Westwood Lodge 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.

Westwood Lodge is a purpose-built home with three units, which provides nursing and personal care for up to 76 people. Two units are part of the main building, with one adjacent unit called Westwood House. It is situated in a residential area of Wigan and is about five minutes’ drive from Wigan town centre. All rooms are for one person and they all have a toilet and a hand wash basin. The home is situated in its own grounds and has gardens with car parking spaces at the front of the home.

At our previous inspection in July 2017 the home was rated as good overall and in all domains and there were no breaches of regulations. During this inspection, we found breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 regarding safe care and treatment, person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.

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.

Regular audits were undertaken by the home to check that medicines were being managed safely and action plans were in place to address any issues raised, however these had failed to identify some of the issues we found regarding the safe administration of medicines.

The monitoring of the fridge and room temperatures was not being recorded on all the units each day to ensure that medicines were being stored at the recommended temperatures. We found four people had not received their medicines as prescribed. Medicines being given covertly to one person was being mixed with a supplementary feed when it should be given on an empty stomach which may affect its absorption.

We found that there were excessive quantities of some people’s medicines. Some people had regular analgesia prescribed, but when they regularly refused it a review had not taken place to see if the prescription should be changed to a ‘when required’ dose. Where protocols were in place for ‘when required’ medicines the information relating to signs and symptoms of the condition or the side effects of the medicine was not always completed.

We found there were inconsistencies in the use of documents to support the administration of medicines. There were discrepancies in people’s allergy information recorded. When medicines were not administered an explanation was not always recorded on the MAR. The template used to record the application and removal of pain relief patches did not include the signature of two members of staff.

We found the service failed to demonstrate that medicines were always managed safely.

We found a lack of written evidence regarding the actions that were identified to be taken regarding advanced care planning and there was no evidence of these being in place in 19 of the files we viewed. One person’s written statement of intent was out of date. In three care plans there was no evidence of preferred place of care documents or advanced care planning documents and no written documentation regarding any conversations held.

One end of life care plan had been partially completed but there was no record of this having been communicated to the wider staff group. There was no record to identify the reasons for commencement of the end of life care plan or discussion with the person’s family.

We looked at care planning documents for two people, recently deceased, and found one person who had been admitted to the

Westwood Lodge is a purpose built home with three units, providing nursing and personal care for up to 76 people. At the previous inspection the home was also contracted to provide 10 beds on the ground floor nursing unit for NHS patients referred for a period of rehabilitation and at this inspection we found the home was no longer providing this service and all beds were for nursing residents.

The home is located in a residential area of Wigan close to the town centre. All rooms are single occupancy and have en suite facilities. The home is situated in its own grounds and has gardens with car parking spaces at the front of the home.

At the time of our visit, there was no registered manager in place, though the newly appointed manager was in the process of registering with the Care Quality Commission. 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.

At our previous inspection undertaken on 09 May 2016, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safe management of medication. At this inspection we found improvements had been made in the safe handling of medicines throughout the home and the service was now meeting the requirements of this regulation.

People we spoke with at Westwood lodge told us they felt safe. Care and support was provided in a safe manner and considered the individual requirements of each person.

Medicines were managed safely and were secured in appropriate medicines trolleys. MAR sheets were complete and administration records up to date. Controlled drugs were stored in controlled drug cabinets and keys held separately by the nurse in charge. Medicines action plans were in place, creams and fluid thickeners were locked in cupboards in the treatment room and people’s rooms and administration records were now all completed. However we noted some gaps in records, for example staff signature sheets (used to recognise a staff member’s signature/initials) needed updating and protocols needed to be followed for some ‘when required’ (PRN) medicines in documenting request prompts for these medicines which would provide assurance of meeting people’s needs.

Processes were in place to identify and mitigate individualised risks posed to people such as mobility, including the use of mobility aids such as hoists, wheelchairs and bath aids. Environmental risk assessments and audits were also in place in addition to effective fire procedures and each person had a personal emergency evacuation plan (PEEP).

The provider had a ‘Business Continuity’ management plan which identified the action to be taken for an unforeseen event such as loss of utilities.

The service had a safeguarding procedure in place which offered guidance to staff on how to effectively raise a concern.

The service had created an easy read incident reporting flow chart for staff to follow should they require to and accidents and incidents were managed effectively.

Staffing levels were adequate to meet the needs of the people using the service. Agency staff were still being utilised however this usage had reduced since the previous inspection. The provider had robust recruitment procedures designed to protect all people who used the service and ensured staff had the necessary skills and experience to meet people’s needs. Everyone we spoke with said the permanent staff were professional and they trusted them.

Staff indicated they had received a suitable amount of training and this was valued for their own professional development. Staff training records included details of training previously undertaken and dates for when training was due for renewal. All staff spoken with confirmed t

This was an unannounced inspection carried out on the 09 May 2015.

Westwood Lodge is a purpose built home with three units, providing nursing and personal care for up to 76 people. The home is also contracted to provide 10 beds on the ground floor nursing unit for NHS patients. It is situated in a residential area of Wigan close to the town centre. All rooms are single occupancy and have en suite facilities. The home is situated in its own grounds and has gardens with car parking spaces at the front of the home.

At the time of our visit, there was no registered manager in place, though the newly appointed manager was in the process of registering with the Care Quality Commission. 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.

At our previous inspection undertaken on 30 July 2015 and 06 August 2015 , we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safe management of medication, the management of infection prevention and control, End of Life Care, assessing and monitoring the quality of service provision, suitable staffing levels, safeguarding concerns and the submission of statutory notifications to the Care Quality Commission (CQC). As a result, we took enforcement action in relation to the concerns we had identified. The home was also placed into ‘special measures,’ which meant significant improvements were required, or further enforcement action would be undertaken. Following that inspection, the home sent us an action plan, detailing the improvements they intended to make. As part of this inspection, we checked to ensure that improvements had been implemented by the home to meet legal requirements.

During this inspection, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection, we found that although improvements had been made in the safe handling of medicines throughout the home, further improvements were still required to meet the requirements of regulations.

We saw that three people had run out of a supply of their medicines, which placed people’s health at risk of harm. We found creams were kept in bedrooms and were not safely locked away. We saw the records about creams were poor and sporadic and could not show that they were applied as prescribed.

The medication room was locked and could only be accessed by means of a keypad rather than the safer method of a key. The medicines awaiting disposal were still not stored according to current guidance. Creams and fluid thickeners were not always stored safely.

This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment. This was because the provider did not have appropriate arrangements in place to manage medicines safely.

During this inspection, we found the home was now meeting the requirements of regulations in respect of infection control practice. The service had an infection control link nurse, who was able to provide advice and current best practice guidance to staff.

People were now protected from services that were degrading and that included acts that were intended to control or restrain the person. We found people were protected against the risks of abuse, because the home had appropriate recruitment procedures in place. Appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults.

We found there were sufficient numbers of staff to effectively meet the needs of people who u

Westwood Lodge Care Home is a purpose built home with three units, which provided nursing and personal care for up to 76 people. The Units are located on the ground and first floor of the main building with an additional annex known as The House. At the time of our inspection there were 72 people who were resident at the home.

During our visit we spoke to six people who used the service, seven relatives and friends and two visiting health care professionals. We also spoke to 12 members of staff during our visit.

Our inspection was co-ordinated and carried out by an inspector from the Care Quality Commission together with a specialist advisor in nursing. They addressed our five standard questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed that people were treated with respect and dignity by the staff. People told us they felt safe and secure at Westwood Lodge. Visiting relatives told us; “I feel my X is very safe here.” “My X is safe here, no concerns on that score.”

We found safeguarding procedures were robust and staff were able to explain what action they would take if they had any concerns about any of the people who used the service. Staff were able to demonstrate an understanding of whistleblowing and the circumstances in which they would use it to raise concerns.

The home had suitable policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had recently been submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

We found the service to be clean and hygienic. Equipment was well maintained and serviced regularly therefore people were not put any unnecessary risk.

Recruitment practice was well organised, safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

On the day of our inspection we found people who used the service were at risk due to insufficient numbers of suitably trained staff on duty.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe administration of medication and unsafe staffing levels.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

The premises were a purpose built nursing home adapted to meet the needs of people who required care and treatment.

Visitors we spoke to confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

We observed people being supported by kind and committed staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, “The staff are very good on this floor.” “The staff are very caring and respectful.” “No concerns about the quality of care I’m getting.”

People who used the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

We found that care and treatment was provided in accordance with people’s wishes.

Is the service responsive?

The service employed an activities coordinator and some people were able to participate in a range of activities.

People we spoke to knew how to make a complaint if they were unhappy. Information and leaflets on how to make a formal complaint was readily available around the home.

We found people could be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The service worked very well with other agencies and services to make sure people received their care in a joined up way.

The service had quality assurance systems, records seen by us showed that identified shortfalls were addressed promptly.

Staff told us they were clear about their roles and responsibilities and felt very supported and appreciated by the registered manager.

This inspection was completed as at our last inspection in May 2013, the service was not meeting the required standards in three areas. We visited this time to check that improvements had been made.

Most of the people we spoke with were happy with the care they received. The comments we heard included “There is nothing to change here. I have been in other places and this is one of the best”; “I like this home just as it is.”; “The food is OK” and “I can’t find anything wrong with the food.”

We found that the service had made improvements and was now meeting the standards with regard to the food provided. Improvements had also been made with infection control practices and the monitoring of the quality of care at the home.

Two people commented that they did not like the quality of some of the meats served at the home and we discussed this with senior staff. We found that there was a process in place to monitor people’s comments and concerns about the food and we were confident that this would be addressed.

We spoke with 10 people who lived at the home who said that they were happy living at the home. One person told us; "The staff are good here.” Another person said “I like it here. I even have a fridge I my room."

We looked at nine care plans and found that risks had been highlighted and risk reducing actions were in place to protect people who lived in the home. The standard of record keeping had improved since our inspection in August 2012. We also found that the home was meeting the standards about protecting people from abuse and those about requirements for workers.

Some people we spoke with told us the food was cold and they were not offered alternative food if they did not like what had been ordered. We raised this with the manager and we were informed that action would be taken to rectify these issues.

We were concerned that people were not fully protected from the risks of infection as infection control measures were not always followed. We found that the quality monitoring programme in place had not alerted senior staff to the issues regarding infection control and effective action had not been taken to address people’s concerns about cold food.

At our last inspection in March 2013, we found that there not enough staff on duty to meet the needs of the people living at the home. At this inspection we found that there were 22 vacant rooms and although staff were very busy, there were able to meet people’s needs in a timely manner.

This inspection was undertaken during late evening because we had received information there were not enough staff on duty during the night shifts and that that the lock on the patio door in the downstairs lounge was broken meaning that there was a risk of people leaving the building un-noticed or that somebody could gain access from outside.

During the inspection we only spoke with one person. This was because of the time that we arrived and the fact that a lot of the people in the home were asleep. He told us that he was unable to use the call bell and had to rely on shouting the staff members when he wanted the TV off so he could go to sleep. He said, “Depending where the staff are it sometimes takes them a long time to respond.” He also said that he told staff members on a regular basis not to bother with his night time medication because it was too late and he wanted to go to sleep.

We were informed that there had been a variety of staffing problems in the home and that a recruitment drive had been undertaken. However we were aware that as new staff members had been appointed existing staff had left. This has meant that the home was consistently short staffed at night and as a result the people in the home could be at risk of poor care. We have asked the provider to take action to address this problem as soon as possible and have already asked for written confirmation that the night shifts for the next six weeks are adequately staffed.

We spoke with five people who lived at Westwood Lodge and two visitors. Most people were happy with the care that was given to people.

We heard a range a comments about the home and these included, “Staff are very kind”, “Everything is fine” and “I like this home very much.” One relative told us “staff deserve a medal.”

People told us that they were well informed about their care and that they knew what was happening with their care. We asked all of the people who lived at Westwood Lodge if they would change anything about the home. No-one was able to think of anything that needed to change.

We found that people’s care needs were properly assessed and people generally received the care that was required. However, care was not always accurately recorded or recorded in a timely manner.

People told us that they felt safe living at Westwood Lodge, they liked the staff and were treated well.

Comments included:

‘It’s very nice ’

and

‘I have a cup of tea with my tablets- all the others are nice I have no trouble with them.’

Westwood Lodge is a purpose built home with three units, providing nursing and personal care for up to 76 people. It is situated in a residential area of Wigan close to the town centre. All rooms are single occupancy and have en suite facilities. The home is situated in its own grounds and has gardens with car parking spaces at the front of the home.

We undertook an unannounced focused inspection at Westwood Lodge on 30 July and 06 August 2015. This inspection was undertaken to ensure that improvements that were required to meet legal requirements had been implemented by the service following our last inspection on 17 March and 16 April 2015. At the time of the inspection 72 people were living at the home.

During the inspection on 17 March and 16 April 2015 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were for; safe care and treatment; person centred care; and good governance. The provider then wrote to us telling us what action they intended to take to ensure they were meeting regulatory requirements.

As part of this focussed inspection on 30 July and 06 August 2015, we checked to see that improvements had been implemented by the service to meet legal requirements. This report 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 'Westwood Lodge' on our website at www.cqc.org.uk

We found that people were not protected against the risks associated with the unsafe management of medicines. We continued to find concerns in a number of areas.

The morning medicines round took a long time to complete with one unit finishing the morning medicines at lunchtime. Nurses told us that the way they found medicines organised made it difficult for them to readily locate the medication they were looking for.

We found a lack of information to guide staff how to safely administer ’when required’ (PRN) medicines. Medicines records were not always clearly completed to show the treatment people had received. Medicines that were awaiting disposal were not stored according to current guidance.

This is a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; the proper and safe management of medicines, because the provider did not have appropriate arrangements in place to manage medicines safely. CQC are currently considering its enforcement options in relation to this failure, on the part of the provider to meet the regulations.

We found that people were not protected against the risks associated with the spread of infectious diseases. On the day of our inspection, the home reported an outbreak of gastrointestinal disturbance. We could not locate appropriate care plans covering gastro intestinal disturbance for any of the people affected. We found that staff were therefore not provided with clear guidance on how to provide appropriate support in this instance. There was confusion around the management of one person’s infection status. The registered manager told us that their understanding was that barrier nursing had been discontinued for this person. However, they were unable to provide documented evidence to support this.

We found the Infection Outbreak Policy did not provide adequate advice and guidance to staff on what actions to take in the event of an outbreak. We could not locate a supply of Personal Protective Equipment (aprons, gloves etc.) for visitors to use to reduce cross infection. We found that none of the affected people had been referred to their GP for medical assessment.

We also found that relatives of people affected by the outbreak had not been informed by the service. We observed three different members of staff who had been supporting people who were subject of the outbreak then walking around communal areas without changing their aprons.

This is a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; assessing, preventing, detecting and controlling the spread of infections, because the provider did have effective systems in place to prevent the spread of healthcare associated infections. CQC has issued a Warning Notice with conditions to be met by 05 February 2016.

During the inspection on 30 July and 06 August, both staff and people who used the service consistently said that staffing levels were insufficient to meet people’s needs. Nursing staff informed us that they struggled to get the medication rounds completed in time, which we observed during our inspection on 30 July 2015.

At our inspection on 30 July 2015 we were provided with evidence that the service had sourced training around drug calculations in respect of end of life care (EoL) However, this document was a register of attendance of drug calculations training and did not demonstrate that measurement of specific competencies of registered nurses had been completed. We spoke to one registered nurse who stated that they were not confident in several areas relating to the use of syringe driver equipment that may be used in the delivery of EoL care. We spoke to the registered manager about this issue and identified the shortfall of training and competency audits, which gave rise to our concerns regarding the effectiveness, safety and responsiveness of the provision of EoL care that was delivered by the home.

This is a breach of Regulation 12 (2)(c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the service failed to ensure all staff providing EoL care had the necessary qualifications, competence, skills and experience to do so safely. CQC has issued a Warning Notice with conditions to be met by 05 February 2016.

During our inspection on 30 July we found a bedroom fire door propped open with a chair and a person inside the room in bed with cot sides up in a very anxious and distressed state. The nurse call buzzer was out of reach of this person. We pressed the nurse call buzzer on several occasions and had to wait for over five minutes in each instance for a member of staff to assist the person. We asked a member of care staff why the person was still in bed and they replied “because they (the person) shout at other residents.” The care staff also informed us it was easier because of their (the person’s) challenging behaviour. We also found that food and fluid charts for this person were in place but contained inconsistent entries. Prevention of pressure sore development charts were also in place but not fully completed.

This is a breach of Regulation 13(4)(b)(c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because care and treatment of people who use services was provided in a manner that was degrading and included acts that intended to control or restrain a person that was disproportionate to the risk of harm posed to them. CQC has issued a Warning Notice with conditions to be met by 05 February 2016.

We found the service did not effectively monitor the quality of service provision. The service undertook a range of audits of the service to ensure different aspects of the service were meeting the required standards. However, as a result of the continuing concerns we identified around medication, infection control and end of life care it was apparent the service was not effectively assessing and monitoring the quality of service provision.

This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service did not have effective governance and auditing systems in place to monitor their service against Regulations 4 to 20A Part 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC has issued a Warning Notice with conditions to be met by 05 February 2016.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We will report further when any enforcement action is concluded.