This inspection was carried out on 23 January 2018 and was unannounced. At their last inspection on 7 October 2016, they were found to be meeting the standards we inspected. At this inspection we found that they had continued to meet all the standards.

Westbrook House 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.

Westbrook House provides accommodation for up to eight people with learning and physical disabilities. The home is not registered to provide nursing care. At the time of the inspection there were eight people living there.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People’s demeanour around staff indicated that they felt safe and relatives told us that they felt people were safe. Staff knew how to work safely and promote people’s welfare. There was effective infection control procedures in place and people’s medicines were managed safely. Lessons learned were shared with staff to help reduce a reoccurrence of an incident.

People were supported by staff who were trained and received regular supervision. People were encouraged to eat a healthy, balanced diet and there was access to healthcare professionals when needed. Staff understood the principles of the Mental Capacity Act and people were given choices throughout their day. The design and layout of the building met the needs of people who lived at the service.

People were supported by staff in a kind and respectful way which promoted their dignity. Staff had established relationships with people and this allowed for effective communication. People and their relatives were involved in planning their care and their views were listened to.

People received care that met their needs and care plans were written in a way that provided staff with clear guidance about the person’s needs and the life they liked to live. People participated in activities, hobbies and interests on a daily basis and recently all enjoyed a holiday together.

There was a complaints process available and people were asked for their views at meetings. In addition people, their relatives and professionals were invited to give their feedback in a survey where we found feedback was all positive.

The home was well managed by a management team who were passionate about the standards of care provided to people they cared about. There were systems in place to ensure the service maintained standards they expected.

This inspection was carried out on 6 September 2016 and was unannounced. At the last inspection on 8 December 2015, the service was found to not be meeting all the standards we inspected. This was in relation to management of medicines and sending statutory notifications. The provider sent us an action plan stating how they would make the necessary improvements. At this inspection we found that they had made the required improvements to meet the regulations.

Westbrook House provides accommodation and personal care for up to eight people with learning and physical disabilities. At this inspection six people were living at the service.

The service did not have a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. There was a manager in post but they had yet to register with the CQC. The service had been without a registered manager for in excess of the acceptable timeframe.

People’s medicines were managed safely and robust control measures had been put into place to monitor this. People had their individual risks assessed and staff were aware of these. Staff knew how to report and recognise any concerns about people’s safety and welfare.

People were supported by sufficient numbers of staff and recruitment processes were in place to help ensure they were fit to work within a care setting. Staff received training and supervision and told us they felt supported with an appropriate level of guidance.

People received care that met their needs. Relatives told us that they were happy with the standard of care people received. Care plans included information for staff to support people safely and people and their relatives, were involved in their development.

People were supported in accordance with the Mental Capacity Act 2005 and their consent sought before care was offered. Advocacy was available when needed. People’s choices and preferences were recorded and respected. People were treated with dignity and respect.

People had sufficient amount to eat and drink. Staff supported people with nutrition and hydration in accordance with their individual needs. People had access to health and social care professionals regularly.

There were individual and group activities available that people enjoyed. There were regular days out and people attended day centres. There was a policy in place for managing complaints and the management team told us they would start to document minor comments to ensure they could identify themes.

Staff told us that they were happy with the progress the service had made and relatives told us staff were doing a good job. The deputy manager was knowledgeable and worked well with the staff team. There were systems in place to monitor the quality of the service and the manager was sending statutory notifications appropriately.

This inspection was carried out on 8 December 2015 and was unannounced.

Westbrook House provides accommodation and personal care for up to eight people with varying learning and physical needs. There were seven people living at the service on the day of our inspection.

There was no registered manager in post. 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 and associated Regulations about how the service is run. The service was being run by the deputy manager with support from a senior support worker and the locality manager. The service was recruiting for a registered manager.

At the last inspection on 10 February 2015, the service was found to not be meeting the standards. We found concerns in relation to safeguarding people from abuse, consent, care provision, staff training and supervision, management and governance and the management of complaints. At this inspection although we found they had made some improvements, they were not meeting all the standards. We found there to be issues in regards to the management of medicines and relating to the governance of in the home.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome.

People’s care needs were being met and care plan’s included detailed guidance to support staff to meet their needs. There were short versions of the plans available for agency staff to read when they worked at the home. Staffing had been an issue at the home and shifts were frequently covered by agency staff, however, there was a plan in place to reduce the impact of this on people. The locality manager was recruiting for the vacant staff positions and they followed a robust recruitment procedure.

Staff told us the training had improved and we saw records to support this and showed most areas were up to date. However, training in the management of medicines was an area that was lacking. Staff had recently started receiving one to one supervision and told us they felt supported.

People received appropriate support with eating and drinking and had regular access to health care social care professionals. People were treated with dignity and respect and their feedback was sought. Complaints were responded to appropriately and surveys were sent out to obtain the views of people, their relatives and professionals.

We received positive feedback about the management of the home even though they were without a manager. The deputy manager, senior support worker and the locality manager were working together and we were told this had been effective.

The inspection was carried out on 10 February 2015 and was unannounced. At our previous inspection in February 2014 the service was found to be meeting the required standards.

Westbrook House is a care home which provides accommodation and personal care for up to eight people with learning and physical disabilities. At the time of our inspection there were eight people living at the home. There was a registered manager in post. 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. However, the registered manager was not responsible for the day to day running of the service.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. The manager and staff were familiar with their role in relation to MCA and DoLS.

People did not always have their individual needs met in timely manner due to routines set up in relation to continence care. Personal care was personalised in regards to how it was carried out but restriction on times meant that it was sometimes task orientated.

Recent staffing changes had impacted on the standard of care provided and this was being worked on to improve the service through on going recruitment. The staff at the home had developed a folder to advise new staff and agency staff of people’s care and support needs.

People’s relatives and staff told us that staffing levels meant that people did not always have their social needs met. This was in relation to activities outside the home and supporting hobbies and interests while at the home. This significantly affected people who did not access day centres.

People had not had their ability to make decisions assessed and therefore best interest decisions were not documented, or who was able to make decisions on their behalf. The service had started to work with the local authority to rectify this.

Medicines were managed safely. Staff were clear on how to promote health and safety within the home. However, we found that some staff had not received any training and for others the training was out of date. This had been identified by the deputy manager. Staff supervisions were also out of date but were being started by the deputy managers.

People’s nutritional and healthcare needs were met. Care plans required updating, however, staff were aware of people’s specific needs and health conditions. The deputy managers were working on updating care plans.

The management in the home was unstable and this had meant systems to monitor and manage the quality of the service were not properly used and areas for improvement had not been identified or resolved.

At this inspection we found the service to be in breach of Regulation 9, 10, 11, 18, 19, 22 and 23 of the Health and Social care Act 2008 (Regulated activities) Regulations 2010, which corresponds to regulations 9, 11,13, 16, 17, 18 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.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

At the time of our inspection, the service was having a new kitchen fitted. This had a minimal impact on the people who used the service, who were out at a day service during the day. We saw that meals were being provided for, and taken, in the adjoining service. Staff told us that the previous evening had been the first joint meal and people from both services had enjoyed the time together and had asked if they could do it on a more regular basis.

We were not able to speak with people who use the service due to their complex needs; however we observed that they appeared happy and we saw positive interactions with staff.

We saw from records that people were involved in planning their care and making decisions about their support. Processes were in place to gain consent for care and treatment from people who used the service, or their representative. We found that other professionals were involved in people's support.

We found that appropriate standards of cleanliness and hygiene were maintained in the home.

Staff told us that they attended a lot of training and felt very well supported. One person told us, “I look forward to coming to work." Another said, "It’s really nice here, a lovely atmosphere."

A small number of people were able to verbally communicate with us, although communications were limited. We talked to people about their experiences and made observations during our visit.

People who were able to communicate verbally told us that they were happy living at the home. One person said, "I like it here, I have a very comfortable bed and chair" and “I get to chose what I want to eat and can have a drink whenever I want it”.

We observed that people were treated with respect and that staff supported them during the day. However, we observed that activities provided on the day of our visit were limited.

Staff told us Westgate House was a nice place to work and that they thought they had enough staff to meet the needs of people. They also told us they felt supported by management. We observed the home to be visibly clean on the day; all the people appeared to have had their personal care needs met.

We were told that people could chose their meals and something different was offered if they did not want what was being offered from the menu. There were menus available but these did not have pictures of the meals on them to assist people with their choice. We observed staff supporting people who needed help with eating. However, we observed that not all people received a drink with their meal and their choice of a different meal did not always have adequate nutritional value.