Westholme is a care home for up to 13 people who have an acquired brain injury, mental health needs or who are living with Autism. At the time of our inspection 13 people were living at this home.

At the last inspection on 24 and 25 June 2015 the service was rated Good.

At this inspection we judged that the service provided remained Good.

Why the service is rated Good.

People received the support they required to live a full and active life, while maintaining their safety and well- being. There was a temporary shortage of established permanent staff. Action was being taken to cover these vacancies and in the longer term to recruit permanent staff. The registered provider had established robust recruitment checks to ensure new staff were suitable to work in adult social care.

Risks relating to people’s healthcare needs and lifestyle had been assessed. Staff were aware of the support people needed in these areas, and we saw staff providing support that was consistent with these assessments.

The majority of people required the support of staff to manage their medicines, although arrangements were in place for people to be able to do this independently whenever this was possible. Staff responsible for administering medicines had been trained and assessed to be competent. The systems to manage and check medicines were robust.

Staff had received training and support to ensure they were aware of people’s needs and how to meet them. People were supported to see a wide range of health professionals and they received the help they required to maintain good health. People had the opportunity to plan, shop for and prepare a wide range of meals and drinks that they enjoyed and that would ensure they maintained good hydration and nutrition.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive ways possible. When restrictions on people’s liberty were necessary the registered manager had ensured the correct applications had been made to protect each person’s legal rights.

The staff we met knew people well, and were able to tell us about people including their needs, preferences and had knowledge of what was important in the person’s care. We saw people joking with and teasing the staff. This showed that they had built up trusting relationships with the staff that were supporting them.

A range of activities and opportunities were provided each day that were tailored to each person’s needs and preferences. People were encouraged to develop skills related to independent living such as making simple meals and drinks, housework and laundry. People had been supported to maintain links with people, places and activities that were important to them, and which they had enjoyed earlier in their life.

As far as people wished and were able they were involved in developing and reviewing their care plans. When people could not or chose not to contribute to this process staff had involved people that knew the person well and used their knowledge of the person to plan care that they felt was in the person’s best interest and best fitted their known preferences and wishes.

People and their relatives felt able to raise concerns and complaints. Two complaints had been received, and these had been dealt with thoroughly.

We received consistent feedback that the home was well run, and that the registered manager and senior staff team were supportive and promoted good practice. The registered manager had stayed up to date with changes and developments in adult social care, and had ensured he had a good knowledge of the specific health care needs that people living at this home experienced. This ensured care was always delivered in line with best practice. The registered manager and registered provider had a wide range of checks and audits in place that ensured the on-going safety and quality of the service. These had been effective at providing assurance that

People we met,staff,relatives and healthcare professionals told us that they were generally pleased with the opportunities and support offered by Westholme. Specific comments included; "The people who live here are great. We do as much of the stuff they want to do as we can" , "Generally I am cared for by wonderful people" and " I am pleased with Westholme. The staff are lovely."

People were offered opportunities to stay clean and be healthy. There were opportunities for people to undertake their personal care to a good standard and people were supported to see the healthcare professionals they needed. Risk assessments, weight management and mobility were not being well managed to meet people's needs.

We found that medicines were always available in the home and staff had been trained about how to give these safely. However we identified some errors that had not been picked up by the home that showed people had not always had their medicines as prescribed.

Staff were motivated and people told us they liked the staff and could talk to them about things of concern to them. We found enough staff were on duty and staff were delegated to meet the needs of people when they needed help.

We found that the home was generally well managed and that people had opportunity to comment on how the home was run. Audits had not been entirely effective at identifying shortfalls or ensuring that the required action was taken to address these.

When we visited, the service was providing personal care to 13 people, some of whom had complex needs. We spoke with four people who used the service, the manager and three members of staff. We also looked at care records and staff files to understand the experiences of the people living at the home.

All the people we spoke to told us that the workers caring for them had a good manner, respected their dignity and spoke to them as adults. One person who used the service told us, “The staff are really great. They deserve to win a best team award”.

We found that the provider had robust recruitment processes in place to ensure people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were protected from the risks of unsafe or inappropriate care and treatment because records were kept up to date and staff were delivering care in line with care plans. We saw the provider had responded to concerns raised at a previous inspection to ensure records were completed properly so that staff knew how to meet the care and welfare needs of the people who used the service.

We noted that there was a new manager in post however they were not registered. The provider is aware of the need to formally apply for this person to become a registered manager in accordance with the relevant legislation.

The purpose of this inspection was to follow up on shortfalls we found in March 2012. These related to care records and the premises. We did not talk with people about these areas at this follow up visit.

During our inspection we met six of the people who currently live at Westholme. They all appeared relaxed and comfortable in the home. We saw that people had been supported with their personal care and were all dressed in a style that suited their age, gender, and the weather.

We were shown a letter of compliment submitted to a local newspaper by a relative. This praised the care and support the person had received while living at Westholme. We were informed of a further compliment paid to the home by a social worker.

We found evidence that people were being well supported with their care and to live a lifestyle of their choice. However we did not find that records supported this. We have made a compliance action about this.

We found that work had been undertaken to improve the appearance and comfort of the home. We were informed that further work had been agreed and scheduled.

People who use the service were positive about the staff and the support they provided. One person who lived at the home said, ‘I have been here for eight years, its still fine here, yes I still like it’. Another person said, ‘We have lovely staff here, I don’t know how they get so many nice people when they pay such a pittance’.

Throughout our visit we heard staff speak to people in a kind and friendly way. We heard lots of jokes and laughter being shared. The atmosphere in the home was pleasant and lively.

We observed care staff treating people with respect and dignity. We saw that care staff offered help to develop people’s independence skills, such as, making meals, housekeeping duties and going out alone. This means that care staff promote peoples independence.

This unannounced inspection took place on 24 and 25 June 2015. The service was last inspected in January 2014 when we found three breaches of legal requirements. In January 2014 we found the registered provider was failing to safely manage medicine administration, did not have effective systems in place to monitor safety and quality and that people’s care needs were not always well met. We asked the provider to take action and at this inspection we found the required improvements had been made.

Westholme can support up to 14 people who may have an acquired brain injury, a learning disability or mental health needs. The home had bedrooms and bathrooms on the ground, first and second floor. There were shared lounge, kitchen and dining facilities on the ground floor. Lift access was available to all floors. At the time of inspection 12 people were living at the home.

There was a registered manager in post. 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.

We found that people using this service were safe. The registered manager and provider had been pro-active in assessing, identifying and acting upon risks that people may present or be exposed to. Measures had been put in place to ensure these risks were well managed and that people were protected, however this was undertaken discreetly in a way that still enabled people to enjoy freedom, independence and ability to maintain their human rights.

Adequate numbers of staff were on duty; they had been well trained and had been supported to develop the skills they needed to meet the needs of the people they were working with. Robust checks were made on staff before they started work in the home to ensure they were suitable to work in adult social care.

Medicines were safely managed. We observed staff practising good medicine administration, and records showed staff had received training in this. Records and stocks of medicine were checked and this audit suggested people had received the medicines they required at the correct time.

People were supported to stay healthy. Opportunities were provided and people were supported to see a wide range of health professionals and to attend health related appointments.

People had access to a wide range of food and drinks. People were encouraged to be independent and where they were able people could make their own hot drinks, help themselves to a range of snacks, and prepare a light meal. Staff offered people the opportunity to help or to observe with the preparation of meals each day.

Staff were aware of their responsibilities under the Mental Capacity Act 2005. They had ensured people received the assessments and support they required and when necessary had made applications to the local supervisory body for Deprivations of Liberty Safeguards (DoLS). Staff we spoke with were aware of the act, and how this affected them in their day to day work with people.

We observed and were informed that staff were kind and compassionate in the way they supported and cared for people. People were treated as individuals and had chance to pursue interests and hobbies that they had earlier in their life.

There was a complaints procedure in place. People told us they had opportunity to raise concerns and to give feedback about their experiences and things that were of concern to them. People told us, and records showed that action was taken to address these matters.

We received consistent feedback that Westholme was a good place to live, to work and visit. People told us the home was well managed, and the findings of our inspection supported this. The registered provider had developed and used a wide range of tools and systems to ensure the service being offered was safe and of good quality.