The inspection took place on 27 June 2017 and was unannounced.

Westgate House Care Centre is a purpose built care home providing nursing or personal care for older people. The home has a purpose built unit for people living with dementia and also provides nursing, intermediate and rehabilitation care. The home is registered to provide care for up to 109 older people and there were 94 people living at the home when we inspected.

The home had a registered manager. 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.

At the last inspection of this service in July 2015 the service was rated Good. At this inspection the overall rating remained as Good however, there were some aspects of the service where people would benefit from some improvements being made.

People received the support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed. However, the meal time experience on one unit needed further development to help ensure people had a positive experience and the system in place to monitor people’s fluid intake was not robust. We noted some examples where staff used terms that did not promote people’s dignity and where staff did not always seek people’s consent. For example, moving people in their wheelchairs without explaining what was going to happen.

People felt safe living at Westgate House Care Centre. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 06 July 2015 and was unannounced.

Westgate House Care Centre is a purpose built care home providing nursing or personal care to older people. The home has a purpose built unit for people living with dementia and also provides intermediate and rehabilitation care. The home is registered to provide care for up to 109 older people and there were 93 people living at the home when we inspected.

The home had a registered manager. 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Westgate House Care Centre and some were pending an outcome.

When we last inspected the service on 24 October 2014 we found they were not meeting the required standards and they were in breach of regulations 9, 10, 12, 13, 14 15, 20 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations 9, 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had taken action to address the identified concerns.

There were suitable arrangements for the safe storage, management and disposal of people’s medicines, including controlled drugs. The environment was clean and fresh and the atmosphere throughout the home was calm during the inspection. Staff knew how to recognise and report allegations of abuse. Staff recruitment processes were safe and a range of training was provided to staff to give them the skills and knowledge required to undertake their roles.

People told us that staff were kind and caring. Appropriate care and support was delivered in a way that promoted people’s safety and protected their privacy and dignity. Meetings were arranged to support people and their relatives to share their views and opinions on the service provided.

We received positive comments about the management team and the management ethos from people who used the service, their relatives and the staff team. The provider and manager monitored and sought feedback about the services provided to identify areas for improvement and drive forward improvements in the home.

At a previous inspection of Westgate House Care Centre in June 2014 we had found that people were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not maintained. Our concerns were such that we issued a Warning Notice to the provider.

We revisited Westgate House Care Centre on 19 August 2014 to assess compliance in this area and found that some improvements had been made.

During a previous inspection on 23 April 2013 we found that people's dignity was not always maintained and staff did not always treat people with respect. We also found that people who used the service and their relatives did not always feel involved in the planning of care. We followed up with an inspection on 26 June 2013 and found that the provider had made improvements in these areas. People told us that they felt involved in their care, and that staff listened to their requests. One person told us, "My routine is set in stone, and the staff respect that, I know what I want, how I want it done and when. I like things done a certain way and it's important my wishes are followed."

We found that the provider had taken steps to improve the environment that people lived in. During our inspection on 26 June 2013 we found the home was clean, welcoming and free from odours. The provider had recruited further domestic staff, and had reviewed their use of detergents. One person who used the service told us that, “It is much nicer here now, I am happier to have friends and family visit me.”

We previously found during our inspection on 23 April 2013 that people's records were not stored securely. We also found that records relating to resuscitation of a person were not completed sufficiently. During our inspection on 26 June 2013 we found that the provider had taken action to remedy these issues. People's records were stored securely and documentation had been completed appropriately.

We found that the home involved people in decisions about their care. However we also found that people's dignity was not always respected.

We found that care records were comprehensive and contained individual goals for people to achieve. One member of staff told us, "If any care worker comes here to work, we make sure the records are clear and up to date. That way anybody can read how to care for that person."

People we spoke with told us that the food they received was good. One relative said, “They do get a good meal here.” One person who used the service said that the food was “very nice”.

We found that the home had an infection control policy in place and staff had received training in how to manage and reduce the risk of infection. We saw that the home had achieved a five star food agency rating for cleanliness, meaning that people received food that had been stored, prepared and cooked in a very hygienic environment. During our inspection we also found that the home had a bad odour for the majority of our visit. People who used the service told us, “Sometimes the bedroom was cleaned but not the bathroom."

We found that staff had received appropriate training for their role and medicines were only administered by trained nurses. We saw that medicines were given to people appropriately and when they required them.

Records were comprehensive and fit for purpose, however we found that people's care records were not stored securely.

Three people told us that they the home was a good place to live in. One person commented: “It is wonderful here, they are very kind and help us how we want.” All three people told us that staff respected them, asked them if they were happy with care and listened to them. All three people felt safe. One person explained that they would tell the unit manager (calling them by names) if, “there was any problem, or we wanted something, or to say what we want.”

People explained that they had an opportunity to express their views through their residents meeting, that they called “Residents Committee”, through “Residents and Families Meeting”, through yearly survey or speaking directly to unit managers. One person explained how appreciative they were when staff helped them write their views on the written survey form.

Several people told us that they preferred to sleep with their bedroom door open, but when staff were helping people with personal care the doors were closed to ensure respect for people privacy and dignity. One person wanted to have their doors closed and staff respected this preference and kept the door closed.

Two people commented that staff were knowledgeable and skilled in helping them with all the tasks and particularly singled out the unit manager as, “Very well trained and skilled.”

All three people confirmed that they were consulted about their care plan when care plans were reviewed and stated that they had choice regarding their care and provision provided within the home.

One person stated that transport services that take them out were excellent and well coordinated. The same person explained that there were enough staff per each shift to respond when people called them.

This inspection was carried out on 21 and 24 October and was unannounced.

At our last inspection we found the service to be meeting the requirements of the regulations, However, at this inspection we found the service to be in breach of Regulations 9, 10, 12, 13, 14, 15, 20 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report summary.

Westgate House Care Centre is a nursing and residential care home that provides accommodation and personal care for up to 109 older people some of whom live with dementia. The home has three floors with a residential dementia care unit on the ground floor and nursing units on the upper floors.

The provider had recently appointed a manager who had submitted their application as a registered manager on 07 October 2014. 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 and associated Regulations about how the service is run.

The CQC is required to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to some people who lived at Westgate House. The provider had therefore, acted in accordance with the MCA 2005 and DoLS.

There were insufficient numbers of care staff available to meet people’s care needs. We observed that people had lengthy waits for personal care in circumstances that compromised their dignity and care needs.

Guidance published by the Department of Health for prevention and control of infection in care homes had not been followed. There were a lack of cleanliness and infection control procedures in place throughout two of the three units at the home and we noted a prominent malodour in both. This meant that people were not adequately protected from the risk of infection.

Effective and safe recruitment practices had been followed.

Medicines were safely ordered and stored but not safely managed in the home. Staff who administered medicines had been appropriately trained. However guidance for when required (PRN) medicines were not clear which resulted in people being administered medicines when they may not require it. People were not encouraged to manage their own medicines and where people were prescribed medicines that made them drowsy these had not been regularly reviewed in line with published guidance.

People and relatives gave mixed views about the food provided. People who required assistance with their meals did not always receive this.

Where people were at risk of malnutrition or dehydration staff ensured people’s fluid and food intake was monitored effectively to ensure they had adequate amounts to meet their needs. However, we found that healthy snacks were not always offered to people, and those at risk of malnutrition had not always had their meals fortified to support a high calorific dietary intake.

People’s individual needs were not met by the adaptation and decoration of the service. Rooms were sparsely decorated with some rooms cluttered with chairs and equipment. The ground floor which supports people living with dementia was not decorated to ensure people were orientated and stimulated.

Staff were supported by the manager and told us the training they received supported them to provide care to people.

People were happy with the care they received from staff and we observed positive interactions when staff assisted people with their care needs. People were generally treated in a courteous and respectful manner.

People and relatives were aware of how to make a complaint and the manager responded to them effectively. People’s personal preferences were not always acted upon when providing care and support and records relating to people’s care did not always sufficiently detail the care needs of the person or what had been reviewed. Records were also written illegibly at times.

Activities were in place but were not reflective of people’s specific interests or needs, particularly where people lived with dementia.

There was a quality assurance system in place, however robust auditing had not always been completed. Prior to the appointment of the new registered manager, the provider had not ensured robust auditing had been completed. Action plans were not always in place to address issues of concern, such as staffing. Where concerns had been identified there had not been a timely response to reduce the risk of harm for people who used the service.