About the service: Westerleigh provides residential care for up to 55 people. No nursing care is provided by the service. At the time of our inspection there were 45 people using the service

People’s experience of using this service:

Since our last inspection the manager had made a successful application to CQC to become registered and a new deputy manager had been employed at the service. Improvements had been made and the service was no longer in breach of Regulation 11 – consent, Regulation 12 – safe care and treatment and Regulation 18 – staffing.

We found there was a continued breach of Regulation 17. This impact of poor governance has meant the rating remains requires improvement. Records to show people were given their medicines in a safe manner and ate and drank sufficient quantities required improvement. Audits carried out in the home showed mixed findings on these issues. Whilst some audits had identified areas for improvement, other audits had failed to pick up and address on going issues.

People and their relatives were complimentary about the registered manager and the staff. They spoke with us about feeling that issues they had raised with the staff team had been addressed.

The provider had introduced new arrangements to monitor the quality of the service and the quality team carried out audits. Actions to improve the service were listed on an improvement plan and signed off when completed by the regional manager who also carried out regular checks on the service.

People’s safety whilst living in the home was promoted using regular checks on the building and the environment. These were carried out by maintenance staff. Checks to reduce the risks of fire were carried out on a regular basis.

Staff had received support through training and supervision. This included safeguarding people and staff told us they felt confident in reporting any concerns to the manager.

The registered manager used a dependency tool to identify how many hours staff were required. There were consistent levels of staffing on each floor.

People were weighed on a regular basis and actions were taken to address people’s needs when they continued to lose weight. Advice from dieticians was incorporated into people’s care plans. Kitchen staff were informed of people’s dietary needs and understood how to prepare food to meet people’s individual needs.

People told us they experienced being cared for by staff who were kind and caring. Staff understood how to protect people’s privacy and dignity.

Arrangements were in place for on-going cleaning and for staff reduce the risks of cross infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were given choices and their decisions were respected.

The registered manager invited relatives to be a part of the service through residents and relative’s meetings.

Complaints and concerns had been addressed by the registered manager and practical solutions found to improve the delivery of care.

People’s care plans had improved since our last inspection. These were reviewed each month to check if they were accurate and up to date.

When we discussed activities with people in the home we received a mixed response. A new activities coordinator was putting together new activities plans. We found meaningful activities were carried out in the home and due to the timing of the inspection Christmas events were underway.

Staff felt there was good communication in the home and they worked as a team. Handover records between shifts were signed by staff to say they understood people’s up to date needs and wishes.

People were supported with their health needs by staff who had regular contact with other healthcare professionals to discuss people’s conditions.

This inspection took place on 20, 21 and 22 February 2018 and was unannounced. At our last inspection in May 2017 we rated the service as ‘Good’. There were no breaches of the legal requirements. During this inspection we found four breaches of regulations 11, 12, 17 and 18. The breaches appertained to consent not been obtained by the service to provide people’s care. People were at risk of receiving inappropriate care and care records were not accurate or up to date. Staff were not supported through supervision and appraisal.

Westerleigh 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.

Westerleigh is a purpose build care home and can accommodate up to 55 people across three floors. One of the floors specialised in providing care to people living with dementia. It is registered to provide accommodation for people who require personal care. Westerleigh does not provide nursing care. At the time of our inspection 45 people were using the service.

At the time of our inspection there was not 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.

Records throughout the home were incomplete and failed to document accurate and contemporaneous information about people’s care needs. This in turn meant people were put at risk of receiving care which was inappropriate.

We found there were gaps in people’s topical medicines records. People had a number of topical medicines on one document and we were unable to discern what topical medicines had been applied. Improvements were required to medicine records to guide staff on when to give people ‘as and when’ required medicines.

Although the home was generally clean and tidy we found some areas of the home needed improving to reduce risks of cross infection. This included bedding provided by the service which we found to be stained.

The risk of a fire in the home was reduced through regular checks. However we found consistent assessment of risk was not applied throughout the home. For example emergency pull cords in bathrooms and toilets were not accessible to people who may fall to the floor.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However we found care and treatment of people who used the service was not always provided with the consent of the relevant person. We saw staff understood the concept of making decisions in people’s best interest but failed to document the rationale for decisions.

Staff had not been supported through the regular use of supervision and appraisal as prescribed in the provider’s policy. The service had a training matrix in place. We saw staff had not been trained in end of life care and diabetes. The acting manager told us they had requested diabetes training from a training provider.

Audits had been carried out by the provider. However the regional manager and the acting manager were unable to provide us with audits the previous regional manager had carried out prior to December 2017. We saw an audit carried out by the provider’s quality improvement team. The audit had led to improvements in the service.

Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. We found we had not been notified of serious injuries to people. This regulatory breach is being dealt with outside of the inspection process.

We found there were sufficient staff on duty to meet people’s needs. However we recommended the provid

The inspection took place on 3 and 4 May 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Westerleigh in January 2015, at which time the service was compliant with all regulatory standards and was rated Good. At this inspection the service remained Good.

Westerleigh is a residential home in Stanley, County Durham, providing accommodation and personal care for up to 55 older people, including people living with dementia. There were 53 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

There were sufficient numbers of staff on duty in order to keep people safe, meet their needs and ensure the premises were well maintained. All areas of the building were clean, with infection control risks well managed.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). The service had recently introduced an electronic medicines administration system and we found this to be working well, with no errors identified. Where people administered their own medicines, this was risk assessed.

Other risks people faced, such as trips and falls, were managed through risk assessments and associated care plans. These were reviewed regularly and incorporated advice from healthcare professionals to keep people safe.

Safeguarding principles were well embedded and staff displayed a good understanding of what to do should they have any concerns. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.

There were effective pre-employment checks in place to reduce the risk of employing an unsuitable member of staff.

There was prompt and regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff completed a range of training, such as safeguarding, health and safety, dementia awareness and moving and handling. Staff displayed a good knowledge of the subjects they had received training in and had a good knowledge of people’s likes, dislikes and life histories. Feedback regarding the face-to-face training provider was extremely positive.

Staff had built positive, trusting relationships with the people they cared for. Staff were supported through regular supervision and appraisal, as well as confirming the registered manger was willing to talk at any time.

People enjoyed the food they had and confirmed they had choices at each meal as well as being offered alternatives. We observed staff supporting people calmly and attentively to eat and drink, both at mealtimes and throughout the day.

The premises benefitted from some aspects of dementia-friendly design, although we found the registered manager was yet to fully incorporate person-centred care into the design of communal areas. Likewise, whilst care planning documentation was extensive, this had yet to be translated into easily accessible person-centred care documentation. Person-centred care means ensuring people's individual likes and preferences are considered and acted on when planning all aspects of care and people's environments.

Group activities were varied, well advertised and well attended. The activities co-ordinator required additional support to ensure the activities they planned were done so from a person-centred perspective.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for thems

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including carrying out an observation and speaking with people who used the service who could share their experiences. During our observation we saw people were treated with consideration and respect.

People who were able to share their experiences, and relatives we spoke with, told us that their wishes were taken into account by staff. One person said, “The staff are very good. They are always checking that I’m happy. I feel that they listen to me.”

However, other evidence did not support this. We found the provider had not always acted in accordance with people's wishes and legal requirements.

People told us they were happy with the care which was provided. One person said, "It’s a wonderful place, I wouldn’t want to go anywhere else." A relative said, "It’s champion here. The staff are very good with my mum. I have no complaints at all. Her health has been much better since she’s been here. She needed 24/7 care and they can really look after her well here.”

Appropriate arrangements were not in place to protect people against the risks associated with medicines.

We saw processes were in place to ensure staff were of good character and qualified to work within the service.

There was an effective system to regularly assess and monitor the quality of service people received.

People we spoke with said they were happy at Westerleigh. One person said "I like it, the atmosphere in here" and another person told us "I'm highly satisfied to be quite honest."

People told us they felt safe at Westerleigh and with the care staff employed by the service. People said they were happy with the staff and the care they provided. One person said "They're a good set of carer's" and another added "I get on with some of the staff."

People said they were happy with the care and treatment they were receiving. One person said "They (the staff) look after you."

People told us they were happy with the service and knew how to raise issues, should they have any. The people we spoke with said they didn't have any complaints or concerns.

We inspected this service on 29 and 30 January 2015 and it was unannounced.

The service is registered to provide accommodation and personal care for up to 55 people. The home is set in its own grounds with private gardens. Set over three floors, the lower ground floor is used to accommodate people who suffer from dementia.

The home is based in the Stanley area of County Durham, close to local shops and amenities.

At the time of our last inspection there we found concerns relating to the storage, administration and disposal of medicines. We saw during this inspection improvements had been made and there were no breaches of the legal requirements.

At the time of the inspection there was a manager in post but they had not been registered with Care Quality Commission. 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.

Care plans and risk assessments were completed with people who used the service and contained information which gave staff details about the level of assistance people required.

Robust recruitment and selection processes were in place and pre-employment checks had been carried out to ensure people who used the service were cared for safely.

The service had an appropriate medications policy in place and staff had been trained on the correct way to administer, store and dispose of medicines. There were body maps in place and these showed staff where creams and lotions should be applied.

Staff working in the home received regular supervisions and comprehensive records of discussions were held in personnel files. Additional supervisions were carried out if there was a concern about their ability to carry out a particular task.

People who used the service received care and support that was person centred and individual to their needs.

There was a formal complaints procedure in place and people who used the service were given information on how to raise a complaint if they wished. All complaints received were forwarded to the Akari Care head office for review as well as being dealt with by the manager of the service.

Advocacy services were available and information was displayed on a notice board for people to view.

There was a quality assurance system in place which was used to ensure people received the best care possible.