The inspection took place on 30 April and was unannounced.

Westcott House provides residential and nursing care for up to 60 people living with dementia or who have mental health needs. Westcott House is a ‘care 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 accommodation at Westcott House is spread over three floors and includes a purpose-built single storey building as an annexe. There are two dining rooms and several lounge areas in both the buildings. The buildings are joined by a short outside walkway and there is a separate day activity centre at the service. On the day of our visit there were 59 people living at the home and one person who moved in that day.

The majority of people living at the home had cognitive impairment and six people had complex mental health needs. Six people were nursed in bed due to the advanced nature of their 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. 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 our last inspection, we recommended that care plans should be written in a format to make them easier for staff to follow. However, at this inspection we found that care plans were still in the old format and that some were providing staff with out of date information about people’s needs and risks. We highlighted where this had impact on people’s safety and explored how the risks to people were managed.

We also previously recommended improvements to the range of activities and social interaction provided throughout the home to people living with dementia. On this visit, staff engaged with people in the communal areas. They were using some of the new equipment that the registered manager told us they had purchased to improve stimulation for people living with dementia.

The risks people face, due to their health conditions, were identified. There were good examples of risk management. However, some staff were not aware of the risks people faced or confident in managing some of these. We made a recommendation about increasing staff awareness and their learning on how to respond to certain risks.

There were also some poor hygiene practices that needed to be addressed. We have made a recommendation about staff refresher training in infection control.

People were protected from the risk of abuse and systems were in place to ensure that concerns were identified and reported to the registered manager.

People were cared for by sufficient numbers of trained staff. There was good recruitment and retention of permanent staff. We could see that staff were working in every part of the building and supporting people in the communal areas.

People were receiving their medicines safely. The use of medicines for individuals was appropriate and under regular review. Medicines were stored safely and the recording of medicines given was being done accurately.

People were supported to maintain their health and to get treatment when they needed it. The service had developed effective relationships with health and social care professionals.

People were supported to eat and drink enough. Their nutritional needs had been assessed and there were systems in place to monitor people’s fluid and food intake.

The environment was adapted to meet people’s needs and premises were being kept clean. Improvements had been made in the last year, such as Wi-Fi being installed, and new dining room furniture purchased. The need for further improvements was recognised.

The Mental Capacity Act and the Deprivation of Liberty Safegu

Westcott House is a well-established Nursing Home providing care and support for up to 60 people with a past or present mental illness and people living with dementia. The home is owned by Mr and Mrs Charalambous and Mrs Charalambous is also the registered manager. Accommodation is arranged over several units and there are ample communal lounge and dining areas provided. The home is located in Westcott Village and within easy access to local amenities. There were 60 people living in the home on the day of the inspection.

The registered manager/provider was present for the duration 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 and associated Regulations about how the service is run.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

There were sufficient numbers of staff on duty to meet people’s care needs. Staff recruitment procedures were safe. Employment files contained all the relevant checks to help ensure only appropriate staff were employed in the home.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the registered manager had good management oversight of the home.

Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

People were encouraged and supported to be involved in their care as much as possible. People had individual care plans. These were informative and updated regularly. They also contained information for staff to enable them to be able to respond to people’s needs effectively.

People and staff interaction was relaxed. It was evident staff knew people well and understood people’s needs and aspirations. Staff were very caring to people and respected their privacy and dignity.

People were provided with a range of nutritious foods to maintain a healthy diet. People told us the food was very good and home cooked. We saw people had access to drinks and snacks throughout the day and staff provided support for people to eat and drink when required.

People had risk assessments in place for identified risk of harm. The registered manager logged any accidents and incidents that occurred and put measures in place for staff to follow to mitigate any further accidents or incidents.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain good health. They had access to a wide range of health care services and the input of health care professionals.

Staff received a good range of training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

The registered manager operated an open door policy and we saw several examples of this throughout the day when staff, relatives and people who used the service sought their support and advice.

If an emergency occurred people’s care would not be interrupted as there were procedures in place to manage this.

Systems and audits were in place to monitor the service provision and best practice, in order to improve outcomes for people who used the service.

A complaints procedure was available for any concerns. This was displayed in the home. People and relatives had been provided with a copy of this when they were admitted to the home.

People and their relatives were encouraged to feedback their views and ideas into the running of the home.

Westcott House is a nursing home providing care for up to 60 people with a past or present mental illness and people living with dementia. The home is owned by Mr and Mrs Charalambous. Mrs Charalambous is also the registered manager. Accommodation is provided over several units and there are several communal lounge and dining areas provided. Bedrooms are mainly single ensuite with five large shared rooms. The home is located in Westcott Village and within easy access to local amenities. There were 59 people living in the service on the day of our inspection.

A registered manager /provider is a person who has been registered with the Care Quality Commission to manage the service. 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 service also had a deputy manager and a head of care nurse in post.

People who were able to told us they were treated well by staff who were kind and caring.

When risks had been identified not all risk assessments were in place with guidance for staff to follow to minimise risk to people. For example manual handling, skin integrity, and a smoking risk assessment needed to be updated.

Care was not always provided for people according to their agreed care plan. We found some concerns around the management of pressure area care and wounds.

People said they were safe and had “Nothing to worry about.” A relative said the service was caring and they would be able to tell if their family member felt unhappy or worried. Staff told us they would be able to recognise signs of abuse and would be able to escalate this to the nurse in charge. They were aware of the safeguarding procedures in place and knew where to locate this if they were required to do so. However we found not all staff had undertaken training regarding safeguarding adults and when staff had been trained this had not been updated regularly.

People’s privacy and dignity was maintained and we saw staff knocked on people’s doors before they entered.

Visitors were welcome in the service and people were supported to maintain links with family and friends. Relatives said they visited frequently and were always greeted with a warm welcome.

People had their needs assessed before moving into the service and care plans were drawn up from the information obtained at these assessments. People and their relatives were involved in planning their care whenever possible.

People’s health care needs were being met being met. People were registered with a local GP and had visits from other health care professionals. Regular health checks were undertaken and appropriate referrals made when required.

The provider and staff had a good understanding of how to apply the Mental Capacity Act 2005. However we found not everyone who required a deprivation pf liberty safeguards (DoLS) authorisation had one in place. We recommended that the provider reviewed the DoLS arrangements in place.

People had sufficient food and drink and there were good comments made regarding the food.

We looked at the medicine policy and found staff gave medicine to people in accordance with this policy. Medicines were managed safely and people received their medicine in a safe and timely way.

There were enough staff working in the home on the day of our inspection. Staffing levels and deployment of staff was calculated according to people’s needs and occupancy levels.

Staff recruitment procedures were safe and the employment files contained all the relevant checks to help ensure only appropriate staff were employed to work in the home.

The service had a day centre on site. There was an activity coordinator who provided a range of activities in the day centre for people who were able to attend. However we found several people who did not attend the day centre or who were being nursed in bed lacked stimulation and were socially isolated.

Systems were in place to monitor the service being provided. Regular audits were undertaken and annual surveys carried to monitor the quality of service provision.

People had been provided with a complaints procedure and were confident that any complaints would be handled appropriately.

Procedures were in place to manager foreseeable emergencies.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulates Activities) Regulations 2014. You can see what we told the provider to do at the back of the full report.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Information was provided to people who used the service and their relatives prior to being admitted to the home to help them make an informed choice.

People who were able to told us that they were happy living in the home. Relatives told us they were extremely satisfied with the care provided. They also felt the provider and the staff team were very supportive to them and kept them informed of any change to their relative's needs.

We found the standard of cleanliness in the home was good and the premises and garden were well maintained.

Staff told us they were well supported by the management structure in place and they had undertaken all the relevant training to enable them to undertake their roles efficiently.

We looked at the provider's quality assurance systems and found that there was a range of monitoring processes in place to enable the provider to respond to issues of quality

We spoke with several people who used the service and observed care practices for other people who were less able to communicate with us.

People told us that they were happy living in the home and that everyone was friendly and kind. Two people told us that they had been living in the home for several years and had become good friends.

We were told that there was a good activity programme in place and we were able to talk with people in the day centre who were watching a black and white film and enjoying a glass of sherry.

We saw that the people who were being nursed in bed looked comfortable and well cared for.

We saw staff interacted with people in an inclusive and engaging way. They offered sensitive support to people who needed help to walk to the bathroom or their bedrooms.

There was good feedback regarding the food. We were told that the meals were home cooked and that there was always something available that people liked to eat. We saw people enjoying fish and chips for lunch.

Staff told us that they enjoyed working in the home. They felt that they had sufficient training and support to undertake their roles and responsibilities effectively.

People who use the service spoke about their involvement in choosing activities, how they liked the home and their rooms, how the home was always clean, that they were well cared for, and how the nurses were very good.

People told us the food was good, they liked it, and that they could have something else if they didn’t like what was on the menu.

People said they felt safe at the home, that they were treated well, that the manager listens to them and makes changes where they can, that they had no complaints but knew how to make one if they did.

People’s relatives told us they were always greeted warmly by staff, that their relative’s privacy and dignity was always supported, that that they and their relative were informed about changes to medication, that staff always discussed this with them, that there always seemed to be enough staff around, and that they worked to a high standard and seemed to be genuinely caring people.

People’s relatives also told us they felt that their relative was always safe at the home and that they could rely on the home and the manager to protect their relative, that they couldn’t fault the care and nursing their relative received, and that it was a relief that they didn’t have to worry about their care when they went home

Relatives of people who use the service said they thought the food was excellent, that they were offered meals when visiting for long periods of time, that the home was always clean and fresh, and that when they were considering which home to use, the cleanliness and fresh smell of this home was one of the influencing factors.

People’s relatives told us that the manager knew all about their relative’s needs and everything that was going on in the home, because they were involved in care themselves and had a very hands-on approach. Relatives of people also spoke about the manager being very approachable, and that they felt they could raise any concern with them if needed, but they never had the need to yet.

A visiting NHS continuing care nurse assessor told us that the home was a preferred place for them to make placements. They said that they rated the care at the home highly and wouldn’t use it if they didn’t.