About the service: Westwood 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. This service supports older people. At the time of the inspection there were 73 people using the service.

People’s experience of using this service:

• The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2017. More information about this is in the full report.

• The risks to people’s health and safety were fully reflected in the care they received. People were protected by staff who understood how to protect them from avoidable harm. There were enough staff in place to keep people safe.

People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection. The registered manager and the provider worked in partnership to learn from mistakes. This included the detailed analysis of accidents and incidents.

• Staff training was up to date; action had been taken to address some gaps in the frequency of staff supervisions. People were provided with care and support which protected them from discrimination. People received the support they needed to maintain a healthy diet. People had access to other health and social care agencies where needed. People were supported to make decisions about their care, the provider ensured these were made in accordance with appropriate legislation.

• People liked the staff and found them to be kind and caring. People were treated with dignity and respect. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

• People had their needs assessed prior to coming to live at the home to ensure they could be cared for safely and effectively. People’s personal preferences were considered when care was planned. People had access to information in a format they could understand. Complaints were handled appropriately and line with the provider’s complaints policy. People did not currently receive end of life care but people had discussed their wishes with staff if they had any personal preferences.

• Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (23 and 24 August 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor this service and will return within the next 30 months if we are satisfied that there are no serious risks at the service during this time.

This unannounced inspection was carried out on 23 and 24 August 2017. Westwood Care Home is run and managed by Runwood Homes Ltd. The service provides accommodation and personal care for up to 78 older people including people living with dementia. On the day of our inspection 67 people were using the service, which is split into four units over two floors.

The service had a registered manager in place at the time of our inspection but they were unavailable during 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.

At our last inspection on 30 and 31 August 2016 we found the provider was in breach of one Regulation of the Health and Social Care Act 2008. This was in relation to the staffing levels and the staff skill mix and experience. The provider sent us an action plan detailing what action they would take to become compliant with this regulation. At this inspection we found the provider

had taken action and this breach in regulation had been met. Whilst we concluded staffing levels on the day of our inspection was appropriate and improvements had been made, we asked the provider’s operations director to further review the deployment of staff to ensure this was fully effective.

Some people told us they felt unsafe at night due to other people entering their room uninvited. Staff had received safeguarding training and had information available about the action required to respond to any safeguarding incidents or concerns.

Risk assessments associated with people’s needs were either missing or lacked detail in places. The health and safety of the environment had been assessed. Whilst people had personal evacuation plans used to inform staff of their support needs, these lacked specific detail that staff would require to support people safely and effectively.

Medicines were found to be managed and stored appropriately, but records used to inform staff of people’s needs associated with their prescribed medicines lacked detail in places. The action required when people received their medicines covertly in food, had not been fully followed.

Not all people felt staff understood their needs, and an example of this was observed during the inspection.

Staff received an induction and ongoing training and development. Some staff felt they would benefit from further training in how to effectively support people at periods of heightened anxiety that affected their mood and behaviour.

Staff gained people’s consent before providing care and support. The principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were understood and applied. Where people communicated their anxieties and needs through behaviour that was challenging at times, staff had limited instruction and guidance to support them.

People’s nutritional needs had been assessed and planned for and people received a choice of meals. Some concerns were raised by people who used the service about the availability of suppertime snacks. Positive feedback was received from external healthcare professionals about how people’s health needs were monitored and managed. However, a relative raised a concern about how health needs were met. During the second day of the inspection concerns were identified about the lack of action initially taken by a member of staff in response to a person experiencing pain and discomfort.

Staff were kind and caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy and independence. Information about an independent advocacy service was available for people should this support have been required.

People and or their representatives

We carried out this unannounced inspection on 30 and 31 August 2016. Westwood Care Home is run and managed by Runwood Homes Ltd. The service provides accommodation and personal care for up to 78 people. On the day of our inspection 74 people were using the service, which is split into four units over two floors.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.

People were not always supported by sufficient numbers of staff. There were times when the number of staff the provider had identified were required to meet the needs of the people who used the service were not met. As a result people received care that was either rushed or they had to wait for long periods of time before staff could assist them. This meant the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (regulated activities) regulations 2014. We have asked the provider to report on actions they plan to take to meet this regulation.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager had shared information with the local authority when needed. Appropriate risk assessments were in place for both individuals and the environment. People received their medicines as prescribed and the management of medicines was safe.

People were supported by staff who had received training and supervision to ensure they could perform their roles and responsibilities effectively.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. The service had acted in accordance with the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed and people’s health needs were well managed.

People, who used the service, or their representatives, were encouraged to contribute to the planning of their care. They were treated in a caring and respectful manner and were encouraged to take part in a range of social activities both in and outside the service.

People, who used the service, or their representatives, were encouraged to be involved in the running of the service and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

During this inspection there were forty people who used the service. We spoke directly to eight people, six relatives, seven care staff, the housekeeper, deputy manager and the registered manager.

We saw evidence that people were consulted before receiving care. One of the people who used the service told us, “I can tell them if I need something, staff will always ask if it’s ok to help me.”

People told us they thought the care provided met their needs and they were safe. A relative of a person who used the service told us, “I find that they are safe there. The staff are very caring, I can’t fault them at all.”

People were protected from the risk of infection and the home was clean and tidy. A relative we spoke with told us, “I feel the care given here is excellent and the standard of cleaning is very good.”

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person who used the service told us, “Yes they (staff) are knowledgeable, I am supported."

The provider had an effective system in place to monitor the quality of the service that people received and to learn from incidents when they have occurred.

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 practicing professional.

We conducted a Short Observational Framework for Inspection (SOFI 2). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

During our visit to Westwood on 09 October 2012 we spoke with people who told us they were happy living there and were well looked after. They said staff treated them with dignity and respect. They told us the food was good and they had a choice