Westfield Residential Home is a home for up to 23 people who may be living with dementia. At the time of our inspection 23 people were using the service. Westfield Residential Home is a family run home with a registered manager who has been in position for over 15 years. The registered manager was actively supported by the director. The management had a clear vision and spoke passionately about the service they delivered and the continuous improvements they were working towards achieving. However, we found the quality assurance systems in place were not used effectively to identify trends and lessons learnt.

The care workers kept people safe by monitoring and risk assessing safety equipment and utilities and infection control measures were effective. There was a communal lounge and dining room and areas for people to sit quietly if they wished. Bedrooms were personalised and staff were clear about the importance of paying attention to people’s well-being, privacy, and independence.

The service provided safe staffing levels, and care workers received supervision and training. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service provided a good standard of care to the people who lived there. The care workers were aware of people’s needs and treated them with dignity and respect. They listened to people and their needs and acted accordingly when asked for assistance. People who lived at Westfield Residential Home told us they felt safe and well cared for. When we discussed safeguarding with staff, we found they understood their responsibility to protect vulnerable adults from abuse and poor practice. Staff ensured documentation was regularly reviewed in order to ensure they continuously met the person’s changing support requirements.

Staff supported people to live as they chose and to enjoy a variety of activities. People were supported to keep in touch with family and friends and visitors were made to feel welcome. Staff and relatives were aware of how to raise concerns and were confident any issues would be dealt with promptly.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way.

Staff were knowledgeable about people's needs and we found that people were receiving the care they required. However, training required updating in safeguarding, mental capacity and DOLS.

Staff were aware of people's nutritional needs. Support was provided with eating and drinking, people were supported to maintain a healthy diet, and people's dietary needs and preferences were catered for.

Further information is in the detailed findings below.

The inspection of Westfield Residential Home took place on 11 January 2016 and was unannounced. At the last inspection on 30 April 2014 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Westfield Residential Home is located in a residential area of Willerby with bus access to Hull and beyond. It provides support and care to 23 older people who may be living with dementia and on the day of our visit there were 23 people in residence with a waiting list of 30 people wishing to take up residence. All bedrooms are single occupancy, some with an en-suite toilet and wash hand basin. There is a communal lounge and a communal dining room. There is a passenger lift to the upper floor, a pleasant enclosed garden and parking for eight cars. A family philosophy was used for the basis of the care provided. All staff employed shared the care of people that used the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager that had been registered and in post for the last fifteen years. They had worked at the service in another capacity twelve years prior to this. A registered manager is a person who has registered with the Care Quality Commission (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.

We saw that the service was very well-led by a consistent management team that had many years combined caring experience between them. The registered manager demonstrated passion and commitment to people, strong values and a desire to learn about and implement best practice throughout the service. We found that the culture and the management style of the service were extremely positive and based on an ethos of hard work, teamwork, commitment and dedication to improvement, which meant people that used the service benefitted highly from this in the way they were treated and cared for.

What was striking about the management team at Westfield (the registered provider, registered manager and deputy manager), was their absolute commitment to providing a team approach to supporting people with their needs; their physical and emotional wellbeing, as well as all tasks that needed doing, however menial. This ethos was passed down to the staff team who responded very well and embraced the same ethos in their approach to caring for people that used the service. This meant the staff were highly motivated and were actively involved in and contributed to continuous improvements in care, which meant that people received excellent care wherever possible. Staff were proud of their work.

There was an effective system in place for checking the quality of the service through the use of audits, satisfaction surveys, meetings and very good communication on a daily basis, with healthcare professionals, other stakeholders and especially people and their relatives. This showed that the registered provider gathered information about the quality of their service from a variety of sources. This information was used to enable the provider to identify where improvement was needed and to implement and sustain continuous improvement in the service. Everyone we spoke with; people that used the service, relatives, staff and a community nurse stated that they felt the service was extremely well-led and the management team were firm, fair and dedicated, making for a very well run care home. They all agreed their views were sought.

People had very good opportunities to make their views known through direct discussion with the registered provider or the staff and throug

Our inspector visited the service and assessed six essential standards of quality and safety which helped us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were generally included in the daily decisions about their care and we saw in care files that there was evidence they had been included and consulted about their needs, likes, choices and preferences at the time of admission and whenever needs had changed. The files we looked at did not contain any information about peoples' mental capacity, but the manager understood about assessing this under the Mental Capacity Act 2005, as part of the overall assessment of peoples' needs. Therefore people were safely assessed and cared for with regard to the full range of needs they may have had.

We found that people had clearly written care plans that enabled staff to care for them in a way that best met their needs and ensured their safety. People had risk assessments in place that identified and reduced risks to their health and welfare. We observed staff providing people with care in relation to their mobility and nutrition for example, in a professional way that was safe and reflected their wishes and preferences.

The service had systems in place to address, record and report suspected or actual concerns of a safeguarding nature and staff had been trained in safeguarding people from harm or abuse. This ensured people were protected from the risk of harm and were appropriately treated and protected if they were harmed.

The service had sufficient staff on duty throughout the day and night to meet the needs of the people that used the service. This meant people received safe care and support.

Is the service effective?

People told us they thought the service was effective at meeting their needs. They said, "Staff ask me what I want to eat, when I want to get up and what I want to do" and "Oh yes, I make up my own mind about everything."

We saw that people had care plans in place which had taken into consideration their assessed needs, preferences, choices and wishes. Care plans informed staff how best to care for people on an individual basis and showed the service was responsive to issues of health, mobility, nutrition, wellbeing and social interaction.

The service had taken steps to ensure staff had received updated training in safeguarding people from harm, moving and transferring, fire safety and infection control. This meant the service was effective at ensuring people were cared for by skilled staff. There were plans in place to continue with updating training for staff in first aid in May 2014. Further training would be sourced throughout the year.

Is the service caring?

We observed staff providing efficient and professional care to people that used the service. We saw staff assisting people with mobility, nutrition and social activities in a kind, caring and respectful manner. People told us they were very well cared for. They said, "We are very well cared for and the staff are absolutely lovely", "Everyone (the staff) is so helpful and kind" and "There is nothing I want, as everything is done for me when I need it doing".

We saw that staff were polite when they approached people and gave them time to respond. Staff offered choices and waited for decisions. Staff were supportive and encouraging.

Is the service responsive?

The service responded well to peoples' needs and wishes. We saw people making decisions about where they would sit, what they might do, who they wanted to talk to and what they wanted to eat or drink. We heard people asking for support with their personal comfort. We observed that when people made these choices or requests staff were supportive, respectful and caring. Staff exercised discretion when offering people assistance and ensured their privacy and dignity was maintained.

Staff we spoke with demonstrated an understanding of peoples' care needs and preferences. They expressed a culture of caring which put people at the front of everything they did. Staff had empathy with the people they supported and were compassionate and skilled in meeting their needs.

Is the service well led?

We found that people were able to make as many decisions as possible for themselves and where they found this difficult then relatives were consulted. The manager ensured staff had an ethos of listening to people and encouraging them to make choices. The manager led by example in almost all aspects of care and support and expected staff to care and interact with people in the same way that she cared and interacted with them.

People had clear care plans for instructing staff in how best to care for them and these were compiled by the manager and deputy manager using all of the information they had gathered about people that used the service. Care plans were reviewed each month and changed as peoples' needs changed. The manager ensured all areas of a person's individual care were well planned for and completed and so they experienced individual care. The staff told us there was a culture and ethos within the service which put people at the centre of the service.

The systems for monitoring and assuring the quality of the service enabled the manager and staff to identify areas requiring improvement and so people were confident that improvements would be made. In all of these respects the service was well led.

We found that people were well cared for and supported with their independence, received the help and guidance they needed with tasks they could not manage and were encouraged to feel useful which meant they lived fulfilling lives. They said, "It's quite nice here, I enjoy the company", "We are looked after very well" and "I am very well cared for".

We saw the food that people were given and looked at menus. From talking to people we found that they experienced satisfactory food provision, enjoyed variety and choice of meals and ate well.

From information we were given we found that wherever people went for care or treatment they could be confident that the appropriate relevant information about them was passed on so that other care professionals could maintain continuity of care. This meant people that used the service received the right support to meet their needs.

After looking round the premises and speaking with people that used the service we found that they experienced a living environment that was appropriate, safe, was accessible and promoted their wellbeing.

From speaking with staff and viewing the safety documentation held on equipment we found that people were protected from unsafe or unsuitable equipment and so their needs were safely met.

We found, due to unavoidable circumstances, that the provider had been unable to give consideration to training in the last year and little had been completed the previous year and so people were at risk of harm from receiving care and support from staff that might not be skilled or competent to do so.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were satisfactorily maintained. Staff had occasionally not completed records in a timely manner, but this had not affected the care people received.

We spoke with people that used the service, with a relative of one of them and with the manager and director of the home. We looked at peoples' case files and care plans and we looked at some of the records held in the home. We also looked round the property and considered infection control measures in place. All of this was to determine the quality of the service that was provided at Westfield.

People told us they were well cared for and enjoyed living in the home. They explained it was not like living in their own home but that there was no better alternative. One person said,"We are well looked after, the staff are lovely". Another said, "If I were unhappy about anything I would talk to the manager or one of the staff. They are all approachable." We saw that people had given consent to the care they received.

We saw that the staff maintained high standards of care and cleanliness, that the home was a hygienic environment to live in and that people were cared for by staff that had been safely recruited. We saw that there had been no complaints about the service in the last twelve months, people told us they hadn't needed to complain but knew how to, and we saw that there was an open and transparent management style in use. We found the service of care to be friendly, family orientated and yet professional.

We spoke with three people that lived in the home and with one relative. They told us they were included in their care and in daily living arrangements and that they felt staff respected them completely.

They told us their privacy and dignity was always respected, whether in respect of receiving personal care or dealing with private information.

We spoke with people about the care they received and they told us they were highly satisfied with everything.

They told us the staff were very helpful, the food was good, the home and their rooms were very clean and comfortable and they enjoyed a selection of pastimes and activities. They told us they thought their needs were well met.