The inspection took place on 13 and 21 September 2018 and was unannounced.

West View Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 74 people across four units. At the time of the inspection 65 people were being supported in the home. The service supported up to 20 people who were assessed as requiring rehabilitation with a view to returning home. Over the course of a year up to 400 people access this service.

The service did not have 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.’

The provider had appointed a manager who had submitted their application to become the registered manager and was waiting for their fit person’s interview.

Following the last inspection in February 2018, the service was rated as 'Good' overall, with 'Requires Improvement' under 'Responsive'. This was due to risk assessment information not being transferred to care plans. At this inspection we found two breaches of regulations relating to safe care and treatment and good governance. As a result, the overall rating has deteriorated to Requires Improvement.

Risks to people had not always been identified, assessed or managed safely. In some cases, there was insufficient information or guidance in care records in relation to people's care and support needs.

The provider's system of assessment and subsequent recording did not give an overview of people's needs. It was difficult to ascertain the primary care needs of people and readily locate key information such as whether people needed adapted diets.

The staff in the rehabilitation service used care templates designed for people receiving respite care and these made it difficult for staff to readily identify what support people needed.

Staffing levels did not consider the dependency needs of people in case of an emergency.

Substances, which if ingested could cause harm to people, were not stored securely.

Issues relating to fire safety had not been addressed in a timely manner.

Conditions attached to people’s Deprivation of Liberty Safeguards authorisations had not been met.

The provider’s quality assurance process had not identified all the concerns found at this inspection.

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

The provider’s recruitment process was safe and robust. Checks were made to ensure only suitable people were employed.

Staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service. Accidents and incidents were recorded and monitored as part of the provider’s audit process.

Health and safety checks had been completed such as gas and electrical safety checks. Equipment used to support people had been checked and/or serviced.

Medicines were managed by trained staff whose competency to administer medicines was checked regularly. Medicine administration records (MAR) were completed correctly.

Staff felt supported and received regular training, supervision and an annual appraisal.

People were provided with a varied healthy diet. People’s health was monitored and when necessary staff ensured people had access to health care professionals when necessary.

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

This inspection took place on 7 March 2016 and was unannounced. This meant the provider did not know we would be visiting. A second day of the inspection took place on 10 March 2016 and was announced.

We last inspected the service in March 2014. At that inspection we found the service was meeting all the regulations that we inspected. Westview Lodge is a 74 bedded purpose built residential care home situated over two floors. It provides residential support for older people and people living with dementia care needs. The home also provides a transitional service for people recuperating from a hospital admission and preparing to return home. At the time of the visit 71 people were living at Westview Lodge.

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.

The home was clean and had recently been decorated throughout. The enclosed garden had been designed and created by people living at the home, staff and the support of the local Dementia Friends group.

People, relatives and staff we spoke with told us that there were enough staff on duty. Staffing numbers were sufficient to ensure people received a safe level of care.

Where risks were identified they were assessed and managed to minimise the risk to people.

Staff had a good understanding of safeguarding and were clear on what actions to take if they had concerns about a person’s welfare or safety.

The provider had an effective recruitment process in place which included ensuring appropriate checks were undertaken prior to an applicant commencing work.

Medicines records we viewed were up to date and accurate. This included records for the receipt, return, administration and disposal of medicines.

Staff understood and applied the principles of the Mental Capacity Act (MCA), and supported people to make individual choices and decisions.

People were supported during meal times and wherever possible were encouraged to be independent.

Staff had completed mandatory training the provider had deemed required to perform their role. Supervisions and appraisals were not conducted in line with the provider’s programme.

The home had a good working relationship with external professionals visiting the service. We saw evidence in care plans of cooperation between care staff and healthcare professionals including, occupational therapists, nurses and GPs.

People were treated with dignity and respect. Staff had a sound knowledge of the people they supported.

Where people had no family or personal representative the registered manager advised the home would assist people to obtain support from an advocacy service.

People were able to take part in a range of activities including bingo, crafts, gardening, baking and going on outings. Staff supported people to maintain family relationships and links with the local community.

Care plans were detailed and reflected people’s individual needs. Reviews were regularly completed.

The home had a happy atmosphere. Staff told us they enjoyed working at the home and they felt supported by the registered manager and senior staff.

A grab bag containing people’s personal emergency evacuation procedure (PEEP), torches, emergency blankets and the provider’s business continuity plan was accessible to staff in the event of an emergency.

The registered provider had developed a range of systems to monitor and improve the quality of the service provided. An electronic feedback point was available in the foyer of the home. People who lived at the home, relatives and staff were encouraged to provide constant feedback.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

One person we spoke with said, "Oh I can tell them anything and they do listen to us". People told us that they were very happy at the home and that staff were "lovely".

During the visit, we spoke with 15 people who used the service and eight relatives. As this was a routine visit we asked people about the choices on offer; what the care was like; and what people thought about the staff. People told us that they really liked the home, thought the staff were good at their jobs and felt they were being supported to either return to their own accommodation or live comfortably at the home. People said ‘’If you asked me on a scale of 1-10 how I would rate the home I’d say 50, as it is an exceptionally good service’’, ‘‘The staff are fantastic, the food is excellent. I’m due to go home but would stay given half the chance’’ and ‘’I I love it here it is smashing’’.

People told us that the service was run well and that the manager was very committed to making sure everything operated smoothly. All of the relatives told us that they felt that all the staff were competent and supportive and the home met people’s needs. People said ‘People get plenty of attention, the food is very good and no one would ever go hungry because there is always plenty’’ and ‘’The staff are very approachable and attentive so much so the buzzers never ring for long, which is a big contrast to the home my relative was in last time’’ and ‘’We have found that the staff obviously care about the people and nothing is a bother to do’’.

We spoke with six people who used the service. People who used the service told us, "I love, love, love it here", another person told us that they thought that the home was wonderful and said, "We can all have a laugh here, you have got to laugh, they really do look after me and I keep them all right!"

Throughout our SOFI observations we saw that there were a lot of smiles and laughter between people living at the home and staff and the home had a very relaxed environment.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were enough qualified, skilled and experienced staff to meet people’s needs.

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.