The inspection took place on 7, 9 and 13 November 2018 and was unannounced, which meant the provider did not know we would be visiting.

At the last inspection in April 2018 the provider was placed in special measures. We found a breach of regulation 12 as care and treatment was not safe. We also found breaches of regulations 9,10 and 17 as people were not always treated with dignity and respect, care was not always person-centred and good governance was poor.

Following the inspection, the provider sent us a detailed action plan to explain how they would address these concerns. We also met with the provider and registered manager and they gave us their assurances that the issues found would be taken extremely seriously and rectified.

At this inspection the provider had made many improvements, but we still found some previous issues were outstanding which needed to be addressed. The overall rating is no longer inadequate, which means they are no longer in special measures.

Westwood Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Westwood Lodge Care Home provides accommodation for up to 44 people with residential and nursing care needs. People had a range of health care needs, including those with mental health, alcohol misuse related conditions and those living with dementia. At the time of the inspection, there were 31 people living at the service.

The service had a registered manager who had worked at the service for many years with the last two as 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. The service also now had a deputy manager who had been appointed since our last inspection.

People told us they felt safe, and although improvements had been made, further action was required and this needed to then be maintained.

Medicines management had been improved, however, we observed some poor practice. Although no person came to harm and it was dealt with immediately, this type of issue had been raised at the last inspection as a concern.

People’s needs had been assessed prior to moving into the service and care plans had been developed. However, care plans were not always in place for all identified need and they were not always reviewed in a timely manner. Risk assessments had improved but not all had been put in place. There were two different care plan formats in use, including a newer version which was much more person centred. The registered manager was aware that further work was required.

Quality monitoring systems had improved and a range of audits and checks had been implemented, including infection control and medicines monitoring systems. The audits had not always identified what we had, and the registered manager said they would be reviewed further. A quality assurance person had been employed for a period of months to oversee and support the registered manager while these new processes were put in place.

The provider had spent considerable amounts of money in improving the environment for the people who lived there, including a new wet room, carpeting and new flooring. Staff told us people appreciated the money spent and it had made a difference to everyone.

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.

Everyone we spoke with were complimentary about the care provided by staff. We observed very positi

The inspection took place on 3, 5 and 6 April 2018 and was unannounced, which meant the provider did not know we would be visiting.

At the last inspection in January 2017 the provider had not ensured that people were protected against the risks associated with unsafe and unsuitable premises. They did not ensure that robust systems were in place to assess, monitor and improve the quality and safety of the service or to mitigate the risks relating to the health, safety and welfare of people using the service. Records were also not accurate or completed fully. These issues were breaches of regulation 15 (premises and equipment) and regulation 17 (Good governance). Following the inspection, the provider sent us a detailed action plan to explain how they would address these concerns.

At this inspection the provider had made some improvements but we found other issues needed to be addressed. Following the inspection we wrote and invited the provider to attend a meeting with us to discuss the concerns we had found. We will report on this at the next inspection.

The overall rating for this service is now inadequate and the service has been placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they

do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Westwood Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Westwood Lodge Care Home provides accommodation for up to 44 people with residential and nursing care needs. People had a range of health care needs, including those with mental health, alcohol misuse related conditions and those living with dementia. At the time of the inspection, there were 31 people living at the service.

The service had a registered manager who had worked at the service for over 10 years, the last two as 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. The provider was currently seeking to appoint a deputy manager to support the registered manager in their role.

Although people told us they felt safe living at the service, we found some areas of conce

This inspection took place on 16 and 17 January 2017 and the first day was unannounced. This means the provider did not know we were coming. This was the first inspection of this service following a change in its registration in December 2015.

Westwood Lodge is a care home providing accommodation and personal care for up to 44 people. The service is primarily for people with mental health needs and also provides nursing care. At the time of this inspection 37 people were living at the home.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to keep people safe from harm. Staff were aware of their responsibilities for recognising and reporting any signs of abuse.

Staffing levels were based on occupancy levels within the home and we observed there were sufficient staff deployed to safely meet people’s needs. Staff were deployed flexibly throughout the home to enable them to respond to people’s changeable needs.

Processes were in place to assess the risks to the health and safety of people, staff and visitors. Actions had been taken to mitigate and manage the majority of risks identified. However, the service did not have robust plans in place to continue the service in the event of an emergency and timely action was not always taken to maintain the home to an acceptable standard.

People were assisted to take their medicines safely by staff who had been appropriately trained, although there was a lack of oversight of medicines management. Staff were supported in their roles through the provision of regular training, supervision and annual appraisals. Staff told us they felt well supported and enjoyed working in the home.

The service worked within the principles of the Mental Capacity Act 2005 although care records we reviewed did not capture people’s consent to their care and treatment. Records also did not accurately reflect people and their representative’s involvement in their care planning and treatment.

People were supported with their nutrition and hydration needs and to access healthcare services in order to maintain good health. Appropriate and timely referrals were made to other healthcare professionals, who told us the service was proactive and that staff responded promptly and appropriately to any advice or guidance given.

The service had a well-established staff team, and staff had developed positive, caring relationships with people using the service. Staff were kind, caring and patient in their interactions with people using the service and showed genuine warmth and empathy.

People were encouraged to retain their independence and staff respected people’s privacy and dignity. Care was person-centred and based on people’s individual needs and preferences. The staff team reviewed people’s care plans on a regular basis to ensure they remained appropriate to people’s needs. Where changes were required these were made promptly.

Systems were in place for the service to identify, receive, record and respond to complaints. People we spoke with told us they had no complaints about the home or the staff who cared for them.

The registered manager had worked at the home for approximately 10 years and was very knowledgeable about people living in the home. Staff were complimentary about the registered manager and their leadership of the service, as were external healthcare professionals we spoke with.

Although some systems were in place to monitor and review the effectiveness of the service, these did not provide full oversight of the service and were limited in scope. Records maintained by the service were not always complete and lacked details of actions taken. This