Westbury Lodge is a small care home providing accommodation which includes personal care for up to eight people. At the time of our visit, six people were using the service. The service supports people with a range of needs including learning disabilities, mental health, physical disabilities and sensory impairment. The provider Parkcare homes (No.2) Limited is part of the wider Priory group. The home is arranged over two floors and does not have a lift in place. For this reason the home does not accept any placements where the person has mobility difficulties above the ground floor.

At the last comprehensive inspection in November 2016, we identified the service was still not meeting four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one further breach of the Regulations had been identified. We served a positive condition on the provider’s registration in which the service had to submit monthly reports so we could be assured the concerns were being addressed and monitored. The service remained in special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. The Local Authority placed an embargo on admissions to the home, whilst they made the required improvements and this remains in place.

A registered manager was in post at this service however at this inspection the registered manager was not present and was on a period of planned leave. 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. An acting manager had been recruited and was responsible for running the service during this time. The acting manager was available throughout this inspection.

At this inspection we found the service had made the necessary improvements to be meeting all of the previously identified breaches of Regulations. No further breaches were found at this inspection. The service is no longer in special measures but will continue to be monitored to ensure the improvements are sustained.

At this inspection we found that there were still some areas of improvement needed in the safe management of people’s medicines. People who had been prescribed medicines to take ‘As required’ (PRN) did not always have a protocol in place. We saw that some PRN protocols had not been reviewed monthly as stated. During the time medicines were being administered, staff would interrupt the staff member administrating to ask unrelated questions, which had the potential for errors to be made.

Although the service had sufficient levels of staff in place there was still a high use of agency staff. During our inspection five staff were on duty. In the morning three members of staff were agency. This then dropped to two agency and three permanent staff in the afternoon. The management team had changed the rotas to ensure consistency of permanent staff was maintained across the home including at weekends.

Staff told us they were confident in knowing how to respond if they saw an incident or heard an allegation of abuse and discussed how to identify if someone who could not speak was being abused. One member of staff said they would look for physical signs of abuse such as bruises. Another member of staff said “I know the people here so well, all their quirks and everything, I would notice any slight change in their behaviour and instantly know something was up.”

Mealtimes were a dignified and pleasant experience for people. There was clear teamwork and coordination between the staff to ensure mealtimes ran smoothly and were enjoyable for people. A new way of working had been introdu

At the last comprehensive inspection in March 2016, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way. In addition, medicines had not been safely managed and quality auditing systems were not identifying shortfalls in the service.

We issued one warning notice to the provider and eight requirement notices as a result of the concerns we identified and the service was rated, as inadequate. The service was placed into special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. The Local Authority placed an embargo on admissions to the home, whilst they made the required improvements.

We completed a focussed inspection in October 2016 to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service. During this inspection in November 2016, we found the provider had sustained some improvements but not all. Due to this, there was not enough evidence to enable the service to be removed from special measures. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. While some improvements were observed at this inspection further developments are required and the improvements made need time to embed in practise. For this reason this service will stay in special measures. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Westbury Lodge is a small home providing accommodation which includes personal care for up to eight people. At the time of our visit, six people were using the service. The service supports people with a range of needs including learning disabilities, mental health, physical disabilities and sensory impairment. The provider Parkcare homes (No.2) Limited is part of the wider Priory group. The home is arranged over two floors and does not have a lift in place. For this reason the home does not accept any placements where the person has mobility difficulties above the ground floor.

The registered manager has worked at the home since June 2016, and became the registered manager in November 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. The registered manager was present throughout the inspection.

People were at risk of dehydration and poor nutritional intake. One person who was at risk of losing weight had been prescribed supplement drinks and put on a monthly weight recording chart. We saw that during a period of nine months this person had only been weighed four times. Throughout our inspection we saw this person was not offered appropriate choices around food and drink.

People were not receiving care from regular staff that enabled consistency to be maintained. Staff had continued to leave the service since March 2016 and the registered manager told us during this inspection that one member of staff had failed to show up for their shift last week and had not been in contactable since. One person told us “Sometimes I get cross because I’m left unattended. Like when it comes to having a shower or when you need something urgently”. Staff told us they felt under pressure from not having enough staff. Relatives raised their concerns “If they are there they will support him but they keep leaving don’t they. There is a big turnover. He can get agitated with a

At the comprehensive inspection of this service in March 2016 we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with one warning notice and seven requirements stating they must take action. We shared our concerns with the local authority safeguarding and commissioning teams.

This inspection was carried out to assess whether the provider had taken action to meet the warning notice we issued. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the warning notices have been sustained, to assess whether action has been taken in relation to the seven requirements and provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notice we issued and we have not changed the ratings since the inspection in March 2016. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Westbury Lodge on our website at www.cqc.org.uk.

At this inspection we found that the provider had taken action to address the issues highlighted in the warning notice.

A new manager had been appointed and had submitted an application to the Care Quality Commission (CQC) to become the registered manager. 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.

Due to the concerns raised and incidents regarding people with mobility concerns being safely accommodated at Westbury Lodge, the provider had decided no future placements would be accepted at Westbury Lodge above the ground level, where the person was not independent in their mobility. Everyone had received an in-house placement review in order to decide if they could continue to be safely accommodated at Westbury Lodge and if the service could effectively meet their needs. In addition placement reviews with the relevant local authorities had been requested for everyone living at Westbury Lodge, to be completed by the end of the year.

People who did not have the capacity to call for help should they require support, had all been risk assessed for the level of supervision needed when in their bedrooms. This meant staff completed regular checks in line with these risk assessments to ensure people were not left unchecked for prolonged periods of time.

Incidents were being reported and responded to appropriately. An incident reporting log was in place which showed what actions must be taken. Incidents were totalled and checked by the manager as part of their quality monitoring of the service. Staff told us they felt confident in reporting incidents and that they would be dealt with appropriately commenting “We talk through incidents when they have happened. We are reporting incidents, it’s not being pushed under the carpet and it’s dealt with quickly”.

Safeguarding procedures had been reviewed in the home and protocols for reporting had been revisited with staff in team meetings. Staff comments included “We have had a refresher of safeguarding training” and “Whenever something is wrong you report, I would feel happy especially now to do this”.

The manager and regional manager had developed a comprehensive action plan to address the warning notice and other requirements in the inspection report where they were found to be in breach of regulations. We saw this plan was being updated and amended to reflect the progress made with improving the service. Feedback was obtained through meetings with people who use the service and staff. The meetings were used to explain the actions they were t

Westbury Lodge is a small home providing accommodation which includes personal care for up to nine people. At the time of our visit, eight people were using the service. The service supports people with a range of needs including learning disabilities, mental health, physical disabilities and sensory impairment. The provider Parkcare homes (No.2) Limited is part of the wider Priory group.

The inspection took place on 8 and 10 March 2016. This was an unannounced inspection. The home was last inspected on 29 January 2015 and received a rating of good. This inspection took place in response to on-going safeguarding investigations and information of concern received.

The registered manager had left the service four days prior to our inspection, which meant there was no registered manager in post at the time of our inspection. 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.

The home was being overseen by an ‘acting manager’ in this interim period whilst a new manager was being recruited. The regional manager was making weekly visits to the service to provide support during this time and another registered manager from a home within the same company was providing mentor support to the acting manager. The acting manager was accessible and approachable throughout our inspection.

People were not being protected against risks and action had not been taken to protect people from the risk of harm. People who had the most difficulty moving independently and were at risk of potential falls were accommodated on the upper floors of the building and had experienced several falls resulting in injuries. The building was not suitable to safely accommodate people with mobility needs other than on the ground floor. There were not effective methods in place for people to be able to call staff for assistance.

The home's medicine management systems required improvement in order to fully protect people. This was currently under investigation from the local safeguarding team, and being supervised by the regional manager and internal quality team.

Staff understood their responsibilities in protecting people and reporting any instances of abuse and had confidence to recognise potential signs in people that were unable to verbalise concerns.

Staff had not been supported to maintain skills relevant to their role. Staff did not receive regular or effective supervisions to discuss their development.

People were not afforded choices during the lunch meal. One person did not receive a substitute when they were unable to eat the pudding provided.

Staff were knowledgeable about the people they supported and demonstrated kindness and genuine care in their interactions with people. Staff encouraged people to maintain their independence.

We saw one example of undignified care. All other observations showed staff upholding people’s privacy and treating people with respect.

Care plans were in an accessible format and contained information about the person’s background, and preferences. However the recording of information was not always consistent and people’s needs were not always reviewed and plans updated to reflect their current status.

Relatives told us they were kept informed about events affecting their loved ones. They were given the opportunity to provide feedback on the service, and people in the home had attended ‘Your voice’ meetings so they could discuss matters relating to the home.

The home had not been well led and staff lacked clear direction and leadership. The culture had not been positive and the acting manager and regional manager were putting things in place to address this.

Quality audits had not been consistently undertaken and some recordings w

Westbury Lodge is a residential care home providing  personal care for up to nine people who have a learning disability or mental health needs. At the time of our inspection there were eight people living at Westbury lodge. The main focus of the service is to treat everyone as individuals and involve them in choices which promote their independence. The inspection took place on 29 January 2015.

The service had a registered manager who was responsible for the day to day operation 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 and associated Regulations about how the service is run. The registered manager was present on the day of the inspection.

People liked the staff who supported them and positive relationships had formed between people and staff. Staff treated people with dignity and respect.

The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social care needs. People’s care needs were regularly reviewed to ensure they received appropriate and safe care, particularly if their care needs changed. Staff worked closely with health and social care professionals for guidance and support around people’s care needs.

Staff were knowledgeable about the rights of people to make their own choices, this was reflected in the way the care plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support.

Staff had received training in how to recognise and report abuse. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

There were systems in place to ensure that staff received appropriate support, guidance and training through supervision and an annual appraisal. Staff received training which was considered mandatory by the provider and in addition, more specific training based upon people’s needs.  

The registered manager and the regional manager carried out audits on the quality of the service which people received. This included making sure that the accommodation and the environment was safe.

We were not able to speak with all the people who used the service. This was because some were out taking part in community activities and not all of those who were at home could communicate verbally or wanted to speak with us. We spent time observing how staff communicated and supported people to see people's experiences of care in the home. We spoke with four staff and looked at four people's care records.

One person said “it’s very good. It’s open. I feel safe.” Another two people told us “it’s ok! We observed people were relaxed in their home. People were able to participate in a range of activities of their choice. People were supported to maintain their independence.

We observed people were asked for their permission before they were assisted with care. We saw people were supported to have an advocate to help them with decisions. People's capacity with regard to important decisions was assessed and best interest meetings held with people who knew the person.

Staff worked with other healthcare professionals to ensure people's care and treatment was co-ordinated and safe.

We found the provider had a system to ensure medicines were administered safely and effectively.

Staff said they were supported. There was a comprehensive training programme. Staff supervision was provided on a regular basis. There was just enough staff to meet people's needs safely.

People's records were reviewed and updated regularly.

People told us staff supported their independence and respected their privacy and dignity. We found people were involved in their care planning and their views and opinions about the service were listened to.

People told us "staff are wonderful". We observed care which was kind and caring and provided in line with care plans which were reviewed and updated regularly.

We were told overall the food was "not bad". There was some choice and people's preferences were regularly included in the menu. People's nutrition and hydration needs were monitored and specialist advice sought if necessary.

People were protected from abuse because staff understood their roles and responsibilities concerning safeguarding. People who used the service were well informed about safeguarding and had access to relevant information.

We found staffing levels were improving and overall there were enough qualified and experienced staff to meet people's needs.

We saw the provider had an effective system to regularly assess and monitor the quality of service people received.