We inspected Westwood Care Home on 14 November 2017. Westwood Care Home is registered to provide care to up to 29 people, some of whom were living with dementia. The service comprises of two converted houses, with a lounge/dining area. There were 20 people living at the service during our inspection.

We previously carried out a comprehensive inspection at Westwood Care Home on 18 October 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to inconsistencies in staffs’ understanding and implementation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Additionally, the registered manager/provider did not notify the Commission of incidents as required as part of their registration. We also found areas of practice that required improvement. This was because risks to people’s safety had not always been identified and assessed, people’s privacy and dignity were not respected at all times, and formal systems for people and staff to provide feedback, such as meetings and surveys were not in place. The service received an overall rating of ‘requires improvement’. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Westwood Care Home has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

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.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and bowel care training. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People we

We inspected Westwood Care Home on 18 October 2016. The inspection was unannounced. The home provides residential care for up to 29 people. At the time of the inspection 22 people were living at the home. The home is a large property, over three floors, situated in Brighton. There is a communal lounge and dining room and well maintained gardens. The home is the sole location owned and run by Mr & Mrs M S Sadek.

As part of this inspection we checked what action had been taken to address the breaches of legal requirements we had identified at our last inspection on 24 March 2015. After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. At this inspection we found improvements had been made and sustained and all the breaches previously identified were addressed.

During this inspection we found risks to people’s safety had not always been assessed. Identified risks were not always followed by appropriate risk assessment and management plans. As a result, the provider was unable to ensure people received care that kept them safe.

Staff had knowledge of the MCA and were observed to be working in a way that enabled people to make their own choices and were delivering support to people in their preferred way. However, we found that the provider was not using the Mental Capacity Act (MCA) to care for people who may lack the capacity to make their own decisions. The provider had not submitted Deprivation of Liberty Safeguards (DoLS) applications to the supervisory body, the local authority, that could lead to people being deprived of their liberty unlawfully.

People's respect and dignity was not always considered. They did not always receive care from staff that indicated respect for the person or acknowledged their needs. We observed a person’s bedroom where there was no curtain or blind cover to two small side windows of a dormer type top floor window.

The provider failed to notify us of deaths within the home. It is a legal requirement for these notifications to be received from the registered person.

Although staff we spoke to told us they felt supported, records showed that, outside of the daily staff handover, regular staff meetings were not held. This meant opportunities that could be used to help share learning and best practice and ensure staff understood what was expected of them at all levels was not in place.

People and their relatives were not given opportunities to participate in a survey or similar process to provide feedback on the quality of service. As a result, opportunities to influence and improve the quality and safety of the service were missed.

People were protected from harm and abuse. They said they felt safe and there were sufficient staff to support them. One person told us, “If I want any help I ring my buzzer and they come at once. At night they put the bell near me so I feel safe”. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. Staff had received essential training. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to eat and drink well. There was a choice in what people ate and drank. One person told us, “The food is good and we have a choice”. People’s weight was monitored, with their permission, to look for patterns of weight loss or gain.

People’s health needs were assessed and met by staff who made referrals to external healthcare professionals when required. A health care professional told us, “People

We completed an unannounced inspection of this home on the 24 and 25 March 2015. Westwood Care Home provides residential care and support for up to twenty nine people older people aged over sixty-five years. Some people were living with dementia. At the time of the inspection, eighteen people were living at the home.

Accommodation was provided in individual bedrooms except for one couple who chose to have a twin room. A lift provided additional access to the upper floor. There was a large communal lounge, dining area and garden.

We carried out a scheduled inspection of the home on the 12 August 2014. The inspection identified non-compliance in three outcome areas. The provider completed an action plan which stated all staff would complete adult safeguarding training by the end of 2014. We found this action had not been met and the training was still outstanding by the time of our visit. Staff therefore did not have the skills, knowledge or training and this could have placed people at risk of harm.

There was a registered manager at the home on the day 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.

People’s medicines were not recorded or stored safely. There were inconsistencies in the management of medicines and not all medicines were accurately recorded. We have identified this as an area of practice that requires improvement.

The cleanliness of some of areas of the home such as walls and woodwork had not been maintained to a high enough standard. People were exposed to an environment where cleanliness was not maintained across all areas, increasing risk from poor hygiene maintenance.

Audits of cleaning and maintenance had not identified the failure to complete tasks relating to maintenance, cleanliness and infection control. We have identified this as an area of practice that requires improvement.

The registered person had not protected people against the risks associated with unsafe or unsuitable premises because of inadequate maintenance. We have identified this as an area of practice that requires improvement.

Positive practice which valued the person receiving care, promoted independence and their meaningful activity was not adopted by staff in a systematic way across the whole team. We have identified the continued supervision and development of staff as an area of practice that requires improvement.

The deputy manager had the responsibility of auditing and updating care plans but did not always have time off the floor to complete the essential task to their satisfaction. We have identified this as an area of practice that requires improvement.

People and their relatives were complimentary about the service provided, the staff and the provider. One person said, “Oh yes, people are well looked after. Everyone is so kind and helpful,” Staff understood the principles of the provider and these permeated all areas of the home. The provider was committed to the ongoing improvement of the home.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. They were complimentary about the food and drink offered. People were involved in making decisions about the food they ate.

People and their relatives told us they felt the home was sufficiently staffed. Practice was reviewed with regard to safe ways of working and ensured people were not placed at risk.

Staff had received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments were recorded in line with best practice guidelines and staff were aware of who was subject to a DoLS authorisation and what it meant for the individual.

There were procedures in place to assess the standards of care. Incident and accidents were recorded and reviewed for emerging trends or patterns.

People’s privacy and dignity was upheld. Staff understood how to recognise abuse and were clear on how to raise a safeguarding alert.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

A single adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected issues identified in the assessment. A care worker said, “The care plans are there for us to refer to and make sure that what we do is best for the resident and above all, safe.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We spoke to staff about their understanding of safeguarding procedures. They had an awareness of the different types of abuse and what to do if they witnessed abuse.

Is the service effective?

People who used the service and their relatives told us that they were happy with the care provided and felt their needs had been met. Staff told us they understood people’s care needs and that they knew them well. One person who used the service told us, “I’m quite comfortable. I have a nice good room and I’m treated well.”

Records were maintained of appointments people had with doctors, nursing and hospital outpatient services. We saw that the service assessed and recorded details of people’s medical needs when being admitted to the home. People we spoke with and their representatives were satisfied they could see their doctor when they needed to.

The staff we spoke with said they felt well supported in their roles. They all said they could approach the deputy manager or provider at any time and that issues were resolved. One said, "I definitely get enough support. [The Provider] is always there when I need them." However, the registered person did not have suitable arrangements in place for staff to receive appropriate professional development, supervision and appraisal. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

We saw that staff communicated with people at a suitable relaxed and considerate pace. We observed that people were offered choice such as whether to stay in their room or use the communal areas and were spoken to in a respectful way. The provider told us that people who used the service and their relatives were not given a guide that contained details about the service, important contact details or the complaints policy which contained guidance on how to raise any concerns.

All of the people we spoke with told us they were happy at Westwood Care Home. A relative told us, “As soon as we walked in we found a homely atmosphere which was supportive of [my relatives] needs, now they thrive here.”

Is the service responsive?

The manager told us that they strive to work in cooperation with community services such as specialist nurses and social services, who all visit the home regularly.

Care staff told us about each person’s care needs and support required. One member of staff told us, “People are well cared for here, we know their needs.”

Is the service well-led?

We were told by people we spoke to that the provider was based in the home on most days and was accessible. One person said, “I’m treated very well, I’d soon tell them off if they treated me any other way. The staff are nice and friendly and the boss man comes in most days.” We were unable to identify any visitor, staff or resident comment or suggestion system that was being used. This meant it was difficult to independently establish people’s views of the service and the quality of care provided. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

We spoke with people who used the service, visitors to the home, the rgistered manager and three care staff.

The improvements required to comply with the regulations in relation to staffing have been made.

We looked at a range of information held by Westwood Care Home. We found that additional care workers have been employed to ensure that people who use the services are safe and their health and welfare needs are met by sufficient numbers of appropriate staff. One person who used the service said, “I notice there’s more staff on.” A member of the care staff told us “It has got better. We have two awake night staff on now.”

We spoke with a range of staff including the registered manager, deputy manager, care workers and cleaner. We talked with four residents and a visitor to the home and looked at the residents' questionnaire to help us understand the experience of people who used the service.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One care worker told us “We have some residents who have struggled to make choices. We still ask them and as far as possible give them choices to do as they please.”

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Staff told us that they knew people well and were aware of their needs. One care worker we spoke with told us “most of the residents can communicate their needs and I feel confident they do.” People were registered with a GP and had access to a range of healthcare professionals.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained.

There were not enough qualified, skilled and experienced staff to meet people’s needs. Some staff voiced concern at the levels of staffing at Westwood Care Home.We found that the provider had ensured that staff were properly trained, supervised and appraised.

Staff records and other records relevant to the management of the service contained relevant information and were fit for purpose.

People’s privacy, dignity and independence were respected. People who lived at the home told us they were happy with the care delivered and that the care workers had been able to give them the support they required. One person told us "The care is very good." and “The girls are very sweet.”

People experienced care, treatment and support that met their needs and protected their rights. People were registered with a GP and detailed records had been maintained of visits to and from health care professionals. Medicines had been administered by care workers who had been trained to do so.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Care workers had received up to date relevant training and were aware of the local protocol for safeguarding adults at risk.

Care workers had not had the training they needed to meet the needs of people with dementia type illnesses. A care worker who had prepared meals had not received the training they needed to prepare food safely. Care workers had not routinely received supervision or had an appraisal.

Not all records were up to date and accurate. Some people's needs had not been assessed and not all risks had been assessed and mitigated. People's care plans had not always been updated to reflect changes.

Staff recruitment and personnel records did not contain all the required information.