About the service: Westcotes Residential Care Home is a residential care home that was providing personal and nursing care to 14 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

• Staff were caring and there were enough staff to meet people’s needs and staff had received the training and support needed to enable them to provide safe care. Staff knew how to protect people from abuse. However, recruitment processes did not ensure the required checks had been received in the home before staff started to work.

• Medicines were not always safely managed and good practice guidance was not always followed.

• Risks to people were not fully identified and care was not always planned to keep people safe.

• Care plans contained generic information and did not support staff to provide person centred care. Care plans had not been completed for people on respite care.

• The maintenance of the home had not ensured that high standards were maintained and some infection control issues were identified.

• Systems to monitor and improve the quality of care provided was ineffective and did not identify concerns. In addition, incidents were not properly investigated and effective action was not taken to ensure similar issues did not reoccur.

• People’s views of the care they received were gathered and complaints were investigated in line with the provider’s policies.

• People were offered a choice of food and action was taken to help people maintain a healthy weight.

• People received compassionate care at the end of their lives.

• People’s rights under the mental capacity act were respected and people were supported to make decisions about their lives.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement (report published 23 January 2018). At this inspection we found the provider and manager had failed to make all the necessary improvements.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to

make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 26 October 2017 and was unannounced.

Westcotes Residential Home provides residential care for up to 17 people, including older people and people living with dementia. There were 17 people living at the home on the day we inspected.

There was a registered manager for 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.

At the last inspection the service was rated as requires improvement.

At this inspection the rating remains as requires improvement.

The provider was not meeting the legal requirements in relation to good governance and the safe management of medicines. They had not ensured that the systems to monitor the quality of care were effective and had not taken action when they had gathered the views of people living at the home. In addition the systems in place to manage medicines did not support people to received as required medicines in a consistent manner or to monitor the effectiveness of the medicines. You can see the actions we have asked the provider to take at the back of this report.

There were enough staff available and staff received training to ensure that they delivered people’s care safely. Staff knew how to raise concerns if they had any worries over people’s safety. However, at times due to breaks staff were not in the communal areas monitoring people’s needs. In addition people were felt staff were not able to spend time chatting to them and there was not enough planned activities to keep them engaged and entertained.

Risks to people’s care had been identified and care was planned to keep them safe. In addition care plans contained the information needed to provide safe basic care to people. However, risks assessment and care plans did not contain the information needed to personalise care to people’s individual needs.

People’s rights under the Mental Capacity Act 2005 were respected and where people had capacity they were supported to make decisions and to take positive risks. However, the registered manager had not consistently identified where people were unable to consent to living at the home and were under constant supervision. Therefore some referrals to the Deprivation of Liberty Safeguards supervisory authority had not been made.

The environment and furnishings were not always safe and did not support the needs or ensure the privacy of people living at the home. Some equipment was not working correctly and this impacted on the care people received. There were no secure outside space for people to enjoy.

We carried out an unannounced comprehensive inspection on 28 June 2016. Breaches of two legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

At the last inspection on 28 June 2016 we found that the provider was not meeting the standards of care we expect. This was in relation to the upkeep of the premises and having care plans in place for all people who used the service.

We undertook this focused inspection on 21 March 2017 to check that they had followed their plan and to confirm they now met the legal requirements. During this inspection on the 21 March 2017 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Westcotes Residential Care Home on our website at www.cqc.org.uk.

Westcotes Residential Care Home provides care for people who require personal care. It provides accommodation for up to 17 people. At the time of the inspection there were 16 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 2008 and associated Regulations about how the service is run.

On the day of our inspection we found that the registered provider had made some significant improvements to the premises and now had a system in place to ensure the upkeep was maintained. There were care plans in place for each service user and a specific format for those only using the home as a short term care provision.

We inspected Westcotes Residential Care Home on 28 June 2016. This was an unannounced inspection. The service provides care and support for up to 17 people. When we undertook our inspection there were 14 people living at the home.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks.

There was a registered manager in post. The registered manager also managed another home for the provider in Lincolnshire. 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.

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. DoLS are 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. At the time of our inspection there was no one subject to such an authorisation.

We found that there were insufficient staff to meet the needs of people using the service. The provider had not taken into consideration the complex needs of each person to ensure their needs could be met throughout a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way. This was through the use of a care plan for permanent admissions to the home. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs who were permanent admissions were assessed and plans put in place to minimise risk in order to keep people safe. However, this was not so for three people who were on a short stay admission to the home. There were no care plans in place and there was no evidence to support how they had been assessed and how staff were meeting those people’s needs.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking with staff. Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home. However, the audits to test the quality of the services being provided had not been sustained through out the year. Therefore the provider had no means to judge whether the services provided met people’s needs. No systems were in place to monitor the upkeep of the building, that fire equipment was safe to use and that the safety of people from intruders was being monitored.

Our inspection team on this occasion was made up of one inspector. This was a follow up inspection from our last visit on 3 April 2014 when we made a compliance action because the provider did not have a system in place to ensure staff were supported in their role.

Below is a summary of what we found. The summary is based on us speaking with the staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

The provider had sent us an action plan informing us of what they were going to do to become compliant.

Staff told us they had received supervision at least once since our last visit. This confirmed what we saw in the staff supervision logs.

A policy was now in place which gave staff guidance on how often staff should receive supervision. The records confirmed the details in the provider's policy.

The manager had a supervision planner in place to ensure staff were aware of when they should expect a supervision. The records confirmed the sessions listed.

Our inspection team was made up of an inspector only on this occasion.We set out to answer five questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records. We also spoke with other health and social care professionals.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures are robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, This reduces the risks to people and helps the service to continually improve.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager sets the staff rotas. When doing this they take people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people’s needs are always met.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Is the service caring ?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, "The staff are lovely, so patient."

People who used the service, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Health and social care professionals told us staff followed instructions well.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The provider was not adhering to their own policy about supervision of staff. Staff records were incomplete and staff unaware of the correct policy.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring staff were adequately supervised.

People told us they liked living at the home and staff were pleasant to them. They told us staff asked for their consent before treatment and care commenced. One person said, "Staff are very supportive."

The care plans had been reviewed on a monthly basis after an initial assessment process had been completed. Staff completed daily records and involved other health and social care professionals when necessary. We observed staff responded to peoples' needs in a calm manner. One person told us, "Staff help me with my bath and have everything to hand."

Some staff had been trained to administer medicines. Prescribed medicines had been stored in a secure environment. People told us they had given staff permission to administer and reorder medicines when required. One person said, "I can administer my own inhaler."

People told us their needs were met but each of the 10 people we spoke with told us they felt there were not enough staff. One person said, "Staff tell me they took a long time to answer my call bell because there weren't enough staff." Another person said, "I would like staff to just come and sit with me sometimes." The provider had not completed a needs and skills analysis to ensure sufficient numbers of staff were employed to meet peoples' needs at all times.

We found that people were cared for in a clean, well presented home. People’s care was based about their individual needs. The staff provided care in a pleasant and professional manner. One person living at the home said, “I can’t say enough about this place, I’m 100 and I think it is clean, warm and lovely.”

We saw staff had time to interact with people and were attentive to people's needs. Their interaction with people was friendly, respectful and professional.

We saw the cook provided a choice of hot and cold foods at each mealtime and snacks throughout the day.

We looked at how the premises had been maintained. One person told us, “The building is lovely, really well looked after.”

We reviewed the policies in place to prevent the spread of infection. We found the home was kept clean and that staff observed the guidance provided to them.

People were able to make choices for themselves and they felt that their privacy and dignity were respected. People felt able to express themselves as they wished. One person told us, “I like to wear a suit, I can look how I want to.” People were able to take part in activities in the local community.

People were visited by the acting manager before coming to the home, which they found useful, and had a keyworker to help them. People we spoke with said that they were able to do things they enjoy. We saw one person was knitting and she told us she this was her hobby. We were also told the food was good and people could have an alternative if they wanted.

People we spoke with said they felt safe in the home and one person said, “I have never been treated poorly here.” They also told us the staff were very good and seemed to be trained to do their work.