About the service:

Westfield Lodge Care Home is a care home that was providing personal and nursing care to 40 people at the time of the inspection.

People’s experience of using this service:

People were supported by safely recruited staff who had the skills and knowledge to provide safe and effective support. People were supported safely to manage their risks, whilst promoting their independence. Medicines were managed safely. Effective care planning was in place which guided staff to provide support that met people’s needs which were in line with their preferences.

People consented to their care and were supported in their best interests in the least restrictive way possible. People were supported to eat and drink sufficient amounts in line with their assessed needs.

People’s diverse needs had been planned for, which ensured people received individualised care in all aspects of their life. Professional advice had been sought and acted on to ensure people’s health and wellbeing was maintained. Systems were in place to ensure people received consistent care across the service and from other professionals.

Staff were kind and caring towards people and promoted choices in line with individual communication needs. People were treated with dignity and their right to privacy was upheld. Advocacy services were utilised to ensure people were supported by independent representatives when making choices about their care.

People were supported to be involved in hobbies and interests that were important to them. People and their relatives were involved in the planning of their care, which meant people were supported in line with their preferences. Complaints systems were in place, which people and relatives knew how to use. People’s advanced decisions had been gained in respect of their end of life.

Systems were in place to monitor the service, which ensured that people’s risks were mitigated and lessons were learnt when things went wrong. There was an open and person-centred culture within the service. People and staff approached the registered manager who acted on concerns raised to make improvements to people’s care.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection:

Requires Improvement (report published 19 October 2017)

Why we inspected:

At the last comprehensive inspection in September 2017 the service was rated requires improvement overall (in all of the key questions of Safe, Effective, Caring, Responsive and well led). The key question Well Led was rated inadequate. The provider was meeting the regulations. However, we found some improvements were needed in medicines management, risk management, people’s experience during meals and the governance systems needed to be imbedded and sustained at the service.

At this inspection the required improvements had been made and the service had met the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through the information we receive.

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

This unannounced inspection took place on 6 September 2017. At our previous inspection in April 2017 we had concerns about people's safety and wellbeing. We found several breaches of Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had rated the service as Inadequate and placed it into special measures. At this inspection we found that improvements had been made, however further improvements were required. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures .

Westfield lodge provided accommodation and nursing care for up to 54 people. At the time of the inspection 38 people were using the service.

There is 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.

Although we saw improvements in the way that risk of harm to people were being managed, we found that some risks had not been recognised and responded to, to keep people safe.

There were sufficient numbers of suitably trained staff, however they were not always deployed appropriately throughout the building to meet people's needs in a timely way.

People had enough to eat and drink to maintain a healthy diet, however the dining experience was chaotic and at times potentially unsafe due to an overcrowded dining room.

People did not always receive care that met their individual assessed needs and preferences as staff were not always aware of people's needs and consistent in their approach.

People were not always treated with dignity and respect.

New systems had been put in place to monitor and improve the quality of the service. However further improvements were required to ensure a consistent approach to people's care was achieved.

New potential staff were employed using safe recruitment procedures to ensure they were fit and of good character.

People's medicines were being stored and managed safely. The registered manager monitored and investigated medication errors.

People were being protected from the risk of abuse as staff and the registered manager knew what to if they suspected abuse.

The provider was following the principles of the Mental Capacity Act 2005 to ensure that people who lacked mental capacity were supported to consent to their care.

People received health care support when their needs changed or they became unwell.

People's right to privacy was upheld. People were offered choices and these choices were respected.

There was a complaints procedure and people and their relatives knew who to speak to if they had concerns.

The provider had responded and took action to improve the service. The registered manager and deputy manager had worked hard to implement the new systems and improve the quality of care.

People, their relatives and staff told us that the management was approachable and supportive.

This inspection took place on 11 April 2017 and was unannounced. This was the provider's first inspection since registration in September 2016. We found that people were not always receiving care that was safe, effective, caring, responsive and well led. We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is Inadequate which means it will be placed into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Westfield Lodge provides accommodation and nursing care for up to 54 people. At the time of the inspection 46 people were using the service.

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.

Care being delivered was not always safe. Risks of harm to people had not been minimised through the effective use of risk assessments.

The systems the provider had in place to monitor and improve the service were ineffective. Action was not always taken to keep people safe following incidents and accidents.

People's medicines were not always managed safely. People were at risk of not receiving their prescribed topical creams.

Staff we spoke with all knew what constituted abuse and told us they would report it if they suspected abuse had taken place. However, incidents of potential neglect and poor practise were not always investigated.

There were sufficient numbers of staff, however people told us there were delays when they called for assistance.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so and the DoLS ensures that people are not unlawfully restricted. We found that people could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves and some people were at risk of being unlawfully restricted.

Staff told us they felt supported however they did not receive adequate supervision to ensure they were effective in their roles.

People had sufficient