At the inspection of 4 and 5 July 2017 we found a breach of Regulation12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection the provider wrote telling us the actions they were taking to make improvements. At this inspection we found the required improvements had been made.

This inspection took place on the 26 and 27 September and 1 October 2018 and the first day was unannounced. The registered manager was aware of the subsequent visits.

Westbury Court is a care home providing nursing and residential care for up to 60 people. At the time of the inspection there were 50 people living at the 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.

The home is arranged over three floors. The ground floor accommodates people with residential care needs. The first floor accommodates people with dementia care needs and the second floor accommodates people with nursing needs.

A registered manager was 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 2008 and associated Regulations about how the service is run.

At the last inspection we found that medicines were not always managed safely. At this inspection we found the required changes had been implemented. However, processes around accurate recording required improvements. These included the application of prescribed creams, recording opened dates on medicines and fluid thickeners and accurate referencing of medicines in the medicine record book.

Medicines profiles included an up to date photograph of the person and essential information such as known allergies and how the person preferred to take their medicines. Most ‘as required’ (PRN) protocols were in place and those that were missing were actioned during the inspection.

People told us they felt safe at Westbury Court. Safeguarding processes were in place and the service sent us Notifications appropriately. Any safeguarding issues were discussed daily. Staff had received training in safeguarding, but not all staff we spoke with knew the procedures for whistleblowing.

There were comprehensive risk assessments in place for some people but not all areas of risk for other people had been minimised. We saw fluid and nutritional supplement monitoring charts which were not fully completed. Fluid thickeners were stored in an unlocked cupboard and were being administered by relatives who had not been risk assessed.

The home used a root cause analysis investigation tool to monitor incidents and accidents, identify themes and take appropriate actions. At the time of the inspection not many of these were up to date. The examples we reviewed were robust and gave the service guidance on the lessons learned from the incident.

People, their relatives and staff raised concerns about low staffing levels across the whole home. The home had a safe staffing dependency tool in place and the rotas showed that the home mostly staffed over the recommended safe level. However, these were ‘safe levels’ and did not necessarily reflect the quality aspect of the concerns raised around interaction time with people and staff being visible around the home.

Infection control practices around the home were in place and the home was clean, tidy and fresh. However, the kitchen was not clean and we observed some examples of poor food hygiene practices. The service had a rating of four stars for food hygiene from the local authority.

People told us their choices were respected and care plans contained person centred details relating to their health and social care needs. However, we found inco

Westbury Court is registered to provide accommodation which includes nursing and personal care for up to 60 older people, some of who are living with dementia. At the time of our visit 44 people were using the service. The bedrooms were situated over three floors. There were communal lounges and dining areas with satellite kitchens on each floor with a central kitchen and laundry. People also had access to a communal garden on the ground floor.

We undertook a full comprehensive inspection on the 4 and 5 July 2017. The first day of the inspection was unannounced. Since our last inspection in July 2016 Westbury Court has re-registered and therefore under the new registration does not have a rating. However, during our inspection under the previous registration we found the provider did not meet some of the legal requirements in the areas we looked at. After the previous inspection the provider wrote to us with an action plan of improvements that would be made in order to meet the legal requirements in relation to the law. We found on this inspection the provider had taken steps to make all the necessary improvements.

A registered manager was employed by the service and up until recently had been managing the service with the support of another regional support manager. Both these managers were present throughout our inspection. The service had recently appointed a new home manager who will be applying to become the registered manager. They will also be taking over the day to day management of the home. 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’s medicines were not always managed safely. Processes for the crushing of medicines had not been followed. Some administration records of medicines were not completed. There were arrangements in place for the safe storage of medicines.

Whilst the provider had systems in place to monitor the quality of service to ensure improvements were identified these had not picked up the areas of improvement we had noted. Staff and people’s views on the service provided were sought and where necessary acted upon. Complaints were appropriately investigated and actions were taken to resolve the situation.

People told us they felt safe living in Westbury Court. Risks to people’s personal safety had been assessed and support plans were in place to minimise these risks. Staff had the knowledge and confidence to identify safeguarding concerns and were aware of the actions they should take if they felt people were at risk of receiving unsafe care.

The staff employed at Westbury Court were kind and caring in their approach towards the people they were providing care and support for. Interactions with people were friendly and supportive. People and their relatives spoke positively about the care and support people received. People’s dignity was maintained and their privacy respected. People were able to participate in a range of activities.

Care and support plans were personalised and detailed daily routines specific to each person. People’s needs were reviewed regularly. Handover between staff at the start of each shift ensured that important information was shared.

People were encouraged to make their own choices and remain as independent as possible. Staff sought permission before they provided care and support. Where people lacked capacity to make certain decisions, best interest decisions were made involving relevant others. Deprivation of Liberty Safeguards had been appropriately applied for.

There were robust recruitment practices in place that protected people from being cared for by unsuitable staff. Sufficient numbers of trained and experienced staff were deployed to ensure people’s needs