Westroyd Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Westroyd is registered to accommodate up to 55 older people; at the time of our inspection, there were 37 people living in the home.

At our last comprehensive inspection on 19 and 20 July 2017, we rated the service as inadequate and identified breaches of legal requirements. The provider was asked to complete an action plan to tell us what they would do to meet legal requirements in to breaches in Safe care and treatment, Safeguarding service users from abuse and improper treatment, Premises and equipment, Dignity and respect and Good governance. The service was also in breach of the registration regulations failing to notify the Commission of events affecting people.

We carried out a focused inspection on 5 December 2017 to review the actions taken by the provider to meet the legal requirements. You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Westroyd Care Home on our website at www.cqc.org.uk.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The inspection took place on the 27 February 2018 and was unannounced.

A registered manager was not in post at the time of the inspection. 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. The registered manager had left the service and there was a temporary manager in place. Following our inspection the provider confirmed the manager had been offered the position on a permanent basis and would be applying to register with CQC. We will continue to monitor this.

We made two recommendations in relation to ensuring environmental checks were carried out at all times and information about people’s dietary needs being written down and available to staff who work in the kitchen.

People received safe care. There were risk assessments in place, which ensured identified risks were mitigated. Staff were appropriately recruited and there were sufficient staff to meet people’s needs. Although people worried the staffing levels were not always correct due to sickness or absence of staff. The manager explained staff recruitment was on-going and wherever possible staffing levels were maintained through the use of agency to cover any sickness.

People were protected from the risk of harm. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People's health and well-being was monitored by staff and they were supported to access health professionals. Some people felt they were not always supported to do this in a timely manner.

People were cared for by a staff team who were friendly, caring and compassionate. Positive relationships had been developed between people and regular staff. People were treated with kindness.

People's care and support needs were monitored and reviewed to ensure care was provided in the way they needed. People or th

Westroyd Care Home provides accommodation, care and support for up to 55 older people. At the time of our inspection there were 40 people using the service.

We carried out an unannounced comprehensive inspection of this service on 19 and 20 July 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider was asked to provide an action plan to tell us what they would do to meet legal requirements in relation to breaches in Safe care and treatment, Safeguarding service users from abuse and improper treatment, Premises and equipment, Dignity and respect and Good governance. The service was also in breach of the registration regulations failing to notify the Commission of events affecting people. We did not receive the action plan.

We issued two warning notices to the provider in relation to safe care and treatment and Good governance. We undertook this focused inspection to check that the provider was compliant with the warning notices by the date we had asked them to be. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westroyd Care Home on our website at www.cqc.org.uk.

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.

People felt safer with the support the received. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

Risks to people were assessed and monitored regularly. However, records relating to risks associated with malnutrition were not completed consistently. The risks to people could not be effectively managed to ensure people who were at risk of malnutrition had enough to eat and drink.

The premises were maintained, however some checks to ensure the property was safe had not been completed when the maintenance person was off work for a period of six weeks.

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place.

Medicines were managed in line with the prescriber’s instructions. The processes in place ensured the administration and handling of medicines was suitable for the people who used the service. Medicines had not all been dated when opened. Action was taken to address this during our inspection.

Systems were in place to ensure the premises were kept clean and hygienic.

There were arrangements in place to identify when action was required and learning took place when things went wrong to improve safety across the service. Tis had not always happened.

People, their relatives and staff felt confident to approach the registered manager and felt they would be listened to.

Quality assurance systems had been improved to monitor and review the quality of the service which was provided. Notifications of events which had happened were made when necessary.

We made one recommendation in relation to a second nominated individual to carry out environmental checks.

We could not improve the rating for Safe above requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

We inspected Westroyd Care Home on 19 July 2017. This was an unannounced comprehensive inspection. We returned on 20 July 2017 to carry out a second day of inspection which was announced.

Throughout May and June 2017 we received a number of concerns about the service. This inspection was carried out in response to the concerns that had been raised. These included a lack of staffing, staff not being fully trained, people being got up very early against their wishes, poor maintenance of equipment in the premises and concerns that people were not being kept safe.

At our last inspection on 7 February 2017 we found a breach of regulation 12 safe care and treatment. After this inspection the provider wrote to us to say what actions they would take to meet legal requirements in relation to this failure to provide safe care and treatment. At this inspection we found the provider had made most of the required improvements in relation to this breach. However we found that further improvements were required and additional breaches of the regulations were identified.

Westroyd Care Home provides care for up to 55 people who require residential care without nursing. The home had two separate buildings; the House and the Lodge. The House provides care to people who have needs associated with older age. The Lodge provides care to people who are living with dementia. Each building had two floors. There was a communal lounge, dining room and kitchen in each building. At the time of inspection there were 44 people 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 were not consistently protected from the risk of abuse at the service because incidents had not always been reported appropriately so they could be investigated. Staff had received training in safeguarding adults and knew how to report concerns.

People were not consistently protected from risks relating to their health and safety. Assessments of people's needs had not been completed fully. There was a lack of consistency in the information that had been recorded in assessments of need, care plans and risk assessments. Risks associated with some people's care needs had not been fully assessed. Guidance for staff was not detailed to ensure staff knew how to meet people's needs safely.

Medicines practices had improved. Staff were trained and deemed competent to administer medicines. However, a concern about inhaled medicine had not been identified, and charts to record where cream needed to be applied were not used consistently.

Equipment people used had been checked to make sure it was safe. Equipment that was used as part of the service such as a washing machine were not maintained appropriately and were not always fixed in a timely manner. Areas of the service people did not access were not kept clean. Appropriate infection control measures were not always used.

There were not enough staff to meet people’s needs. People had to wait for support and staff left people to ensure others remained safe. Staffing levels had been assessed. This was not based on all people’s actual needs as these had not all been identified.

People were supported to access healthcare services. People had a choice of meals. Where people needed a specific diet such as low sugar or soft this was not always identified or provided. Records to ensure people at risk of dehydration were not always completed correctly.

The provider had safe recruitment practices. They checked staff for their suitability before they started their employment. Where this had not happened it had been identified and measures put in place to carry out relevant checks.

Staff

We inspected the service on 7 February 2017 and was unannounced. We returned announced on 8 February 2017.

Westroyd Care Home is registered to provide care for up to 55 people who require residential care without nursing. The home is split in to two units, the House and the Lodge. The House provides care to people who have needs associated with older age, whilst the Lodge provides care to people who live with dementia. Each unit provides care on two floors, has its own lounge and dining rooms. At the time of our inspection there were 42 people using the service.

A manager had been in post since October 2016 and was in the process of applying for registration. It is a requirement that the home has 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 a comprehensive inspection in August 2016 the overall rating for this service was Requires Improvement with one breach of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 was identified. We asked the provider to make improvements to ensure the safe management of medicines.

The provider sent us an action plan stating they would have addressed the breach of Regulation 12 by September 2016.

During this inspection we found the provider was continuing to breach this regulation. Medicines were still not managed in a safe way. People could not be assured they would get their medicines when they were prescribed.

You can see what action we told the provider to take at the back of the full version of the report.

People said they felt safe at the home. Staff understood how to report any concerns and were confident these would be dealt with by the manager. People did not always think there were enough staff on duty to support them. Staff had been recruited in a safe way to make sure they were suitable for their role.

People received support from staff who had the appropriate skills and knowledge to support people living at the service. Staff had received regular training in areas relevant for the people they supported.

People and relatives told us staff were kind and caring. Staff were respectful and helpful when supporting people. Staff were able to develop good relationships with the people who lived at Westroyd Care Home.

Relatives felt the activities in the Lodge were good but people living in the House still felt they needed to improve.

Staff understood the requirements of the Mental Capacity Act (2005) and understood how to obtain people’s consent before they offered care and support. Staff knew how to support people to make decisions for themselves. Where people may have lacked the capacity to make their own decisions, the provider had followed the requirements of the Act.

People enjoyed the food that was offered to them and received the right support with their nutrition and hydration needs. People could choose what they ate and their preferences and requirements were known by staff.

People had access to healthcare professionals to maintain good health.

The provider has systems in place to enable people to make a complaint or comment on the service and where comments were received these were acted upon. Relatives and staff felt they could talk with the manager at any time and said they were approachable.

Staff were clear about their roles and responsibilities. They knew how to raise concerns if they had needed to about the practice of a colleague. Staff were able to make suggestions for how the service could improve.

The manager understood the requirements of their roll, including informing CQC of any incidents or accidents.

The provider’s quality assurance systems were not always effective in making sure people received a safe

The inspection took place on 9 August 2016 and was unannounced we returned on 10 August 2016 announced.

Westroyd Care Home is registered to provide care for up to 66 people who require residential care without nursing. The home is split in to two units, the House and the Lodge. The House provides care to people who have residential needs whilst the Lodge provides care to people who live with dementia. Each unit provides care on two floors, has its own lounge and dining rooms. At the time of our inspection there were 38 people 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.

Systems for the safe management and storage were not being followed. The medicines room was not secure and procedures to monitor the use of pain relief patches was not always being followed.

Recruitment practices were not always followed. Risk assessments had not been completed before staff with spent convictions commenced work.

Complaints procedures were not being followed. People may not have their complaints investigated and receive information about any action taken.

Quality assurance systems were not robust or effective enough to identify all the shortfalls in the service. These included lack of some risk assessments and not all records being up to date and accurate.

People on respite were not always supported to retain their skills for returning home.

People told us they felt safe living at Westroyd Care Home

There were sufficient staff to provide people's care needs but the deployment of staff had an impact on the personalised support provided. Although staff were provided in the numbers that had been assessed as needed by the registered manager, staff were very busy, responding and providing care tasks such as personal care to people.

We found that staff were knowledgeable about people's needs and risks and what action to take to protect them from these risks. However new care staff or agency staff did not have this knowledge or access to up to date information to provide appropriate and safe care to people.

People were supported to have sufficient to eat and drink to maintain good health. People had mixed views about the quality of the food. Information in care plans did not always reflect the dietary support people received.

Suitable arrangements were in place for people to receive on-going support from healthcare professionals.

Some staff and people who used the service did not have confidence in the registered manager as they did not feel they managed the service in the best interest of people living there.

Mental Capacity Act (MCA) 2005 and best interest decisions were general and did not reflect the person's needs. The registered manager had not made to apply for a Deprivation of Liberty Safeguard authorisation when they were required. This meant people were being deprived for their liberty without due authorisation.

People were cared for by caring staff. People's privacy was respected and promoted. We saw examples of caring practice from staff. People's preferences, likes and dislikes were not always recorded in their care plans. Which meant that new or agency staff would not be aware of how people preferred to receive their care.

The environment in the Lodge was not dementia friendly and there was a lack of directional signage to communal areas and the stairs, lift or bedrooms.

The business contingency plan that was in place to minimise the risk to the home in the event of an emergency such as fire, adverse weather conditions, power cuts or flooding was significantly out of date.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can

This inspection was carried out to see if improvements had been made to Westroyd Care Home following our inspection of 12 and 18 November 2013. We spoke with two people who lived at Westroyd Care Home to ask for their views on the care that they received. We also spoke with two relatives visiting their family members and eight members of staff. We looked at the records belonging to five people who were using the service.

We found people experienced care and support that met their needs and protected their rights. A relative told us: “This was previously a good home, now it is a very good home. It is very homely and the staff are very caring.” Care and support was delivered in a way that met people’s needs and ensured their safety and welfare. We saw that when people required medical attention this was arranged promptly.

We found that there were sufficient numbers of staff on duty to ensure people were safe and their needs were being met. One member of staff told us: “It’s [Westroyd Care Home] a lot better now. We have a new manager who is approachable, pleasant and a big help. The staffing levels are now good, with no short staffing.”

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping. Systems were also now in place to audit the quality of the care records on a weekly basis.

This inspection was to see if improvements had been made to Westroyd Care Home following our inspections on 12 March, 14 May and 5 June 2013.

We looked at the records belonging to eight people who were using the service. We assessed whether improvements had been made with regard to people’s care and welfare, and the appropriate completion of records. We also assessed whether improvements had been made with regard to the suitable handling and management of infection control, and the safe handling of medicines.

We found that staff members were not always following instructions from within the care plan documentation. This included the weighing of people who had been identified as at risk of losing weight. This meant that people’s care and welfare needs were being put at risk.

We looked at the provider’s infection control procedures and found that staff members were following the procedures in relation to infection control.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had put in place robust systems relating to the management of medicines.

The records seen on this occasion were not all up to date as required by regulation. We found the records did not include all the information to evidence that people’s needs were being met.

This inspection was to assess if improvements had been made to the service following our inspection on 14 May 2013. We looked at the records belonging to six people who were using the service. We reviewed if improvements had been made with regard to the appropriate handling of medicines and appropriate completion of records.

Not all the records seen on this visit were up to date or accurate. These included people’s care plans and medication records.

We checked the medication and found that there were inconsistencies within the medication records. There were issues with the dispensing and recording of medication. This meant that people were not protected against the risks of inappropriate administration of medication.

This inspection was to assess if improvements had been made to the service following our inspection on 12 March 2013. We looked at the records belonging to five people who were using the service. We reviewed if improvements had been made with regard to the appropriate completion of records, the appropriate handling of medicines and the suitable management of complaints.

During our visit we also looked at the services infection control procedures. We found that staff members were not following the provider’s policy in relation to infection control.

Not all the records seen on this visit were up to date or accurate. These included people’s care plans and medication records.

We found that staff members were not always following instructions from outside professionals or from within the care plan documentation. This meant that people’s care and welfare needs were at risk of not being met.

We checked the medication for some of the people we spoke with and found that there were inconsistencies within the medication records. There were issues with the dispensing and storage of medication. This meant that people were not protected against the risks of inappropriate administration of medication.

A complaints log had been developed and people knew who to go to if they had a concern of any kind.

During our visit we spoke with seven people who were using the service. They told us that they were happy with the support they received. One person told us: “It is excellent, the food is good and the staff are very nice.”

We spoke with seven visitors, eight staff and one professional to gather their views on the service. A visitor explained: “The staff are very nice, they always look after her [her relative] and she always looks well cared for.”

We were told that people had been asked for their consent to the care and support that they received before they moved into the service.

We looked at some care plans and found that although they were comprehensive, they hadn’t always been reviewed as often as they should and some had inconsistent advice in them.

We checked the medication for some of the people we spoke with and found that there were some inconsistencies within the medication records and medication had run out of stock.

Everyone spoken with told us that they felt safe. One person told us: “I feel quite safe thank you.” A relative explained: “I can go away and not worry; it is a weight off my mind.”

Some of the people we spoke with knew what to do if they had a complaint to make, others were not so sure. One concern raised by one person we spoke with, hadn’t been addressed and no record of this concern had been made.

We were told that the staff were supportive and we observed them carrying out their duties in a kind and patient manner.

We spoke to three people who used the service and four relatives pf people who used the service.

The three people who used the service were complimentary about the home. One said, "I like it here. The carers help me get dressed and with washing." Another person said, "Everything is excellent for me. It's easy going here. I enjoy my lunch every day." A third person told us, "Everything is up to scratch."

One relative relative said, "I can talk to the registered manager about any problem and she sorts it out. The carers do everything that is in the care plans. I'm satisfied with the care my mother is getting. She's well looked after."

Another relative said that, "It's very good here. My mother settled here from day one. carers do what is in the care plans, they go beyond that sometimes. I visit every day. My mother is always clean and well dressed."

A third relative told us, "The home has been great for my mother. It's a great comfort and reassurance that I know my mother is here. I don't have to worry about her. I'm very impressed with the carers and the food. the home is very clean and well furbished. If I had any concerns I know I could discuss them with the manager."

A fourth relative told us, "I cannot fault this home. I looked at eight other homes before deciding this was the home for my mother. I cannot praise the senior carers enough. I've been involved in the care plan, I've been kept informed. I've completed a questionnaire every year. I come here every day. I can't thank them enough."

People who use the service told us that they are happy with the care they receive. One person reported that if ‘you have to go into a home, this is the one to go to’. People stated that they are treated with dignity and respect. They reported that staff members are friendly and helpful.

Some people stated that there is enough going on at the home to occupy their time. Other people reported that they would like more activities and outings.

Most people told us that they are satisfied with the food provided. They appeared to enjoy both breakfast and lunch on the day of our visit. One person stated that there is a long gap between breakfast and a mid morning drink at 11.15.

People who use the service stated that they are happy with the environment in which they live. Several people commented on the attractive views over open countryside. They reported that the home is kept clean and tidy.

People who use the service stated that there are sufficient numbers of staff on duty to meet their needs. We did, however, identify an issue with regard to the availability of staff at mealtimes. The registered manager stated that the circumstances on the day of our visit were exceptional.

The inspection took place on 21 July 2015 and was unannounced. We returned on 22 July 2015 and this was announced. Our inspection took place following information of concern relating to poor staffing levels particularly during the night shifts.

Westroyd Care Home is registered to provide care for up to 66 people who require residential care without nursing. The home is split in to two units, the House and the Lodge. The House provides care to people who have residential needs whilst the Lodge provides care to people who live with dementia. Each unit provides care on two floors, had its own lounge and dining rooms. At the time of our inspection there were 57 people using the service.

The service does not have 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. There was an interim manager on the day of our inspection who told us they had started the registration process to apply to be registered manager.

Inconsistencies in how the House and the Lodge were managed meant that people were not always kept safe.

Staffing levels had improved following a recruitment drive by the manager. Staffing levels were based upon people’s dependency needs. The provider had taken appropriate action when people’s needs had changed to ensure they were met. Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work.

Staff received appropriate and relevant training to support them in their roles. How staff implemented their learning was not consistent across the two units.

We found that people’s capacity to consent to their care and treatment and others areas associated with their care had been considered, there had not been any decision specific capacity assessments carried out. Not all potential forms of restraint had been considered when creating care plans.

Inconsistencies were seen in how staff cared for people. Staff were task orientated in the House whereas in the Lodge they took time to support people in the way they needed.

Medicines were not managed consistently across the two units and there was potential for errors to occur. Medicines were safely stored but there were inconsistencies in the administration of ‘as necessary’ medicines.

People’s needs were assessed and plans were in place to meet those needs. Risks to people’s health and well-being were identified and plans were in place to manage those risks. People had their healthcare needs met by appropriate referrals to healthcare professionals. However care plans were complicated and it was not always clear where information was. The provider is introducing new care plans to make improvements in this area.

People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided.

There were systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service. Additionally, monitoring the quality of service provided the manager with information to learn from incidents and make improvements. People’s complaints and issues of concern had been responded to promptly and appropriately.