The inspection was unannounced and took place on 8 and 14 June 2017.

The last inspection took place on 18 and 24 November 2015. At that inspection we identified three breaches of the relevant regulations in respect of staffing, safe care and treatment and person centred care. At this inspection, we found that improvements had been made and the provider was no longer in breach of any of the regulations.

The Westbourne Care Home is registered to provide accommodation with nursing and personal care for up to 50 older people who may be living with dementia. The home is purpose built and is divided into two units, one on the ground and one on the first floor. The kitchen and laundry areas are on the second floor of the building together with a large room which is used as a base for staff training. There is an enclosed garden area and parking to the front of the building. On the day of our inspection there were 43 people living in the home.

The home has a registered manager who had been registered since April 2016. 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 found that the arrangements for the administration, storage and disposal of medication were safe, however we saw that there were some shortfalls in the recording of when topical creams had been applied. These had been picked up by the provider’s quality assurance system and a new system was being put in place.

We observed that there were sufficient numbers of suitably qualified, competent, skilled and experienced staff deployed within the service to meet the needs of the people living there.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke with confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

There was a flexible menu in place which provided a good variety of food to the people using the service. People were provided with specialist diets but the presentation of soft food diets could be improved.

Peoples’ weights were now being consistently monitored and managed and advice taken appropriately where significant changes were noted.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year.

We observed caring relationships between staff members and the people living in the home.

Personal information about people was now stored securely.

We found that that there had been improvements in the care plans and these were being updated regularly and were clear. Staff were now consistently keeping contemporaneous records where additional monitoring was required.

The provider had a quality assurance system in place and regular audits were being completed, and issues identified were addressed in a timely manner. The registered manager continually sought feedback from people living in the service, relatives and staff in order to improve the service.

Staff members and relatives we spoke with were very positive about how the home was being managed. Everyone spoke of the improvements observed since the current registered manager had been in post.

We carried out this inspection to look at some previous areas of concern that we had found on our previous visit in September 2013 and in response to some information of concern that we had received from the local authority quality monitoring team and from a whistleblower.

We spoke to two people who used the service and one relative and they all said that they were very happy with the support that they received. One person said; "The staff are really nice here."

We looked at the care plans and risk assessments for four people and saw that they had been regularly reviewed and updated using a new system that had recently been implemented.

We looked at the procedures in place for keeping people safe from harm and we saw that they were clear and the staff understood how to recognise the signs of abuse and use the systems in place.

We spoke to the registered manager and three members of staff who all said that they enjoyed working at the service and that they thought that the service offered quality support to the people who lived there.

We looked at the systems in place for recruiting new staff and saw that all the appropriate checks were carried out prior to staff commencing work at the service.

We carried out this inspection in response to some information of concern we had received regarding the care that people in the home received and the choices they could make. We attended the home at 6am to see how people were supported to start their day. We saw that people were well cared for and were able to make choices about what time they got up and what they had for breakfast. We also saw that staff had warm positive relationships with the people who lived in the home.

We looked at the procedures in place to protect people from harm. We had some concerns that the home did not follow it's own procedures in relation to an incident that had occurred and had not contacted the appropriate authorities to enable them to investigate.

We looked at the staffing levels in the home and we saw that there were adequate staff on each shift to meet the needs of the people in the home.

We looked at the care records and we had concerns regarding the detail on the records and the frequency of when they were updated.

We carried out an unannounced inspection visit on 2 April 2013 to The Westbourne Care Home to follow up on our visit in June 2012 where we found areas of non-compliance. The updated action plan from the area manager stated they would be compliant in all areas by December 2012. During the course of this inspection, we found there had been improvements made in the maintenance of people's privacy, dignity and respect; care planning, medication record keeping, maintenance and audits of the quality of the service.

We used the Short Observational Framework for Inspection (SOFI) during the course of the inspection. SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We observed positive interactions and engagement between staff and people who used the service. We also observed staff assist people to maintain their independence with their mobility whilst still offering them the support they needed.

We spoke to four people who used the service who told us they were happy with the care and treatment they received. We met and spoke with seven visitors to home and we spoke with three staff members, the area manager and the homes new manager.

However, we observed during the course of the inspection that there were insufficient staff deployed to one floor of the home, which meant that there was a risk of people not receiving care in a timely manner.

We spoke with six of the thirteen people who used the service and they told us they felt that their dignity and privacy was respected. They said the staff were all 'kind', 'helpful' and 'pleasant'. Their comments also included:

"The staff include us in some of the history of their lives too so we get to know about them and it feels more natural to live here, not just a care home."

"They (the staff) asked about my five favourite things to eat. They needed to because the food was not good at all; things have started to improve now. The manager took the issue seriously but it seemed to take a while for this to be sorted out. "

"There are new staff this week and we are just getting to know them, they seem to know what they are doing and are very nice."

“I have no complaints, I enjoy living here, well, as much as you can living away from your own home. I am warm enough, I eat well and I don't have to worry about anything, not even my washing."

"I like living here, the surroundings are lovely, the staff are all very nice, I have no concerns at all."

“It takes time to settle in, but it is a nice place, I'd go as far to say it's as good as you'd get."

We spoke with four family members of people who used the service. Three of the four felt that their relatives were spoken to in an appropriate and respectful manner and one who felt that staff could improve communication where people had impaired hearing.

Their comments included:

"The nurses here are very approachable and are caring."

"When choosing a home be careful. This home does not have a proven record yet."

"The manager told us they had plans to recruit an activity person, but we don't know when that will happen. It would help my relative, I think, to be more sociable. We are happy with the care my relative receives from the staff."

The inspection took place on 18 and 24 November 2015 and was unannounced.

The last inspection of this service was undertaken on 14 January 2014 where it was found to be compliant in all the areas looked at.

The Westbourne Care Home is registered to provide accommodation, nursing and personal care for up to 50 older people who may be living with dementia. The home is purpose built and is divided into two units, one on the ground and one on the first floor. The kitchen and laundry areas are on the second floor of the building together with a large room which is used as a base for staff training. There is an enclosed garden area and parking to the front of the building.

There was no registered manager at the service. The manager had been at the home for four weeks before our inspection having transferred from another of the provider’s care homes where she was registered as manager. She had submitted her application to The Care Quality Commission (CQC) to become a registered manager of The Westbourne. A registered manager is a person who has registered with 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.

Relatives and people living at the home were happy with the behaviours and standards of care provided by staff. We observed how staff spoke and interacted with people and found that they were supported with dignity and respect.

We found that all staff had an understanding of supporting people who lacked capacity with making choices in relation to everyday living. Care staff took appropriate actions to fully support people who lacked capacity to make their own decisions with regard to activities, dressing and choosing food.

The care and treatment people received was based on plans which focused on the person as an individual and contained information about their history, preferences and views. We saw that these plans were not very well organised and it was often difficult to find information. This would not enable any new member of staff reading them to have a good idea of what help and assistance someone needed at a particular time. The plans that we looked at were not being reviewed consistently and were not being updated following a change or a visit from another professional. However the manager had identified this and had commenced a review of all care plans.

People did not always experience care and support in a prompt manner when they asked for assistance due to low staffing levels. People were satisfied overall that the care and treatment they received met their needs and took into account their choices, likes and dislikes.

We found that most staff had received or had been identified to receive training by the end of January 2016 in relation to Mental Capacity. Senior staff had received training including the requirements of the Deprivation of Liberty Safeguards and the new manager had ensured that appropriate referrals had been made to the relevant regulator in respect of depriving people of their liberty.

Staff told us that they received regular training. However the manager had identified that some training necessary to fulfil their role had lapsed and had arranged refresher training so that they worked in line with current guidance and best practice.

Staff had not received structured supervision in line with the provider’s policy. However this had been addressed and planned supervision was now in place for all staff who worked at the home.

Staff sought people’s consent before they supported them with their care and the service followed legal requirements where people did not have capacity to make a particular decision.

Where people needed support to maintain a healthy diet, this was provided. However low staffing levels impaired staff to provide timely assistance to people who needed help with eating and drinking.

There was a caring friendly atmosphere in the home. People felt able to speak openly to both staff and the manager. The manager had identified actions to improve the quality of service provided and had quickly established a management style which was appreciated by staff. There was a system of internal checks and audits and quality surveys which were intended to let the manager monitor the quality of the service and identify improvements. These improvements to the service had commenced and feedback from people who used the service, their relatives and health and social care professionals was positive about the transparency and speedy actions taken by the newly appointed manager.

We found breaches 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 the report.