This comprehensive inspection took place on 4 October 2017 and was unannounced. The service is a care home without nursing care and is registered to provide accommodation for up to 21 people. There were 20 people living at the service on the day of our visit.

The service had 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.

At our last inspection of 8 September 2015 we rated the service as ‘Good’. At this inspection we have rated the service as ‘Good’ overall but Well-led ‘Requires improvement’.

There was an induction procedure and on-going training in place for the staff, as well as planned supervision and appraisals. The induction training of new staff required further organisation and auditing by the registered manager to ensure all training was covered in sufficient detail.

Regular prescribed medicines were recorded accurately but prescribed creams had not been recorded on people’s body maps and there were no individual protocols in place for as required medicines.

Risks to people’s health and well-being had been assessed and recorded with actions to reduce the risk in people’s risk assessments and care plans.

Regular checks of equipment in use at the service were organised to ensure they were fit for purpose.

There were processes in place for the safe recruitment of staff and there were enough staff to provide the care to meet people’s needs. There were systems in place for the safe handling of medicines but there was a need of further recording and auditing of people’s medicine records in particular where creams have been prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to eat and drink sufficient amounts and were encouraged with regard to their capacity to make choices about food and drink and provide feedback. People received effective healthcare support from a range of external healthcare professionals.

The staff knew people well and there was a person centred culture focussed upon supporting people to meet their assessed needs. Some people living at the service had a diagnosis of dementia and staff had been given additional training in dementia awareness. People's rights to privacy and dignity were valued and respected.

People had been involved in the writing of their care plan. Each person had a care plan written from an assessment of their needs.

Relatives were encouraged to provide feedback on the service and felt they could raise concerns. Complaints were taken seriously, investigated and responded to with understanding.

There was a quality assurance process in operation which required further development by the registered manager to be effective to identify and take actions with regard to the medicines and training issues identified. The registered manager planned to increase and develop with the director the senior staffing at the service to support them. The director visited the service regularly and was well known by the people and staff at the service.

This inspection took place on 8 September 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting.

Westhorpe Hall provides residential care for up to 20 people. On the day of our inspection there were 20 people using the service. The service is situated next to a farm in open countryside and suitable for the people who used the service. The service accommodation was clean, tidy and well maintained.

The service had a registered manager in place. 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.

People who used the service and their relatives were complimentary about the standards of care at Westhorpe Hall.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment procedure in place and carried out relevant checks before they employed staff. There was an induction and on-going training program and staff received supervisions and appraisals. The service had a robust medicines policy and procedure in operation.

There were appropriate security measures in place to ensure the safety of the people who used the service. Individual risk assessments had been completed and there were emergency procedures in place to be implemented in any crisis. The provider had procedures in place for managing the maintenance of the premises.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We looked at records and discussed DoLS with the registered manager, who told us that there were DoLS in place and in the process of being applied for. We found the provider was following the requirements in the DoLS.

We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. We also saw staff had completed training in the Deprivation of Liberty Safeguards.

We saw staff supporting and helping to maintain people’s independence. People were encouraged to be independent for themselves when possible. Staff treated people with dignity and respect.

People had access to food and drink throughout the day and we saw staff supporting people in the dining room at meal times as required.

We saw people who used the service had access to healthcare services and received on-going healthcare support. Care records contained evidence of visits from external specialists.

All the care records we looked at showed people’s needs were assessed. Care plans and risk assessments were in place when required and daily records were up to date. We saw staff used a range of assessment tools and kept clear records about how care was provided.

The provider consulted people who used the service, their relatives, visitors and stakeholders about the quality of the service provided.

There was a complaints system in operation and people told us they received care that was personalised to them and responsive to their needs.

The provider visited the service regularly and the service carried out audits and surveys to develop the service.

In June 2013, we found that the service needed to make improvements in several areas. The service submitted an action plan which told us what they planned to do to improve. In April 2014, we returned to the service to see if they had made the improvements they told us they would make. We found that they had.

We looked at the care records for five of the 17 people who used the service at the time of our inspection. In addition, we reviewed audit records, incident records, nutrition records and safeguarding records. We considered our inspection findings to answer five key questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? and is the service well led?

Below is a summary of what we found during our inspection;

Is the service safe?

We found that each person had care plans which set out instructions for staff on how to meet people's needs. This meant we could be assured people were protected from unsafe or inappropriate care.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the service assessed people appropriately which meant we were assured that people’s rights were protected.

The service had in place appropriate safeguarding and whistleblowing policies. Staff we spoke with were able to describe the process they would take if they had a concern about someone who used the service. People we spoke with felt safe, one person told us: "I feel safe here. I didn't feel safe at home." The relative of another person told us: "I'm happy that they’re safe here, I don't have to worry."

Is the service effective?

Audits carried out by the service were effective and identified any issues with service provision. We were shown evidence to support that issues identified in a recent audit had been completed. This meant we could be assured that the quality assurance processes in place at the service were effective.

People had been given the opportunity to take part in a survey of their views in February 2014. The provider had collated responses from these surveys and written to people who used the service to tell them what action they intended to take in response to the survey. We were shown evidence of improvements and adjustments which had been made to the service following the survey. This meant that we could be assured that people's comments and views were dealt with effectively.

Is the service caring?

We found that each of the five care records we reviewed contained detailed personal information about people, which included their likes and dislikes, hobbies and past history. We observed staff respecting people's individual preferences and wishes.

Care records we reviewed showed that people's care was planned and delivered in a way which promoted people's dignity and ensured their safety and welfare. These records had been reviewed and updated as needed. People had been involved in their care planning and reviews. One person we spoke with told us: "They look after us all right. The care is first class."

We observed that staff interacted with people in a caring way, spending time with people and supporting them to carry out activities or hobbies they enjoyed. One person we spoke with told us "They're so caring, and they always have time for you."

Is the service responsive?

Records showed that people who used the service were supported and received input from health professionals in a timely manner.

Is the service well-led?

The leadership of the service demonstrated that they had taken the necessary steps to ensure the service met the needs of the people it provided care for. The provider has shown they were capable of implementing improvements and change at the service. In doing so they had improved care for people who used the service. This meant we were assured that the service was well led.

Westhorpe Hall is a care service for older people. There has been major staff changes within the past months a new manager and head of care had been appointed. Changes to the fabric of the building were also under way with planned improvements to bathroom and toilet facilities.

Two people told us that they liked living at Westhorpe Hall because " It's a friendly place and very homely.” Another person said "Your clothes are well looked after.” We observed that the people residents looked well dressed with properly matching clothing.

There were many positive comments about the staff one person said that "They are very friendly and there's no favouritism here." Another person said, "The staff will sometimes take us shopping in Stowmarket.”

The provider and manager informed us they wished to implement plans and improve the service for the people using the service and staff and have begun with refurbishing the kitchen. During our inspection the atmosphere in the dining room was calm and peaceful and people were not rushed.

A relative said that they had chosen Westhorpe Hall, “Because it was like a large family home friendly and homely in a physical environment which did not feel institutional.” A relative informed us "Things have improved enormously since the new Director came in October 2012 and staffing levels have improved as well."

On this occasion we did not speak to people using the service. We spoke with staff and the provider.

We reviewed care records. We found that improvements had been made in the way that information and risks were recorded in people's care plans. However we still had concerns that some staff were not confident in assessing the risks faced by people using the service and we noted that errors continued to occur.

Whilst some training had taken place, we were concerned that staff have still not been trained in delivering quality care to people with dementia. We saw evidence of supervision for most staff members but we noted that one member of staff had not been formally supervised and so there was no record of their learning and development needs. Given that some staff continued to make errors in risk assessments, there was a continued risk to people’s health and wellbeing.