The inspection was completed on 20 December 2017 and 9 January 2018 and was unannounced.

Westcliff Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 22 older people and people living with dementia in one adapted building. At the time of the inspection, there were 20 people living at Westcliff Lodge.

Westcliff Lodge is a large detached house situated in a quiet residential area in Westcliff on Sea and close to all amenities. The premises is set out on two floors and each person has their own individual bedroom and adequate communal facilities are available for people to make use of within the service.

At the last inspection on the 10 and 11 November 2015, the service was rated ‘Good’. At this inspection, we found the service was rated ‘Requires Improvement’. This is the first time the service has been rated ‘Requires Improvement’.

Our key findings across all the areas we inspected were as follows:

An effective robust system was not in place to assess and monitor the quality of the service.

Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements.

Some aspects of medicines management required further development. Not all risks to people were identified and improvements were required to record how these were to be mitigated to ensure people’s safety and wellbeing. Improvements were required to ensure that people’s care plans reflected all of their care and support needs and how the care was to be delivered by staff. People received limited opportunities to participate in meaningful social activities throughout the day.

Training for staff was not as up-to-date as it should be. Specifically improvements were needed to ensure staff received appropriate training relating to medication, moving and handling, and to ensure this was embedded in their everyday practice. Staff recruitment practices required strengthening as these were not robust or in line with regulatory requirements. ‘In-house’ inductions were not always completed at the earliest opportunity and not all staff had received a robust induction.

The deployment of staff was not always appropriate and staffing levels not always maintained. There was no systematic approach linking people’s dependency needs to staffing levels.

People’s capacity to make day-to-day decisions had been considered and assessed. Staff demonstrated an understanding and knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act (MCA) 2005. The Care Quality Commission had been notified where [DoLS] had been authorised by the Local Authority.

People were protected from abuse and avoidable harm and people living at the service had no concerns about their safety and wellbeing. Staff described the registered manager and management team as supportive and approachable. Arrangements were in place for staff to receive formal supervision at regular intervals and an annual appraisal.

People received sufficient food and drink throughout the day and the dining experience was positive. People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required. Staff had a good relationship with the people they supported. People were treated with dignity and supported to maintain their independence where appropriate.

The cleanliness of the service was maintained to a good standard and people had access to comfortable communal facilities and their bedrooms were personalised.

We have made recommendations about the management of risk and care planning and, linking people’s dependency needs to staffing levels.

You can see what action we told the provider to take at the

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 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 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

The inspection was unannounced. This meant that the provider did not know that we were planning to carry out the inspection.

Westcliff Lodge is a residential care home which provides accommodation and personal care support for up to 21 older people. On the day of our inspection there were 20 people living at the service, the majority of people had been diagnosed as living with a dementia.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

Our last inspection of this service was on 2 December 2013 where we found a breach of Regulation 13. This meant that the provider did not have appropriate arrangements in place to manage medicines. We found unexplained omissions in the records made when medicines were given to people. We judged this had a minor impact on people who used the service. The provider sent us an action plan in January 2014 telling us what they would do to become compliant.

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the safe storage of medicines.

There were enough staff to provide for the personal care needs of people. People were treated with kindness, dignity and respect. They told us that they felt safe and that staff were always kind and respectful to them. However, people did not have regular access to meaningful activities and stimulation appropriate for people living with dementia. Although the provider had ensured that staff received training in supporting people living with dementia, there was little staff interaction for people with limited communication ability. The provider had not ensured that people living with dementia had adequate stimulation or access to meaningful activities to enhance their wellbeing and promoted their autonomy, independence and quality of life.

Staff told us they were happy working at the service and that the manager was supportive and listened to them when they had concerns regarding the care and welfare of people.

The provider monitored the quality of the service provided. The provider audits were ineffective in identifying, assessing and managing risks to people who used the service. The providers monitoring of the service had not led to the necessary action and improvements required to ensure people’s safety and wellbeing had been protected.

People were not protected from the risks of malnutrition and dehydration. Staff were not monitoring or supporting people effectively when they were nutritionally at risk and people were not given appropriate support with access to food and drinks, sufficient to meet their needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find.

We looked at whether the service was applying the Deprivation of Liberty Safeguards (DoLS) appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is appropriate and in the best interest of the person. We found the location was in the main meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had been trained and demonstrated the required knowledge to provide support to people who may lack capacity to make decisions about they lived their everyday lives. They understood the requirements of the Mental Capacity Act (2005) which meant that they had the required knowledge to ensure that worked within the law.

We found significant concerns with the cleanliness and hygiene of the service. The providers system of infection control audit checks had failed to identify these areas of concerns.

We found that there were a number of breaches in the Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010 and you can see what action we have told the provider to take at the back of the full version of the report.

As part of this inspection process we spoke with the registered manager, deputy manager, three members of staff, four people who used the service and one visitor.

Our observations indicated that people living at the service were happy, that they felt safe and were well cared for. Comments included, "It's absolutely fine here and I have no concerns whatsoever" and, "It is lovely here." It was evident that people who used the service had a good relationship and rapport with the staff who supported them.

People's health and personal care needs were assessed and there were detailed care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Staff spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported.

The provider was able to demonstrate that a robust staff recruitment policy and procedure was in place and followed to ensure that people living at the service were kept safe. We found that previous identified shortfalls relating to staff induction, staff supervision and quality assurance had been addressed. Minor concerns relating to the management of medicines were identified as part of this inspection. The manager provided an assurance that corrective actions would be undertaken to address the issues.

People who use the service told us that they were very happy with the care and support provided at Westcliff Lodge. People told us that they were treated with respect and dignity. Relatives spoken with were very complimentary regarding the service. They told us that communication was good and they were always kept informed about their relative's care, support and treatment and told of the outcome of any healthcare appointments. Over the preceding 12 months there had been one safeguarding alert and no complaints.

Further improvements are required to ensure that medication practices and procedures are developed so as to ensure positive outcomes for people. In addition improvements are required to ensure that all newly employed staff undertake a comprehensive induction in a timely manner and all staff receive regular supervision. Effective quality assurance may assist the provider in recognising where there are gaps and areas for devlopement.

People living at Westcliff Lodge had a wide range of needs. Some people had varying levels of dementia and different communication needs. We were therefore unable to fully understand everybody’s specific issues.

Those people with whom we spoke all told us that they were happy living at Westcliff Lodge. One person told us “I give it eight out of 10.” Another person said “It has a nice atmosphere here.”

They told us that their wishes to be independent were respected and they were supported to make decisions about their care. People said that they could choose their own routines, for example, what time they wanted to go to bed or to get up.

People told us that they enjoyed the social activities that were arranged for them. One person gave an account of a trip to the park the day before and how they would like to do this more often.

Everybody said that the meals provided were good and everybody spoke highly of the staff and considered staff to be helpful and supportive. We were told “There’s not a bad one amongst them.” One person told us “The staff are always available and caring” and another said “The people here are kind, thoughtful and very friendly.”

A visiting family member told us that their relative had only been using the service a short time but had already settled and their wellbeing improved since their admission.

People with whom we spoke all spoke very positively about the manager. One person told us “She is always about and always makes time to come and have a chat.” They also told us that, if the need arose, they would feel comfortable to raise any concerns with the manager; they felt that they would be listened to and that the manager would help them.

Overall those people with whom we spoke expressed satisfaction with their rooms and felt the home provided comfort and homeliness.

The inspection was completed on 10 and 11 November 2015 and there were 19 people living at the service when we inspected.

Westcliff Lodge provides accommodation and personal care for up to 22 older people and people living with dementia.

At our last inspection to the service on 6 August 2014 we identified a number of concerns that required improvement. These related to poor medicines management, inadequate cleanliness and infection control practices and procedures and poor nutrition and hydration monitoring. We asked the provider to send us an action plan which outlined the actions to be taken to make the necessary improvements. In response, the provider shared with us their action plan detailing their progress to meet regulatory requirements. At this inspection we found that the required improvements as stated to us had been made.

A registered manager was not in post at the time of the inspection. The manager confirmed that an application to be formally registered with the Care Quality Commission was to be submitted. 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.

Although suitable arrangements were in place to assess and monitor the quality of the service provided, these had partially identified or highlighted where improvements were required.   

Support plans were sufficiently detailed and provided an accurate description of people’s care and support needs. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. People were supported to maintain good healthcare and had access to a range of healthcare services. The management of medicines within the service ensured people’s safety.

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported. Appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected.

There were sufficient numbers of staff available to meet people’s needs. Recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service. Staff told us that they felt well supported in their role and received regular supervision and an annual appraisal of their overall performance.

People were supported to be able to eat and drink satisfactory amounts to meet their nutritional needs and the mealtime experience for people was positive.

People were treated with kindness and respected by staff. Staff understood people’s needs and provided care and support accordingly. Staff had a good relationship with the people they supported.

An effective system was in place to respond to complaints and concerns.