This inspection took place on 31 May and 4 June 2018. The first day of the inspection was unannounced. This meant the staff and provider did not know we would be visiting.

West House Care Home Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package 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.

West House Care Home Limited accommodates 26 people in one adapted building, across two floors. At the time of the inspection, there were 23 people using the service. Some of the people were living with a dementia type illness.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 the service in October 2015 and rated the service as ‘Good’ overall. At the inspection in October 2015 we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 (Person-centred care) and rated the Responsive key question as ‘Requires improvement’. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Responsive to at least good. At this inspection we found improvements had been made in the areas identified at the previous inspection and the service met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at West House Care Home Limited.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. Support plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service.

The provider had recently converted to an electronic care records system but some information was still paper based. The electronic records provided evidence that people and family members had been involved in planning their care. However, the records could be more detailed and person-centred. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and

The focussed inspection took place on 20 and 30 March 2017 and was unannounced. This meant the staff and provider did not know we were visiting.

West House is a residential care home in Chester-le-Street providing accommodation, personal care and nursing care for up to 26 older people. There were 24 people using the service at the time of this inspection.

The service had a registered manager in place. They were on annual leave on the day of our inspection so we returned to speak with them on their return. 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 carried out an unannounced comprehensive inspection of this service on 20 and 22 October 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for West House Care Home on our website at www.cqc.org.uk.

At the previous inspection on 20 and 22 October 2015 we found the service did not have in place personalised activity plans which met people’s needs and reflected their preferences. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the service did have personalised activity plans in place and was no longer in breach of the regulation, although some improvement was still required with regard to the planning and provision of activities.

At the time of the inspection there were twenty-four people who used the service and we were able to meet and speak with some of them and observe their experiences of care and support at West House Care Home. We also spoke to relatives of people who used the service, with the three care staff and the nurse on duty, and the manager. One person who used the service told us, “It’s very good here. The staff are very, very nice”. Another person told us, “I like it here; the staff are lovely and good with everybody”.

We were able to observe the experiences of people who used the service. For instance, we spent time with people as they had their breakfasts and lunches and observed how staff supported and encouraged them. We saw staff had supported several people with eating, we saw they encouraged people to make their own choices and decisions, we saw some people preferred to have lunch at a different time when it was quieter. We saw staff understood each person’s different needs, for example, when they required additional support with their mobility.

We saw that staff supported people to make choices about how they spent their day. People told us that there had been activities in the home if they wanted to take part.

We saw that staff treated people with dignity and respect. We saw that people had freedom of movement around their home and could spend time in their bedrooms whenever they wanted. We saw that each person had their own bedroom which was personalised. Each person had the choice to have a nameplate with a photograph and an information sheet about them on their room door. We saw the provider had made suitable adaptations to meet the people’s physical needs. We observed that staff respected people’s privacy and knocked before they entered their rooms.

We saw that the staff communicated well and appropriately with people in a way that was easily understood. We saw that the staff were attentive and interacted well with people.

We learned more about how care and treatment was provided when we talked with staff, observed their practices and looked at the records of five people who used the service.

“We have plenty of choice. I like the activities, I like to make things.”

“It’s really lovely here. I get on well with the people; the staff are always polite to me. The food is really good.”

“I take things as they come but I am alright here.”

“I enjoy it here; it’s a very happy place to be.”

“I have been well looked after here.”

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that there were good systems in place for the involvement of other health or social care professionals.

We found that people who used the service had their care and welfare needs met.

We found that staff had been well supported to deliver care and treatment safely.

We found that people’s views were important and listened to. We found that there was an effective complaints system in place.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

The relationships between staff and the people who they supported were good and personal support was provided in a way that promoted and protected their privacy and dignity. This was confirmed when we spoke with people who used the service and two of their relatives.

Suitable arrangements were in place for handling complaints and for protecting people from abuse. There was a competent staff team who had the training, skills and experience to meet the specific conditions of the people who they supported.

During our inspection visit we saw the provider had made some significant improvements to the building. We saw 12 nurse profile beds had been purchased and more were on order, and a new fire alarm system was being installed.

The provider may wish to note that other parts of the home were in need of refurbishment for example bedroom and lounge furniture, two bathrooms and improved storage facilities for records.

We spoke with some of the people who lived in the home. Everyone spoke positively about the care being provided. One person told us, “The food is lovely, the staff always knock on my door before they come in and the staff come quickly when I press the buzzer.” Another person, who was a Jehovah’s Witness told us that the staff respected their religion.

People told us that they felt there were enough staff to meet their needs. They said if they were unhappy they would speak to the nurses and that they felt safe living in the home. One person was able to compare this care home with a recent hospital visit. They said, “I thought the hospital was tops before I came here. You get a full English here. And the staff are very obliging.”

We also had the opportunity of talking with visiting relatives. One relative said, “We chose this home specifically because it was smaller. My main concern before my mother moved in here was her weight. This has gradually been increasing. It’s the longest she has held her weight in over four years.” They also said they had confidence in Judith (the manager) and if they had any concerns they would feel able to raise them with her. Another relative said, “This is definitely a good service. My mam was desperately ill when she came in, but the staff persevered and got her to eat. The staff are lovely, friendly and obliging.”

Although this home catered for people whose primary need related to general nursing, some people also had dementia. These people, because of their dementia, were not able to tell us what they thought about living in the home. We spent time watching how staff interacted with them. We saw that staff talked with people in a respectful manner and had a good understanding of their communication and psychological needs. However, at meal times we saw that staff did not always sit beside the people they were supporting. We saw staff stand over people when assisting them with meals, which did not promote people’s dignity.

The inspection took place on 20 and 22 October 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected West House Care Home on 13 January 2014, at which time the service was compliant with all regulatory standards.

West House Care Home is a residential home in Chester-le-Street providing accommodation for up to 30 older people who require nursing and personal care. There were 26 people using the service at the time of our inspection.

The service had a registered manager 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.

We found that there were sufficient numbers of staff on duty in order to meet people’ needs. All people and relatives agreed that staff were attentive and there were sufficient staff on duty each day. We saw that call bells were responded to promptly.

All staff were trained, or had training courses booked, in core areas such as safeguarding, health and safety, moving and handling, infection control, as well as additional training intended to ready staff for potential future needs, for example epilepsy training. The service had a training matrix in place to track which staff had attended training courses and when; the registered manager used this to plan when refresher training courses were due. Understanding and support of mental health needs was an area that could be further developed. The service used a keyworker system and we found that staff had a comprehensive knowledge of people’s preferences, needs, likes and dislikes.

We found that the management, administration, storage and disposal of medicines was generally safe and adhered to National Institute for Health and Care Excellence [NICE] guidelines. Where we found isolated errors and areas for improvement the service responded promptly.

We observed dignified and patient interactions during our inspection. Relatives and external stakeholders told us that people were treated well and unanimously agreed that the service was welcoming and effective in their management of people’s healthcare needs.

There were effective pre-employment checks of staff in place and effective staff supervision and appraisal processes.

The service was clean. We saw that a recent visit by an infection control team had identified areas to improve immediately. We checked a sample of these issues and saw improvements had been made. Some areas of the service were in need of or in the process of refurbishment and we saw that there had been improvements since the last CQC inspection on 13 January 2014, notably the installation of the ground floor wet room.

People told us they enjoyed the food and we saw that menus were varied and people had choices at each meal as well as being offered alternatives if they did not want the planned options. We saw that the service had successfully implemented a tool to manage the risk of malnutrition and people requiring specialised diets were supported. This was augmented by an additional tool the registered manager had devised to look at wider weight loss trends.

Person-centred care plans had recently been established in all care files and the provider had sought consent from people for the care provided. Regular reviews ensured those who knew people best were consulted and involved in ensuring people’s medical, personal and nutritional needs were met. Where we suggested areas of improvements to practice the service was responsive. We also found people were protected from the risk of social isolation through regular encouraging interactions by staff and the service had an activities co-ordinator in place. We saw that relatives supported the activities programme by bringing in arts and crafts projects.

Not all people who used the service had their preferences considered or acted on however and we found the service did not proactively plan activities with people’s preferences in mind.

The service had individualised risk assessments in place, quality assurance and auditing processes and policies and procedures to deal with a range of eventualities. Emergency evacuation plans and maintenance of the premises were up to date.

People who used the service, relatives and external professionals were complimentary about the approachability and levels of communication afforded by the registered manager.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The registered manager was knowledgeable on the subject of DoLS and we saw that appropriate documentation had been submitted to the local authority.

During our inspection we found the provider was in breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.