff told us that they encouraged people to make choices about their care and support, when to get up and go to bed and what to eat. We saw staff supporting people to choose what they wanted to do and what they wanted to eat. People living in the home said the care and support they received was good. One person said, "The staff are kind and look after us well”. Another person said, “We are well fed and warm and the staff are friendly. What more could we want?”

We observed people living in the home being treated with respect and dignity. We saw staff knocking on doors and waiting before entering rooms. Staff supported people in a relaxed unhurried way, encouraging them to carry out things they were able to do. People told us staff were helpful. One person told us “The staff take the time to help you properly.” Another person said, “They will always make you a drink when you want one”.

Most staff had enrolled on or had completed national care qualifications. Other training was also available. The staff members we spoke with felt the training they were receiving provided them with the skills and knowledge to support people well.

People living in the home we spoke with on the inspection visit told us they felt

staff respected them, and they had sufficient involvement in the planning and

delivery of their care and service. Relatives spoken with also told us they felt staff were respectful and caring. The following comments were made: "The staff are lovely and very caring", "They (the staff) are very good when they help me with care", "They (staff) help me stay independent and let me do things for myself" and, "Carers treat me properly". One relative said "Staff help them (the resident) to stay independent and encourage them to do things".

People told us they had a choice in such matters as the food served, spending time in their rooms and when to get up and go to bed. A resident said, "The food is marvellous - there is plenty of choice". Someone said, "The cook asks us what we like". People said they could get up and go to bed when they wanted and that there was some choice of activities.

One resident told us that the staff regularly asked her 'if she was all right', and some residents and relatives recalled completing service satisfaction questionnaires to give their views on the care and support, and about the home in general. Some relatives told us they had looked round the home prior to making a decision about whether or not the home was suitable, and also recalled the prospective resident having an 'assessment' before moving in. One person had chosen to live in the home after attending day care.

People living in the home told us they received the care and support they needed

promptly, and that they felt their needs were met. Relatives spoken with agreed with this view. One relative said, "I feel they (the resident) is well looked after". Everyone we spoke with said they 'got on well' with staff. People said: "I get the care I need at the right time and usually don't have to wait for attention from staff", "The staff are lovely; very caring", "It's perfect here and I want to stay here forever", "It's all right here; staff are good. I get on well with them all, we have a laugh", "I have no complaints; staff are fine" and, "I am very comfortable". A relative said, "They ( the resident) loves it here, we have nothing negative to say" and, "Staff encourage them with their hobbies". However one resident said, "There's not much going on".

Staff told us they had sufficient, experience, training and support that enabled them to feel skilled and competent in their work. A member of staff said, "We all work well together as a team".