The inspection took place on 12 and 13 September 2017 and was unannounced. When the service was last inspected in July 2015, there was one breach of the legal requirements relating to the safety of the management of medicines. Overall, the service was rated as good.

At this inspection we found sufficient actions had been taken and improvements made to address the breach of regulation, and we rated the service had remained good.

Why the service is rated good:

The Westbury Nursing Home and Garden Suite provides accommodation and nursing and personal care for up to 114 people. At the time of our inspection visit, 105 people were living in the home.

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.’

Where people were supported with medicines, we found they were managed safely. Risk assessments and risk management plans were in place.

People’s care records were personalised, with evidence of people’s involvement, with choices and preferences taken into account.

Audits were in place to identify shortfalls and actions were completed to make any necessary improvements.

Safe recruitment procedures were followed before new staff were appointed. Appropriate checks were undertaken to ensure staff were of good character and suitable for their role. The staff induction programme was comprehensive. Staff views were positive about the support, guidance, training and supervision they received.

People were cared for in a kind, caring and respectful way. People were supported to maintain their health and the service liaised with other external health professional when needed.

A wide range of activities were provided and community involvement was actively encouraged.

People who used the service, relatives, external health professionals and staff all spoke highly of the leadership and management of The Westbury Nursing Home and Garden Suite.

The inspection took place on 10 June 2015 and was unannounced. The last inspection took place on 13 August 2013 and no breaches of regulation were found at this time.

The service provides accommodation and nursing care for older people. The home is divided into two separate areas of accommodation. The main home provides nursing care and a smaller unit within the grounds of the home provides support for people with residential care needs.

There was a registered manager in place. 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 service was safe in most aspects; however more needed to be done to ensure that the risks associated with medicine management were minimised. Processes in relation to the administration of covert medicines were inconsistent. Covert medicines are given to people without their knowledge when it is in their best interests to do so. Documentation was not always completed fully. This meant that there was a risk that people would not receive medication in line with their identified needs.

People told us they felt safe and were well cared for by staff. Comments included; “you have nothing to worry about with the staff here”, another person said “I don’t feel as if I’m being neglected here and feel very safe…” A relative commented “I really feel X is safe here, it’s an amazing place, and we love it”.

There were sufficient numbers of staff available to support people safely and meet their needs. At the lunch time meal, we observed there were enough staff to support people safely and meet their nutritional needs.

People received effective care in relation to their nursing needs. We saw that people who were identified as being at risk of developing pressure damage to the skin, received support to reposition regularly. Their food and fluid intake was also monitored to ensure adequate nutritional intake. People had the equipment they needed in place to meet their nursing needs safely and effectively. Where necessary, staff worked with other professionals to ensure that people’s healthcare needs were met.

People’s rights were protected in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s capacity was considered in decisions being made about their care and support and best interest decisions made when necessary.

People were supported by staff who were kind and caring in their approach and were treated with dignity and respect. People were able to maintain relationships with friends and relatives.

Staff understood people’s individual needs and preferences which meant that they received care in accordance with their wishes. There was a programme of activities in place, which we observed people actively taking part in and enjoying. Strong links had been built with the community, including a project working with local school children, building relationships with people in the home.

The home was well led. There was a positive attitude amongst staff towards their work and staff responded well to the direction of registered nurses. This ensured that people’s needs were met.

We spoke with fifteen people receiving a service, seven members of staff and two managers during our visit.

When we visited Westbury Care Home and Residential Garden Suite we took an 'expert by experience' with us. The expert by experience in this case was someone who has experience of caring for older people and people with dementia. The purpose of involving an expert by experience was to help us understand the views of people using the service: whether they got the support that they needed as not everyone was able to tell us about their experiences due to their medical condition.

People told us that the staff were kind and helpful and that they liked living in such a lovely

homely environment.

People told us they were involved in activities at the home. One person showed us the artwork they had completed in the painting sessions.

People told us they able to discuss issues openly at the residents' meetings. People said they were aware of the complaint procedure One person said I am quite content, I have no complaints”

A relative visiting told us that their loved one was in the best place, they were happy and settled as staff were kind. Another relative said that staff kept the family up to date with any changes in their relative’s condition.

People we spoke with told us “I am finding it first class, the secret is the personal things they do” and “they are very good, the carers are smashing”. Another person told us “they care for your mind, body and spirit”. People told us they were encouraged to make their views known at the residents meetings and these were acted upon. They told us that there were activities they could attend if they wanted to.

People told us they were involved in planning their care, one person told us “I can tell them if I want to change anything in my care plan”. We found that care plans were sufficiently detailed and gave staff information about how to support people in the home. These were reviewed regularly. This meant staff were guided by up to date information when they assisted people with their needs.

People told us the food was lovely, one person told us “there is always enough food, and you can have seconds if you wish” and “there is always choice and if you don’t fancy anything on the menu, the chef will cook something else”.

Every person we spoke with had positive opinions about the staff who worked in the home, people told us “the staff are lovely” and “if they can do anything for me they will".