About the service:

Westhaven provides accommodation, care and support for up to seven people with learning disabilities. At the time of our inspection, there were four people living at the service.

People's experience of using this service:

¿ People told us they were safe and well cared for living at Westhaven and their independence was encouraged and maintained. One person said, “I'm happy here.”

¿ We found one breach of the regulations in relation to consent. The provider was not completing decision specific mental capacity assessments and best interest decisions for people who might lack the capacity to make decisions about their care.

¿ We found some improvements had been made in relation to providing safe care and treatment however, the provider continued in breach of regulations because not enough improvements had been made in relation to the safe management of people’s medicines, assessment of staff’s competency to administer medication and information in people’s risk assessments. We also found concerns in relation to fire safety.

¿ The service met the characteristics of requires improvement in three out of the five key questions. This is the third time Westhaven in rated as requiring improvement.

¿ We have made three recommendations in relation to medicines, consent and quality assurance.

¿ The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

¿ People were involved in meaningful activities that maintained and enhanced their skills and abilities.

¿ People were supported by staff who were motivated, enjoyed their job and felt well supported through regular supervisions and training.

¿ The management had a clear vision about the quality of care they wanted to provide and there were plans to improve the service.

¿ More information is in the full report.

Rating at last inspection:

At our last inspection the service was rated requires improvement overall. Our last report was published on 10 January 2018.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

Information relating to the action the provider needs to take can be found at the end of this report.

Follow up:

We will continue to monitor the service to ensure that people received safe, high quality care.

Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

This inspection took place on 17 October 2017 and was unannounced. At last inspection in September 2016 we rated the service 'Requires Improvement'. We found the provider was in breach of two regulations; these related to premises and equipment, and governance. The electrical installations at the property had not been checked within the required timescales and provider’s audits had failed to detect the test had not been completed. The provider arranged for the electrical installations to be checked as soon as it was brought to their attention.

Westhaven is a service for up to seven people with learning disabilities. At the time of this inspection five people were using the service.

The service had a registered manager. 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 felt safe living at Westhaven. We saw they were comfortable with people they lived with and staff who supported them. People told us they could talk to members of staff and the manager if they had any concerns.

Staff knew people very well and had a good understanding of their background and histories. Care was planned and risk was managed although this was not always well reflected in the care documentation. The registered manager agreed to take prompt action where care records did not reflect people’s needs or were out of date. People enjoyed person centred activities at home and in the community.

People made decisions about their care and support, and where a person lacked capacity to make decisions appropriate systems were in place to support them. We saw from people’s records their health needs were met. People enjoyed the meals and chose what to eat.

Medicines were not always managed safely; we found issues around the use of non-prescribed paracetamol, medicine protocols and staff competency assessments. People lived in a safe environment but areas needed attention so people were comfortable.

Staffing arrangements were appropriate and staff received training and supervision to help them understand how to deliver appropriate care. Staff had a clear understanding of their role and responsibilities. They told us they enjoyed working at Westhaven and felt well supported.

The registered manager was knowledgeable about the service and worked alongside people who used the service and staff. We received positive feedback about the registered manager and provider. People were encouraged to share their views and put forward suggestions. People who used the service and staff attended regular meetings. The provider had some effective quality management systems although they had not picked up some of the issues identified at the inspection. We made a recommendation around future quality management systems.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. This related to risk and medicine management . You can see the action we have told the provider to take at the end of this report.

This inspection was carried out on 15 September 2016 and was unannounced. This meant the registered provider and staff did not know we would be attending. One Adult Social Care (ASC) inspector carried out the inspection. The service was last inspected on 8 October 2013 and was found to be meeting all the regulations inspected.

Westhaven is a small care home providing accommodation for people who require support with their personal care. It specialises in supporting people who have a learning disability. Westhaven was registered with the Care Quality Commission (CQC) in October 2010 to provide this service for up to seven people. At the time of our inspection, five people were living at Westhaven.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager registered with the 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.

The service's premises were not always safely maintained. The electrical installations at the property had not been checked within the required timescales. We also found some areas of the service required repair, updating and redecoration. This was a breach of a Regulation 15. You can see what action we told the provider to take at the back of the full version of the report.

The registered provider had audits in place to check that the systems at the service were being followed and people were receiving appropriate care and support. However, we found the audits had failed to detect that the electrical installation test had not been completed and that parts of the premises were not adequately maintained. This was a breach of a Regulation 17. You can see what action we told the provider to take at the back of the full version of the report.

We found that staff had a good knowledge of how to keep people safe from harm and we found that the recording and administration of medicines was being managed appropriately in the service. Staff had been employed following appropriate recruitment and selection processes.

We found that while there was a low number of staff employed by the service at the time of the inspection there were sufficient numbers of staff on duty to meet the needs of people living at the home. Action had been taken to address the staff shortage by the register provider. .

Assessments of risk had been completed for each person and plans had been put in place to minimise risk. The service was clean, tidy and free from odour and effective cleaning schedules were in place.

People's nutritional needs were met. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day. People told us they were well cared for and we found people were supported to maintain good health and had access to services from healthcare professionals.

Staff were knowledgeable about the people they cared for and they interacted positively with them. People were supported to make choices and decisions regarding their care.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported.

People were offered a variety of different activities to be involved in. People were also supported to go out of the home to access facilities in the local community.

The registered provider had a complaints policy and procedure in place and there were systems in place to seek feedback from people and their relatives about the service provided.

We observed the care provided and examined documentary evidence to support our findings. We talked with two service users, one male and one female, two care staff, a domestic assistant and a manager.

Records showed that peoples care and social needs had been assessed and were under constant review. Care planning was robust and from our observations was evident in practice.

Access to other healthcare professional was evident and users had choice in the providers of that service.

Services users commented, " I am very happy here, it's my home and I have everything I want" another said " You get everything you need, I am going on the bus soon to do some shopping"

People who used the service indicated that the staff provided them with all the support and assistance that they needed.

Peoples medication was managed safely and it was under constant review, with staff having access to clinical support from the supplying pharmacist.

We found that service user's nutritional needs were met and that the independence of users was encouraged in the food preparation and menu planning.

In speaking to the staff they told us they received supportive and appropriate training. In particular they told us they received safeguarding training and were able to correctly identify different types of abuse.

There was evidence of a skilled and happy workforce who had the support and training they needed to deliver a competent and efficient service.

We spoke with three people who live at Westhaven. They told us they were involved in making decisions about their care. They told us about a forthcoming holiday and how they had chosen the place they were going. They told us that staff were nice, they felt safe and they were well looked after.