The inspection took place on 25 September, 15 and 17 October 2018 and was unannounced.

At the last inspection we found that there was a breach of Regulation 17 of the Care Quality Commission (Regulated Activities) Regulations 2014. In that the registered person had failed to maintain an accurate and complete record in respect of the care and treatment of people with compromised tissue viability. Also that the registered person had failed to improve practice following the identification of record keeping issues during their auditing processes. At this inspection we found that improvements had been made.

Westvale House provides accommodation, personal and nursing care for up to 61 people, some of whom have dementia care needs over two floors. The home was built in 1989 and is located approximately three miles from Warrington town centre. The service is provided by Barchester Healthcare Homes Limited. At the time of our inspection the service was accommodating 51 people.

Since the last inspection there had been a change to the management structure of the home, there was a registered manager at Westvale House. 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 protected from the risks of abuse. Risks were identified and managed effectively to protect people from avoidable harm.

Recruitment processes were in place to make sure, as far as possible, that people were protected from unsuitable staff being employed.

Records of people's dietary intake could be improved with consistent portion management.

People received their medications as prescribed so that they remained well and pain free.

People receive support from staff who receive regular training. Effective processes are in place to monitor staff training needs.

People told us they were treated with care and kindness.

People were treated with respect and their dignity was upheld.

People's rights to make their own decisions were protected. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s needs were assessed and accurate records maintained so that their needs could be met.

People knew how and to whom they should complain.

This inspection was unannounced and took place on the 18 and 19 April 2017.

Westvale House was previously inspected in November 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Westvale House provides accommodation, personal and nursing care for up to 61 people, some of whom have dementia care needs over two floors. The home was built in 1989 and is located approximately three miles from Warrington town centre. The service is provided by Barchester Healthcare Homes Limited. At the time of our inspection the service was accommodating 45 people.

There was a registered manager at Westvale House. 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.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of good governance. The registered person had failed to maintain an accurate and complete record in respect of the care and treatment of people with compromised tissue viability (a pressure area that can break down the skin and underlying tissue). You can see what action we told the provider to take at the back of the full version of this report.

The registered manager was present during the two days of our inspection and was supported by her regional director and a clinical development nurse. The management team were supportive, open and transparent throughout the inspection process and were seen to interact with people using the service and staff in a caring and supportive manner.

We observed that Westvale House provided a homely, comfortable and relaxed environment for people to live in. People were able to receive visits from family members and friends throughout the day and staff were attentive and responsive to the needs of the people living in the home.

We found that the needs of people using the service had been assessed and planned for so that staff understood how to provide person centred care and to keep people safe from harm.

The provider had established a programme of induction and ongoing training to ensure people using the service were supported by competent staff. Additional systems of support such as supervisions, appraisals, daily handovers and team meetings were also in place.

Corporate policies had been developed relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). Staff had received training in relation to this protective legislation and those spoken with understood their duty of care.

People were offered a choice of nutritious and wholesome meals that were provided in dining areas that offered a pleasant environment for people to socialise and eat their meals.

People using the service had access to a range of individualised and group activities.

Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need). Medicines were ordered, stored, administered and disposed of safely.

Systems to monitor key aspects of the service, obtain feedback on the standard of care provided and to respond to safeguarding concerns and complaints had also been established.

The people we spoke with said that they were happy living in Westvale House and could make choices about what they ate, when they got up and went to bed and what activities they chose. They said that staff were very understanding and treated them well. They were always asked to give consent for care or treatment. We received comments such as "Its a very good place.The staff really look after you".

Relatives spoken with said "My Dad seems very happy. The staff are welcoming and friendly.They provide a lot of things for them to do" and "I would recommend it to anybody"

People told us they felt safe and had no concerns about their care.They knew how to complain should they wish to do so.

The provider had a comprehensive system for recruiting staff and supporting them with a range of training opportunities.

The people we spoke with said that they liked living in Westvale House and could make choices about how they spent their day. They said that staff treated them well, were very good and were all very positive about living there. They told us that the staff were all very respectful and always knocked on their bedroom door and waited to be invited in.

People said they felt well cared for by the staff that supported them. Everyone we chatted to was positive about the support provided.

Comment such as “all the staff know me I have been here a while and they look after me well” “I like it here there is always something going on for us to do” were made by people living at the home. Relatives spoken with said “they look after my relative very well” another said “Someone visits every day and the staff are always helpful”

People told us that they felt safe and had no concerns about the care and treatment they receive from staff. People said they could talk to the manager or deputy manager at any time and they would sort anything out. They said that they were always around to talk to and that all of the staff would listen if they had any concerns.

Relatives spoken with were happy with the care their relatives received.

People told us that they liked living in the home They said staff were caring and careful and respected people as being individuals with differing needs. They said that staff are respectful of their privacy and dignity and one person described staff as ‘very diplomatic’ when it comes to personal issues.

One person said staff were very obliging and provided everything needed to make people happy.

Other comments included

“Staff are very helpful and kind”.

“We are provided with a very good service by people who treat us well”.

“We have good food, good company, good service, what more can we ask?”

One of the people living at the home told us that staff are good and they are all checked out to ensure their suitability before they are employed at the home. They said staff were good, kind and they knew what they were doing.

One person said the people living in the home have many activities and can sometimes go out into the community as much as three times each week. They said staff always ensure people are safe and well looked after at all times.

People living at the home told us that they are aware of how to make a complaint but that they have not had reason to.

People said they are consulted about things that may affect them and they feel their wishes are listened to.

People advised they were very happy living at the home. They told us they have regular meetings with staff to talk about the way the home is run.

This inspection took place on the 10 and 12 of November 2014. The inspection was unannounced

The last inspection of Westvale House took place on the 11 December 2013 when it was found to be meeting all the regulatory requirements looked at during the inspection.

A registered manager was 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 and associated Regulations about how the service is run.

A new home manager had recently started work at the and was being supported by the registered manager during our inspection. The current registered manager was leaving the home and was going to take up a new role as a regional clinical support role for the company. The existing manager was going to de-register and the new manager had applied to be registered with the CQC.

Westvale House is a care home providing accommodation nursing and/or personal care for up to 61 people over two floors. The home is located approximately 3 miles from Warrington town centre. The home was purpose built in 1989. There were 55 people living in the home on the day of our visit. At the present time the home had a number of people who were being supported at the end stages of their lives.

This inspection took place over two days and during our visit we spent time in all areas of the home, including the lounges and the dining areas. We were able to observe how people’s care and support was provided.

Because not everyone in the home was able to fully communicate with us we spoke with staff regarding their knowledge of how people wanted to be cared for and looked at people’s care plans to help us understand their care and support needs.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw information that best interest meetings had taken place where people lacked capacity to make decisions for themselves. For example, one person needed to have essential medication given by the use of a syringe and a meeting had been held with the GP, family members and staff at the home to agree the best way to assist the person to take these medicines. This person was then referred and a DoLS was in place.

Care plans included assessments of people’s capacity to make decisions and choices and there was a good understanding by staff we spoke with about the Mental Capacity Act 2005(MCA) and Deprivation of Liberty Safeguards (DoLS) The MCA is a law about making decisions and what to do when people cannot make some decisions for themselves. The Deprivation of Liberty Safeguards (DoLS) are part of the Act. They aim to make sure that people in care homes, are looked after in a way that does not inappropriately restrict or deprive them of their freedom.

We looked at care plans which were detailed and provided good guidance for staff to be able to support and care for people living at the home. Staff spoken with were knowledgeable about the people in their care and we saw good relationships between staff and the people living at the home. The atmosphere in the home was calm and pleasant and we saw that there was smiles and laughter. People spoken with said “It is very good here “and “staff are very good.”

Staff were seen to treat people with respect and preserve their dignity at all times. We saw staff knocking on people’s doors and waiting for an answer before they entered, or saying who they were as they entered the room. We looked at the duty rotas and spoke to people and staff about the numbers of staff on duty. We found there were adequate numbers and skill mix of staff on duty to meet the needs of people living at Westvale House.

People and relatives spoken with were very complimentary about the meals and the choice and standard of food provided. People said the food was “excellent.”

The home had a complaints procedure in place and we saw that complaints were logged and actions taken following investigations were recorded so that the service could be improved.

We looked at staff recruitment records and found that appropriate pre-employment checks had been carried out to ensure that only suitable staff were employed to work with vulnerable adults.

We saw that audits and checks were in place to assess the quality of the service given and when shortfalls were identified action plans were put into place to address this. This was also done by involving people who used the service, their relatives, and health care professionals. This meant the service was identifying where improvements could be made and then addressing them.