About the service: Westfields is a care home for older people situated in a residential area of Swaffham. The accommodation is located over two floors. There were 35 people living at the service on the day of inspection.

People’s experience of using this service:

People at Westfields received an outstanding effective and caring service. People were treated with exceptional kindness and compassion. We received extremely positive feedback about the support that staff provided and how approachable and passionate the management team were.

The staff team were highly motivated and there was a strong commitment on the development of their competence and knowledge. Staff worked innovatively to promote people’s health and ensure excellent outcomes for their physical and mental wellbeing.

The atmosphere was vibrant, happy and thriving. There was a focus on fun. There was a mutually respectful culture, which recognised and valued the contribution made by both the people living in the service and those working at the service. The management team welcomed the involvement of people and staff at every opportunity.

There was a strong recognition that people were individuals and the care and support provided ensured that their needs were met and resulted in positive and improved outcomes for people. Respect for people’s privacy and dignity was at the heart of the service provision. The service was creative in finding ways to ensure people were engaged and stimulated. There were good community links and people accessed the community regularly.

Effective management systems were in place to safeguard people and promote their wellbeing. The management team actively sought the views of people using the service, relatives and staff and acted upon those views to provide a high-quality service with a strong emphasis on continual improvement and best practice.

Rating at last inspection: Good (report published 10 June 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This inspection was unannounced and took place on 5 and 6 April 2016.

Westfields is registered to provide accommodation and personal care for up to 41 older people. There were 31 people living at the service at the time of the inspection.

There was a registered manager in place. 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.

There were appropriate processes and risk assessments in place to help protect people from risks to their safety and wellbeing including the risks of avoidable harm. Staff understood their responsibilities to protect people from harm and were aware of the signs of potential abuse. Staff were confident about how to report these within the service. Medicines were stored safely by staff who had received training and been observed in practice. Medicine records were up to date and clear.

There were enough staff to meet people’s needs. The provider had a recruitment procedure in place and staff were only employed in the service after all required pre-employment checks had been carried out. People living in the home were involved in the interviews for new members of staff.

Some staff lacked knowledge in the Mental Capacity Act and Deprivation of Liberty Safeguards. Improvements were needed in the clarity around recording decisions about people’s capacity to make their own decisions. People were able to make day to day decisions about their care and the staff who cared for them. Care plans were in use however these didn’t always contain all the information required. People’s privacy and dignity was respected.

People and their relatives were positive about the care that people received. People’s health and nutritional needs were met. People had a varied diet and had choices available to them. There were a range of activities available and people were able to participate in them. People could maintain their own interests and hobbies where they chose to do so.

There was an open and transparent culture within the service. People and staff told us that the registered manager was approachable. The management team was visible throughout the home. The registered manager knew people and their relatives well. There was a quality assurance system in place which monitored the quality of the care provided.

The purpose of this inspection was to assess improvements made in relation to shortfalls identified at our previous inspection in April 2014.

People told us that they occasionally had to wait up to 15 minutes for assistance from staff but did not feel this was unreasonable as they knew staff were busy helping others. They reported that they had never felt neglected or harmed as a result of their wait.

People’s requests for assistance were met quickly throughout our inspection and we noted that call bells were answered promptly by staff.

Overall we found that the provider had taken sufficient action to address the shortfalls in relation to staffing and was now compliant with regulation 22 of The Health and Social Care Act 20018. There were enough staff employed, and on duty, to meet the needs of people living at Westfields.

We considered all of the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:-

Is the service safe?

People living in the home told us that they felt safe. We saw that the environment was safe, clean and hygienic. Equipment used at the home was well maintained and had been regularly serviced. People were provided with their medication when they needed it. However, on the day of our visit we found that staff absence had not been fully covered. People told us that they often had to wait for assistance because the staff were busy. Staff members said that there were not always enough care staff on duty to meet the needs of everyone living in the home. We have asked the provider to tell us what they are going to do to meet the requirements of law in relation to maintaining adequate staffing levels.

Staff personnel records contained information that demonstrated that the provider had regularly monitored the work practice of each staff member to ensure that they were effective in meeting the support and care needs of people living in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) that applies to care homes. The provider showed us that, when necessary, DoLs applications would be made. Records, policies and procedures were held and relevant staff had been trained and knew how to submit a DoLs application.

Is the service effective?

People told us that staff did their best to reduce the length of time they were kept waiting for help, when they rang the call-bell. They told us that they received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that staff understood the care and support needs of each person. One person told us. “This is a lovely, comfortable home and the staff will do anything to help you. You only have to ask.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that care workers were patient and encouraged people to be as independent as possible. People told us that the staff were often very busy but did not rush them. Our observations confirmed this. A visitor told us. “I am happy with the care given to my relative. The members of staff are so polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed before people moved into the home and when their needs had changed. A record was held of their preferences, interests and diverse needs. People told us that staff members consulted them and encouraged them to make their own decisions. People had access to planned activities on most days. One person told us. “I am sometimes bored if there are no activities that I can join in with.” The manager demonstrated that they were currently working to increase the range and frequency of the activities provided.

Is the service well led?

All of the staff spoken with had a good understanding of the whistleblowing policy. Quality assurance processes were in place and people told us they had just completed a customer satisfaction survey. Most visitors and all staff said they had felt listened to when they made a suggestion or raised their concerns. People living in the home told us that their views were listened to and they were included in discussions about any planned changes within the home.

During our inspection of 19 June 2013 people told us they were happy living at Westfields. One person we spoke with told us, "Staff are always checking on me and popping into my room with cups of tea.”

We looked at people's care records and found that they provided a clear understanding of people's individual support needs. We also saw evidence of people being involved in the planning of their own care from the day they moved into Westfields. One person told us; “Nothing is too much trouble for staff.”

When we toured the home we saw it was clean and well maintained in all areas. People living in the home told us that their rooms were always cleaned regularly and that staff worked hard to keep things in good condition. Our review of procedures as well as a tour of the building showed us that infection control was appropriately managed. The practices undertaken by staff supported the prevention of cross infection as well as the continued health of people living in the home.

We saw that recruitment files contained appropriate references, background checks plus interview information, showing how new members of staff had been selected. This supported the safety and wellbeing of people using the service.

People living in the home told us that they were asked for their comments and thoughts on a regular basis, allowing people to have a say in the way the home was run. Any concerns or complaints were handled appropriately and fully recorded.

People we spoke with told us that they thought Westfields was a good home and they would recommend it to others. They told us that the staff were, “Kind, caring and understanding.” We were told that staff treated people in a way that promoted their privacy and dignity.

During our observations we saw that people received care which met their needs and wishes. People confirmed that they received whatever help they needed but they were also encouraged to maintain their independence. One person told us, “That is one of the things that makes the staff so good.”

We found that staff had regular training to make sure they would be able to recognise and respond appropriately to any abuse. The people we spoke with told us that they had no concerns about the way they were treated and they would feel comfortable speaking with the manager if there was anything wrong.

We heard some mixed comments about the staffing levels in the home. A few people thought the staff team were too busy and some of the staff told us they would like to have more time to spend with people who use the service. During our inspection we found that people’s personal and healthcare needs were being met with the number of staff on duty.

The manager had systems in place for checking the quality of the service.