Westleigh Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is situated in Leigh, Greater Manchester and provides nursing care for up to 48 people living with dementia. The home is made up of two units spread over two floors, one named Brookdale, the other Parkview. At the time of our inspection 45 people were living at Westleigh Lodge.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During the last inspection, although the home was rated as good overall, it was rated as requires improvement in the KLOE safe, as we identified some minor concerns with medication management, recruitment procedures and odours within the home. During this inspection we found the provider had made improvements within each of these areas.

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 told us they felt safe living at Westleigh Lodge. Relatives also spoke positively about the standard of care provided to their loved ones, telling us their relatives were well looked after and they would recommend the home to others. We saw staff had all received training in safeguarding, which was regularly refreshed and when asked, all knew how to report any concerns.

The home was clean and free from odours, with robust cleaning and infection control processes in place. Staff wore personal protective equipment (PPE) to prevent the spread of infection and toilets and bathrooms contained hand hygiene equipment and guidance. The home had recently undergone a period of refurbishment, with further works planned in the future, to ensure the environment remained suitable.

Staffing levels were allocated based on people’s dependency levels, which were regularly reviewed, to ensure information was accurate and reflected peoples current needs. People, their relatives and staff all told us enough staff were employed to meet people’s needs.

Care files contained both standardised and personalised detailed risk assessments, which were reviewed monthly to reflect people’s changing needs. This ensured staff had the necessary information to help minimise risks to people living at the home.

We saw medicines were stored, handled and administered safely and effectively. All required documentation was in place and had been completed consistently. Staff responsible for administering medicines had been trained and had their competency assessed.

Staff told us they received sufficient training and support to carry out their roles. We saw staff completed an induction programme upon commencing employment and on-going training was provided, both e-learning and practical, to ensure skills and knowledge remained up to date. Staff also confirmed they received regular supervision and annual appraisals, along with the completion of monthly team meetings.

Where possible, people were encouraged to make decisions and choices about their care and had their choices respected. Relatives and/or legal representatives, were actively involved in the care planning and review process, and had access to care documentation upon request. We saw people's consent to care and treatment was also sought prior to care being deli

The inspection of Westleigh Lodge took place on 14 and 15 December 2015 and was unannounced.

Westleigh Lodge is situated in Leigh, Greater Manchester and provides nursing care for up to 48 people living with dementia. The accommodation is set over two floors, with lift access available between the different levels. At the time of our inspection there were 45 people living at Westleigh Lodge.

We last inspected Westleigh Lodge on 19 and 20 January 2015, when the home was rated as requires improvement. At that time we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to; medicines management, requirements relating to workers, training and assessing and monitoring the quality of service provision. We asked the provider to take action to make improvements and they supplied us with an action plan detailing how they would achieve this. We found at this inspection that this action had been completed and the required improvements had been made.

There was a registered manager in post at the time of our inspection. 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 had been a high turnover of registered managers at the service. The registered manager in post at the time of our visit was an interim ‘turnaround manager’. They told us they planned to stay in post until they were satisfied the right candidate had been found to take over the management of the home.

We received very positive feedback from staff and relatives about the registered manager, deputy and senior care staff. Staff told us they felt supported and relatives said they found the management to be approachable and efficient.

Medicines were stored safely and we found there were sufficient stocks of medicines. Accurate records of administration had been kept for most medicines. However, we were unable to locate administration records for the application of creams for two people. At one point in the inspection we observed two nurses were administering medicines at the same time in the same area. This meant one nurse had to sign for two medicines at once following their administration as they did not have access to the MAR charts. This was poor practice.

We looked at records of recruitment of staff. We saw safe procedures had been followed such as; obtaining references, identification and carrying out a criminal records check. However, one application form we looked at did not have full details of the staff member’s employment history, although we saw this had been explored at interview. The provider showed us recent examples of how they had effectively followed-up on gaps in employment history.

We observed there were sufficient numbers of staff to meet people’s needs during our inspection. Staff and relatives told us they felt there were sufficient numbers of staff deployed in the day, but one staff member and one relative told us they thought staffing levels were not always sufficient at night. We found no evidence that this had negatively impacted on the care received at night and the provider told us they had recently turned an evening or ‘twilight shift’ into a permanent shift to address these concerns.

Staff were aware of how to identify and appropriately report any safeguarding concerns. The service had notified CQC as required of safeguarding incidents.

The home employed an activities co-ordinator. We saw few activities taking place during the course of the inspection, although the activities co-ordinator told us they were doing one to one activities. Staff told us due to the needs of the people living at the home most activities took place on a one to one basis and occasionally entertainers

We carried out an unannounced inspection of Westleigh Lodge on 19 and 20 January 2015.

Westleigh Lodge is situated in Leigh, Greater Manchester. The home is registered to provide accommodation and support for up to 48 people who require nursing or personal care, including people with dementia nursing care needs. Accommodation is set over two floors, with lift access available between the different levels. At the time of our visit there were 43 people living at Westleigh Lodge.

At the time of our visit there was no 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 were told the registered manager had left three days prior to our visit.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to medicines, requirements relating to workers, supporting workers and assessing and monitoring the quality of service provision. You can see what action we told the provider to take at the back of the full version of the report.

We found administration of medicines was not always safe and people did not always receive their medicines as directed. People’s photos were not always present in the medication file. This meant there was a risk people would not receive the right medicine or would not receive medicine as prescribed . The provider started to take action to address this during our visit. We found a discarded tablet on the arm of a chair, and one person was given medicine that should have been discontinued. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

One staff file we looked at did not contain documents that are required such as an application form or minutes from an interview. This was contrary to the home’s recruitment policy and meant the home was not able to demonstrate robust procedures were in place to ensure only people suitable to work with vulnerable adults were employed This was a breach of regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw there were enough staff to meet people’s needs on the day of the inspection. However, some relatives felt there had not always been enough staff to provide the support required in the evening. We saw the service had increased staffing to include an extra staff member on a ‘twilight’ shift in response to changes in people’s needs.

Activity sessions were arranged for people and we were told that events were held to mark different occasions. For example, a tea dance and other activities had been held to mark remembrance day. We observed a cake baking activity session with a small group taking place. This had been thoughtfully planned by the activity co-ordinator to support people’s friendships.

The service was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to make choices where possible and where this was not possible there was evidence that proper procedures had been followed to assess capacity and make decisions in a person’s best interests.

Most of the people and relatives told us the staff were kind and caring and spoke to them with respect. We observed many positive and friendly interactions between staff and people living at Westleigh Lodge. However, on two occasions we observed staff supporting people with moving and handling, whilst at times providing little interaction or reassurance.

Some systems used to monitor training and delivery of supervision to staff had not been updated. This meant the manager would not be able to monitor that staff received the support and training required to provide safe, effective care. Staff records we reviewed indicated there were gaps in training including training in safeguarding, health and safety and training for staff to take blood samples. This was a breach of regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw that documents in relation to people’s end of life wishes were present in some people’s files and staff were aware what these meant in relation to people’s care. However, to ensure best practice in this area improvements were required in identifying when end of life care planning should be started in order to ensure good quality end of life care.

The registered manager had recently left and all but one relative we spoke with was unaware of this. People told us they felt able to approach management to raise concerns or complaints, however, not everyone felt confident their complaint would be acted upon.

Audits were undertaken by the service; however we found actions identified were not always followed up. Audits had also failed to identify that care plans were not being reviewed and updated as frequently as was necessary and had not previously identified the problems we found in relation to medicines. This was a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This is a summary of what we found. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We ask five questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing.

There were enough staff to meet the needs of the people who lived in the home and a member of the management team was available on call in case of emergencies. One relative said: "He wouldn’t be here if I didn’t think he was safe."

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider demonstrated staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any concerns.

Is the service effective?

People told us they were happy with the care that had been delivered and we saw their care records were up to date. One relative said: "He had five infections in the other place, not one since he came here." A person who used the service said: "I have never been looked after so well in my life."

Care records confirmed people's preferences and needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said: "He likes being pampered."

We heard information was shared effectively between staff. Several ways of sharing information included staff meetings, handovers, daily statement of wellbeing, and monthly reviews.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and encouragement when supporting people. One relative said: "The nurses are good with him." One person who lived in the home said: "They are kind. It seems to come automatically. "

Is the service responsive?

People's needs had been assessed before they were admitted to the home. Their needs for support and treatment were carefully described so care workers knew exactly what tasks to undertake. Changes in people's care needs were reported to the senior carer and they briefed care staff. One relative of a person who lived at the home said: "They’ve stabilised his medication."

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys and had attended meetings for people who lived in the home which were held every month to seek suggestions for any improvements required. One relative said: "We don’t have to be worried about anything."

Staff told us they were clear about their roles and responsibilities and were well supported by management. One said: “Anything I need she gets me.” Another member of staff said: “ If there is a problem I will go the manager and she will direct me what to do.”

When we carried out our previous inspection of Westleigh Lodge Care Home in April 2013 we found that some improvements were needed. Following our inspection the manager sent us an action plan which showed us what was being done to make the necessary improvements.

During this visit we spoke with people who lived in the home and their relatives. They made positive comments about the standard of care, facilities and services provided at the home. They told us that they were treated with respect and were involved in making decisions about their care and support. People told us that they were aware of their care plans and that they were very happy with them. They said "staff treat me with respect, I have no complaints".

We also spoke with staff and observed them listening and acting on what people had told them. We could see that the people who lived at the home were treated with respect and their views were valued and taken seriously

We saw information in staff files that told us staff received induction and planned supervision. Records showed that staff received ongoing training and support to care for the people who lived in Westleigh Lodge. Minutes of staff meetings were seen and staff told us they enjoyed attending these meetings and being able to have their say.

Staff said they had seen a great improvement in their support systems and "felt good about working in the home."

We used a number of different methods to help us understand the experiences of people living at Westleigh Lodge. This was because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

Relatives of people using the service told us they had not been able to make decisions about their relatives care and support. However they said in general staff had been respectful towards the people living in the home and wherever possible had protected their privacy and dignity and their independence. They told us that they were not sure about what care and support was provided and had not been involved in any discussions about general care needs. One person told us that they had observed staff being unable to meet the needs of the people living in the home due to there not being enough of them on duty. However everybody spoken with said that in general staff were kind and considerate but over worked. People described staff as caring and they told us staff had responded as quickly as they could if support was needed. People's comments included; "When my relative needs them they will do their best to come quickly. This is not always possible because of the shortage of staff" and "The staff are lovely, very respectful and kind although there are not enough of them.”

People told us that they were not sure who was responsible for managing the service but felt they could discuss any problems or concerns with staff.

We spoke with ten people who were living at Westleigh Lodge and three relatives during our visit.

Those who were able told us that they were happy in the home. Relatives told us that staff were very good and explained everything to them about the care and support provided. Comments included;” Nothing is too much trouble for the staff”,” The staff are all excellent”, “I have experienced some bad care in the past and realise how good this place is”, “The activities organiser is excellent. She identifies the social needs of the people who live here and arranges activity and interests which are specific for their individual needs”.

One relative was able to tell us that they were very happy with the care and that the standard of care was always very good whenever they visited. They told us the home had a friendly relaxed atmosphere and staff made visitors feel very much at home when they called.

The relatives told us that they had been provided with clear information about the home before making a decision about admission. They said staff were open and friendly and gave them all the need to know information about the home. Relatives said they had given background information about personal likes, dislikes choices etc. to the staff prior to or just after their family member had been admitted. One relative told us that the care staff were very approachable and that they felt listened to. Another said they were made to feel welcome at Westleigh and staff were dedicated to their caring role and compassionate to her and her family.

Westleigh Lodge is a service for people who are living with different stages of dementia. We talked with people who lived at Westleigh Lodge, their relatives, staff working at Westleigh Lodge and the manager.

People we talked with said that in the main they were satisfied with the service provided at Westleigh Lodge. People also said they liked the staff who worked at the home.

Comments from people about the standard of care included:

"I don’t want anyone to sort me out, I’m all right here.”

"I think it’s brilliant, I can’t fault the care one bit.”

"If x is ill or anything goes wrong they phone my daughter."

And,

"They look after her very well here, the staff are lovely.”

People also told us that the manager was approachable and that they felt able to make their view known. Comments included:

"If I had a complaint I’d just tell the staff, but I’ve no complaints, it’s the best home she’s been in. It’s a good home."

"I like the manager, she knows what the home needs."

And

"I’ve not made any complaints but I would talk to the senior carer for advice."

People said that Westleigh Lodge had a good atmosphere and people were caring.

Comments included:

" It feels like one big family, people are all concerned about each other."

Although most comments about Westleigh Lodge were positive, some people felt that improvements could be made in relation to general cleanliness and possibly more staff in the evening.