The inspection took place on 16, 17 and 23 January 2018. The inspection was unannounced.

At our previous inspection in November and December 2015 the service was rated as Good. This is the first time the service has been rated Requires Improvement.

Westfield Park Nursing Home 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 care home accommodates 111 people across two separate units. One unit provides nursing care and the other is home to people with dementia, this is known as ‘The Haven’.

At the time of the inspection 87 people were living at the home and receiving a service.

The home had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Audits that were in place to ensure guidance and processes to record the storage of people’s medicines were at the correct temperature were not effective. Temperature checks were not always completed which meant people’s medicines may not work. Protocols were not always available to enable staff to safely administer medicines prescribed to be given only as and when people required them, known as ‘PRN’. Because of our findings the provider implemented remedial measures to reduce the associated risks and these actions were on going.

Infection control audits had not been completed monthly in line with the provider’s guidance. Systems and processes in place had failed to identify and remedy all areas of the home that were not clean. An action plan was implemented to reduce some of the associated risks during our inspection and further actions were planned.

During our inspection we found that audits had failed to ensure that records maintained for people were always accurate, complete and detailed in respect of each person using the service.

Staffing was deemed to be sufficient to meet people’s individual needs. We observed people did not have to wait long when they required support from staff. A dependency tool to determine sufficient staffing was provided to meet people’s changing needs was in use but required updating.

Staff received appropriate induction training and supervision to carry out their role. Staff told us they felt supported by their seniors. However audits had failed to ensure that staff received annual appraisal. This meant staff did not receive the required support in line with the provider’s policy. The provider was implementing improvements to make this process easier for staff to complete.

We found checks to assess and monitor the service and maintain standards around the home had failed to ensure that the systems and processes in place were robustly completed following the providers guidance. These included the DoLS register, staff dependency tools, meal time arrangements and staff appraisals.

The provider had failed to ensure systems and processes were effective to communicate information and changes regarding people’s care and support to everybody who required that information. This meant staff did not always have up to date information to provide person centred care and support appropriate for people’s current needs.

People were supported with meal time arrangements. However we found checks the provider completed had failed to identify the concerns we found. For example, information was not always available regarding the food on offer. The provider informed us that menus were available for people in their rooms. We found that there were inconsistencies in the support staff provided to people to ensure they enjoyed the meal time experi

We found people were being looked after by friendly, supportive staff within a warm and homely environment. One person told us, “Staff are friendly and give us the support and help we need” and another said “There is a lovely atmosphere in the home, very friendly and welcoming.”

People were supported to be able to eat and drink sufficient amounts to meet their needs. Everyone we spoke with said they received sufficient drinks and meals and one person said “You only have to mention it to the staff and they will make you or any visitors a drink.”

There were clear processes in place for what should happen when a person moved to another service, such as a hospital, which ensured that the person’s rights were protected and that their needs were met.

People were cared for in a clean and hygienic environment. Two people who spoke with us said they were satisfied with the cleanliness of the home and pleased with the laundry service.

We saw the service had an effective recruitment policy and procedure, which ensured staff working in the service had the right skills and qualifications to meet people’s needs.

The provider had an effective quality assurance system in place and people’s views and opinions of the service were listened to and acted on where necessary. There was also a complaints system available, which people understood and were confident of using if needed.

Records about people who used the service enabled staff to plan appropriate care, treatment and support. The information needed for this was systematically recorded and kept safe and confidential.

We spoke with three people who used the service. They all enjoyed living in the home and were very positive about the care they received and the service. One person said “The care is very good; staff couldn’t do more for us. I like living here in the home.”

People told us they were involved in the decisions about coming into the service and staff discussed their care and treatment with them. They were able to make choices and decisions about their daily lives, and the staff respected their wishes and supported their independence. One person said “I like my own company and prefer to spend my time in my bedroom; the staff respect this. However they do ask if I want to go out on trips or take part in activities.”

People told us that they had a good choice of social activities to take part in and the meals provided at the service offered them lots of choice and variety. One person told us “The food here is very good, with different things on the menu. If you don’t like what is offered then the kitchen staff will do you something different.” Another person told us “There are lots of things for us to do and I like completing the crosswords in the weekly newsletter.”

People said that they had good access to outside healthcare professionals and they were satisfied with the level of medical support given to them. They said staff were good at giving them their medication on time and when they needed it.

People told us they could make choices about aspects of their lives and they were consulted about things. Comments were, “They leave me to do things and check to see if I am managing” and “They asked if I minded a male carer but I told them I preferred a female and so that’s what I get”.

People told us their health and personal care needs were met, “You just have to mention something and it is dealt with – the doctor or the chiropodist”. Comments from two relatives were, “The staff know her very well and how to settle her” and “He is so well looked after, I have peace of mind and they always keep me informed”.

People said that staff helped them to settle into the home quickly. They described staff as kind and caring and said they would do anything to help people.

This inspection took place on 30 November and 1 December 2015 and was unannounced. At our last inspection of the service in January 2014 the registered provider was compliant with all the regulations in force at that time.

Westfield Park Nursing Home is situated in the village of Hook, near Goole. It is registered to provide accommodation and care to 111 people. The service supports older people, people who have a physical disability and people living with dementia. The service is split into two separate units with the dementia unit being known as The Haven.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. 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 told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following robust recruitment and selection processes. Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the service was meeting their internal quality standards.