Our inspection of West Villa Residential Home took place on 2 May 2018 and was unannounced. At the last inspection in January 2017, the provider was in breach of legal requirements concerning good governance; effective systems or processes were not always in place to assess, monitor and mitigate risks to people who used the service. At this inspection, we found some improvements had been made to the governance and quality assurance systems in place, which enable the service to identify and improve where quality, and safety was being compromised. However, these had not been maintained.

West Villa is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

West Villa is a private care home. It is a large detached building. West Villa is registered to provide care and support for up to 32 people who have mental health needs or physical disabilities related to the aging process. At the time of our inspection there were 29 people living at the home.

A registered manager was not in place. However, a new manager had been appointed and had submitted an application to become registered with the Commission. 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.

People told us they felt safe and staff knew how to recognise and report any concerns about people's safety and welfare.

Overall, there were enough staff deployed. Not all the required checks were done before new staff started work to help to protect people. Staff were trained to meet people's needs.

Medicines were managed safely.

Individual risks to people's health and welfare were not always identified and managed. Their care plans were not always detailed enough

and this created a risk they would not consistently receive appropriate care which met their needs.

The home was clean and well maintained. Plans were in place for refurbishment to make the home more dementia friendly.

We found people's capacity to consent to their care and treatment was assessed. However, when people lacked capacity the correct processes were not always followed to ensure those making decisions on their behalf had the legal powers to do so.

People told us they liked the food. People were offered a variety of food and drink, which took account of their likes and their medical, cultural and religious needs.

People were supported to meet their healthcare needs and had access to a range of healthcare professionals. People's needs were assessed. However, care plans were not always in place and this created a risk they would not receive appropriate care, which met their needs.

People were treated with respect and kindness and were supported to maintain their independence. People were given the opportunity to take part in a variety of social activities.

Information about complaints was displayed in the home. Most people told us the manager and provider was approachable and listened to them. People were supported to share their views about the service.

We found the providers quality-monitoring systems were not always working as well as they should be. We were assured of the provider's commitment to making the required improvements.

We found four breaches of regulations in relation to the management of consent to care and treatment, fit and proper person employed and good governance. We are considering the appropriate regulatory response to our findings.

This inspection took place on the 23 January 2017 and was unannounced. We previously inspected the service on 20 October 2015. At that inspection we found that the service was meeting all the regulations we assessed.

There was a manager at the service who had submitted an application to register with the Care Quality Commission, at the time of the inspection, the manager’s registration was in the process of being completed. 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.

West Villa is a private care home, which has been owned and managed by the same family for over twenty- five years. It is a large detached building, situated near local amenities. West Villa is registered to provide care and support for up to 32 people who have mental health needs or physical disabilities related to the ageing process and supports people who are over 60 years of age. At the time of our inspection there were 31 people living at the home.

The home provided 32 single rooms 22 of which had en-suite facilities. The building and furnishings were maintained and decorated and environmental checks were up-to-date. The home was clean and free from unpleasant odours and systems were in place for the prevention and control of infection.

Care staff had a good understanding of safeguarding procedures, how to identify signs of abuse and what action they would take to protect vulnerable people in their care.

From our observations we saw there were sufficient, appropriately trained care staff available to support people to meet people’s needs safely. Recruitment checks had been carried out on all care staff to ensure they were suitable to work in a care setting with vulnerable people. Care staff had received an induction and had undertaken a variety of training to ensure they had the skills and knowledge required for their roles. Care staff received regular supervision which ensured that the standard of their work was monitored.

Medicines were stored correctly and administered by care staff who had received appropriate training and been assessed as competent to safely administer medication. The systems for recording medicines in the service needed to be improved to ensure medicines were managed safely. We have made a recommendation about the management of some medicines.

Although the service was in the process of updating and reviewing all risk assessments and care plans they did not consistently reflect the level of identified risk for people. We have made a recommendation about speeding up the process of reviewing risk assessments and care plans.

People were supported to eat and drink sufficient amounts to meet their needs and residents were actively involved with planning the choice of food offered. People’s weight were monitored effectively and concerns were addressed with health professionals. People were supported to maintain good health and where needed specialist healthcare professionals were involved with their care.

We observed care staff were kind and caring. Through talking with care staff and residents we found people were treated as individuals and that care staff responded to their needs in a caring and dignified manner. Care staff offered encouragement and spoke in a positive way to residents in order to help improve their self-esteem.

Activities were at the heart of the daily life of West Villa and a range of varied activities, suggested by residents, was available.

People using the service, relatives and healthcare professionals were able to express their opinions about the service through regular surveys about the quality and standard of care provided. The home had a complaints procedure and people we spoke with knew how to make a comp

We carried out this inspection under Section 60 of the Health and Social Care Act 2012 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. The last inspection was in August 2013 and there were no breaches in the regulations in the areas we looked at.

West Villa Residential Home provides accommodation and personal care for up to 32 older people, some of whom may also have mental health issues and dementia.

A registered manager was in place, who was also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff were kind and caring and attentive to people’s needs. Relatives spoke positively about the quality of care for their family members. This was confirmed during our observations of people’s care.

People told us they enjoyed the food and we found the staff discussed all dietary needs with the chef, who prepared meals according to people’s tastes and preferred quantities.

Assessments of people’s needs and plans of their care were not always effective and individual risk assessments were not always fully in place or up to date.

Necessary safety checks of the lift had not consistently been carried out. Documentation relating to the running of the home, such as policies, procedures, risk assessments and maintenance records were not always in place or up to date.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and of the Health and Social Care Act 2008 (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

People who used the service were given appropriate information and support regarding their care or treatment so they were aware of what they could expect at the home. We looked at the care records of five people. We saw people were supported to maintain control over their care where possible.

People we spoke with were happy with how they spent their days. Whilst we were there a person went to a local day centre. One person told us they had watched Casino Royale the previous evening and had enjoyed it. There were regular activities organised for people who wanted to be involved. One person told us, "Staff take me out to the shops."

There were effective systems in place to reduce the risk and spread of infection. We found regular cleaning schedules.

We spoke with five members of staff who told us the training they received helped them to have the skills to deliver good care.

The home had systems and audits in place to monitor the quality of the service they provided. Records included monitoring the home's environment, care plan reviews, medication reviews, mattress audits and maintenance of the building.

. People told us they like living in the home. One person said they like the food and they are well cared for. Another said they like the people caring for them and they like their bedrooms and have everything they need. People we could not communicate with were relaxed and comfortable.

People told us they feel safe and like the people caring for them.

Positive relationships were observed being fostered between people living in the home and those caring for them. And their care needs were observed being met in a relaxed and unhurried manner. People told us they like the people caring for them.

The needs of people we could not communicate with were observed to be met in a relaxed and unhurried manner and positive relationships were observed between those living in the home and those caring for and supporting them. People told us they like the people caring for them as they help them do things.

People told us they feel supported and liked the people caring for them. People we could not communicate with were observed to be relaxed and comfortable.

One person said they like living in the home, they like their rooms and the people looking after them. Another said the staff are very good and they listen to what the have to say. One person said the meals are very good and they have a choice and get enough to eat and drink. One visiting relative said they are very happy with the care and they are fully involved and have a say in how care is provided. Another relative said they have tried other homes but this is the best one by far. One person living in the home said they are very happy.

People say they like living in the home. One person said ‘If they have any concerns they can tell someone and its sorted’ Another says the staff listen to what they have to say and things get changed’ One person said they ‘feel very safe and well cared for’. People we could not communicate with appeared to be happy, very relaxed and comfortable. One visiting relative said they are kept informed about their relatives’ progress and if they have any issues they are dealt with immediately.

People say they like the people caring for them. One person said the carers are very good and very caring. Another says ‘there is always someone there when you need them’. One visiting relative said the carers are excellent and nothing is to much trouble. They said they are very happy with the staff in the home.

People say they like the people caring for them. Some people we could not communicate with appeared to be happy and positive relationships were observed being fostered between those living in the home and those caring for them. One person said the staff are very good and listen to what they say. One visiting relative said the staff are always very courteous and welcoming.

People living in the home say they like the people caring for them. People we could not communicate with appeared to be relaxed and comfortable with those supporting them. One visiting relative said they feel they are happy with the care and support their relative receives.

This inspection took place on 20 and 21 October 2015 and was unannounced. Our last inspection took place in February where we found there were multiple breaches of regulations. We found at this inspection the provider had made significant improvements to the quality of the service and had addressed all of the concerns highlighted previously.

There was a manager at the service who had submitted an application to register with the Care Quality Commission, but at the time of the inspection, the manager’s registration was not complete. 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 provider had addressed all issues relating to the legal requirements relating to Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005.

There was significant evidence of widespread improvements to the quality of the provision. The provider had addressed all areas of concern identified at the last inspection. There was marked improvement to the management, staff morale and the culture within the home.

The provider had made investments to the fixtures and fittings in the home to help eliminate bad odours. We saw that the home was very clean and there were no malodours. Cleaning took place constantly throughout the day. Staff practised good hand hygiene and using personal protective equipment appropriately.

We saw that there were sufficient numbers of suitably trained and skilled staff available to meet people’s needs safely. Staff were knowledgeable about people’s needs and had received updated training in many areas.

Risk assessments were detailed and known by staff. Accidents and incidents were closely monitored, although the cause of some accidents was not always investigated thoroughly to prevent a repeat occurrence.

People’s weight was more effectively monitored and there was improvement in the quality and availability of food and drink for people since the last inspection.

Staff were very kind, patient and caring and demonstrated a good regard for people’s privacy and dignity.

Care was person centred and staff understood people’s individual needs and preferences, with regard for people’s personal life histories.

Systems to assess and monitor the quality of the provision were developing, although not fully robust, in line with the new appointment of the manager.

We did not identify any breaches of regulations at this inspection.

We have considered and concluded our enforcement actions in relation to the regulatory breaches identified at the previous inspection as we are satisfied the provider has addressed all areas of concern.