About the service: Westerley Care Home is a service where people can receive accommodation and personal care. The service accommodates up to 30 people who are living with dementia, elderly and frail or who have other health conditions. At the time of our inspection, 25 people were living at the service.

People’s experience of using this service:

People told us they felt safe living at Westerley Care Home. However, we identified some shortfalls in relation to infection control practices by staff and a lack of action taken in response to risks for people. The environment in which people lived required some improvement, however the registered manager was able to evidence they were working hard to address this. More work was needed to ensure the surroundings were suitable for people living with dementia.

Although we received good feedback from people about the food, the way in which people were expected to choose the foods they ate, did not always give people full autonomy and choice.

People were cared for by staff who had gone through a robust recruitment process and staff who followed good medicine management practices.

People gave us positive feedback about staff and told us they were kind and caring. Although we observed this with staff when they spoke with people, we found that the registered manager had not always ensured staff were following best practice. We found that people were not always receiving the social stimulation that they wished and there was a lack of social interaction by staff. However, activities did take place.

People’s care plans contained good information and guidance for staff and staff demonstrated they knew people well. People could feedback their views through meetings and surveys.

People’s consent was sought in line with the Mental Capacity Act 2005 and where people required the input of health professionals staff enabled this.

Although management of the service was such that it was open and transparent and it was evident they were keen to improve the service, we identified shortfalls which had not been picked up through the audits process.

During our inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made four recommendations to the registered provider.

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

Rating at last inspection: We last inspected Westerley Care Home on 13 & 14 July 2016 where we rated the service as Good. We published the report on 13 August 2016.

Why we inspected: This was a scheduled fully comprehensive inspection carried out in line with our inspection methodology which is based on last inspection rating.

Follow up: We found at this inspecting that the service had not continued to meet the rating of Good. We have asked the registered provider to send us an action plan to tell us how they planned to address the concerns we identified. We will carry out a further inspection in line with our inspection methodology to check that the registered provider has taken actions to address the shortfalls found.

This inspection took place on 13 and 14 July 2016 and was unannounced.

Westerley Care Home provides care and support for up to 30 people who are physically and mentally frail; some of whom may be living with dementia. There were 30 people living at the service when we visited.

The service has a registered manager. 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.

People felt safe living at the service. Staff were aware of the processes in place to report incidents of abuse; and had been provided with training on how to keep people safe from abuse and harm. Processes were in place to manage identifiable risks and to promote people’s independence and safety.

The service’s recruitment procedure was robust to ensure that staff were suitable and fit to be employed. Systems were in place to ensure people’s medicines were managed safely and given at the prescribed times.

Staff were provided with induction and essential training to keep their knowledge and skills up to date. They had regular one to one meetings to support them in their roles and yearly appraisals.

People’s consent to care and support was sought before any care was provided. This was in line with the requirements of the Mental Capacity Act (MCA) 2005. They were supported with food and drinks to maintain a balanced diet. When needed, staff supported people to access health care facilities.

People had developed good relationships with the staff team who treated them with kindness and compassion. Systems were in place to ensure that their views were listened to; and their privacy and dignity was upheld.

Before coming to live at the service people’s needs were assessed. This was to ensure that the care provided would be responsive to their needs. The service had a complaints procedure which was accessible to people and their relatives.

There was a positive, open, inclusive and transparent culture at the service. Arrangements were in place for the service to maintain links with the local community. There was a quality assurance system in place to monitor the care provided and to drive continuous improvements.

During our visit to this home we found that people who used the service were treated with respect and were involved in their care and support planning. One person who used the service said " we are very well looked after here, very well indeed, no complaints at all ".

All people had a thorough needs assessment documented in their care records which covered many aspects of daily living, a detailed personal profile, risk assessments and associated daily logs all of which had been regularly updated. One staff member we spoke with said " We are very proud of our electronic care record system, gone are all the problems with trying to read other's handwriting".

Staff we spoke with told us about the importance they attach to ensuring the health and welfare of the people who used the service. One staff member we spoke with said "We have regular health and safety briefings from our manager and team leaders".

All staff we spoke with demonstrated their awareness of their role and responsibilities in relation to safeguarding. All people we spoke with who used the service said they felt confident to raise a concern. One person who used the service said "yes I would feel comfortable to raise a concern if I needed to".

During our visit we saw evidence of audits which had been undertaken and associated action plans which had been developed. We saw how changes had been made to improve the quality of service provision.

One person told us “I feel I am very fortunate to be here. I love it here." Another person said “I can't think of anything negative as I am overwhelmed by the positives." Everyone we spoke with said they were happy with the care that they received from the provider. No one we spoke with had any complaint or concerns to discuss with us.

We found that the provider ensured that people and their relatives were involved in decisions related to their care. People's care plans and risk assessments were reviewed regularly, to ensure people were receiving the care they needed. We saw that the provider had policies and procedures in place, to ensure medicines were managed appropriately. We also found that there was a robust complaint process in place. The provider had an effective recruitment process to recruit staff who were competent and of good character.

People we spoke with during our visit were all complimentary about the care and service provided. A person we spoke with commented, “The service is terrific. The carers are very good. I would recommend this place to anyone. We are well looked after. No complaints.” This was echoed by another person who said, “It’s a smashing place; the staff are great.”

When asked about choices, a person said, “We have lots of choices. I chose my own curtains and bed linen, two sets, and the carpet for my room. I had them fitted recently, all new.“ The same person added, “The food is usually nice. We get choices; today its bacon and sausages, carrots and sweet corn and ice cream.” Another person said, “The service is very good. I can lock my own room whenever I want.”

A relative we spoke with said, “We are very pleased with the service. Staff are very good and caring.”

In recent months, we had received several written compliments about the service from people’s relatives. A relative commented, “In Spring 2010, new people bought Westerley. I cannot praise them enough and all the loyal staff for the careful thought and hard work they have endured in order to achieve the wonderful residential home Westerley has now become. It is now a very happy place, and I would recommend it to anyone. All carpets and fabric-covered chairs are long gone, with laminated flooring and comfortable chairs that can be washed. The staff are always happy in their work and the residents are always busy drawing, playing games, having their nails painted, exercising or in the garden with their cuppa. I visit at different times but the atmosphere stays the same. I can sleep at night knowing that Raz and her staff are such caring people.”

Another family wrote, “I strongly feel that I want to sing the praises of everybody who works at this wonderful care home. Raz and her team are absolutely wonderful. They have made the transition for an elderly couple, so care free and easy to do. They had been adamant that they wanted to stay in their own home. But this has become too difficult. I cannot fault Raz and her team for the care and attention they pay to both of my parents. We are always made to feel so welcome when we visit, and there is nothing that they will not do to make us feel comfortable and worry free. I hope that you will be able to thank them on my behalf, and if there is ever a prize to be won for being so caring, they are definite winners.”