Westerlands Care Village

Westerlands Care Village is a residential care home comprising of 2 different buildings, Elloughton House and Brough Lodge. Brough Lodge is also split into 3 separate units, each with their own communal areas. The service provides personal and nursing care to people aged 65 and above, people living with dementia and those with a physical disability. The service can support up to 62 people. At the time of inspection 45 people were using the service.

People’s experience of using this service and what we found

The quality and the safety of the service has improved. Risks to people’s safety and wellbeing were managed by skilled and knowledgeable staff. People received their medicines safely and as prescribed. The safety of the building and equipment had been maintained and a programme of redecoration was underway.

Staff were recruited safely and there were enough staff to meet people’s needs. Staff understood different types of abuse and internal and external reporting processes. Safeguarding concerns had been appropriately referred and action taken by the provider when required.

People received a varied diet and their preferences were catered for and specialised diets were provided to those who needed them. Most people received appropriate support at mealtimes, though sometimes opportunities to engage people were missed and the management team advised they would address this.

Induction, training and supervision ensured staff had the required skills and knowledge for their roles. Staff worked closely with relevant professionals to ensure people received appropriate care when they needed it.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Quality assurance systems were in place and effectively operated which had a positive impact on the service people received. Systems were in place which enabled people, their relatives and staff to provide feedback on the service and suggestions for improvements. Information from feedback was used to further develop the service.

The management team were open and honest if things went wrong, though written apologies were not always sent.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 January 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider should seek advice from a reputable source regarding the support and quality monitoring of agency staff. At this inspection we found improvements had been made.

Why we inspected

We carried out an unannounced focused inspection of this service on 9 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person-centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westerlands Care Village on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We have made a recommendation regarding duty of candour policies and systems.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Westerlands care village is a residential care home set across two separate buildings, Elloughton House and Brough Lodge. The service provides personal and nursing care to people who may be living with dementia, people aged 65 and above, and people with a physical disability. The service can support up to 62 people. At the time of inspection 48 people were living at the service.

People’s experience of using this service and what we found

Quality assurance processes did not always improve the service. Audits had not identified some of the areas we found at this inspection. When audits had identified areas, prompt action had not always been taken to rectify the issues.

Risks to people’s health and safety had not been mitigated. There was a serious risk with the safety of windows. The provider addressed the issues and window safety had improved by the final day of the inspection. The service was not always clean, the provider organised a deep clean of the service during the inspection.

People were not fully supported with choices of meals. People were not always supported in a dignified manner and in line with their care plans.

Recruitment checks had been carried out, but records were not always robust. We have made a recommendation regarding the induction and support of agency workers.

People were supported to access healthcare appointments.

We received positive feedback regarding the new managers at the service. Staff felt well supported by the management team.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Best interest decisions had been carried out when appropriate.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 22 December 2020).

Why we inspected

We received information of concern in relation to management of risk, medicines and nutrition. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westerlands Care Village on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, infection control, person centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Westerlands care village is a residential care home set across two separate buildings, Elloughton House and Brough Lodge. Brough Lodge is split into three floors; The Garden Suite, Humber Suite and The Ridings Suite. The service provides personal and nursing care to people who may be living with dementia, people aged 65 and above, and people with a physical disability. The service can support up to 62 people. At the time of inspection 50 people were living at the service.

People’s experience of using this service and what we found

People were happy with the service they received and were supported to feel safe. Risk assessments identified potential risks to people and how to reduce these. People received their medicines as prescribed.

Staff had received infection control training and appropriate measures had been put in place during the coronavirus pandemic. This included enhanced cleaning, use of personal protective equipment and regular testing for staff and people who used the service. The provider had recently purchased a visiting room to allow for safe relative visits.

Staff received induction, training and ongoing support through supervision to ensure they had the appropriate skills and knowledge for their role. We received positive feedback from staff regarding the support they received from the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to access health care and we received positive feedback from health professionals regarding the positive partnership working with staff.

Systems were in place such as audits and surveys to monitor and improve the quality of the service. People, their relatives and staff were engaged in the service through meetings and surveys.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 February 2018).

Why we inspected

This inspection was prompted through our intelligence monitoring system and other information we have received.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information, we may inspect sooner

The service had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a 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 on 25 January 2017, we rated Westerlands Care Village as Requires Improvement. The provider needed to evidence a longer track record of consistent good practice in person-centred care; safe care and treatment; consent; nutritional and hydration needs; dignity and respect; safeguarding people from abuse; staffing; medicine management and good governance. At this inspection we found Westerlands Care village provided evidence of consistent good practice and all of these areas and the service no longer required improvement.

The environment at Westerlands Care Village was pleasant, inviting and calm. The registered manager and the staff team were all welcoming and approachable. There was a strong commitment to continuous improvement.

Medicines were managed safely and staff had a good knowledge of the medicine systems and procedures in place to support this.

Staff understood how to safeguard people from abuse; they had training in this area and were able to put this into practice. There was sufficient staff to ensure people were kept safe and the provider evidenced they were working proactively to fill the vacant posts they were recruiting to.

There was a positive culture within the service; people were treated with dignity and respect. Staff had signed up to a dignity pledge and this on display and promoted around the service. People’s care plans showed that there was a strong commitment to person centred care and risks to people were assessed and managed. People were supported to make their own decisions; this was encouraged and reflected in their care plans. Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People’s nutrition and hydration needs were catered for. A choice of meals was available three times a day and snacks and drinks were made readily available throughout the day. The registered manager addressed nutritional concerns, such as weight management, in a proactive manner.

We also looked at recruitment processes and found that staff had been recruited safely. We looked at staff training and found staff had developed a wide range of competencies which demonstrated they could perform their duties effectively. Training was service specific to meet the needs of people; this enabled staff to develop their knowledge to provide person centred care. Staff received regular supervision and appraisal and told us they felt supported in their roles.

People’s wider support needs were catered for through the provision of daily activities provided by the care staff and visiting entertainers.

The management completed investigations into incidents and accidents. Investigations were thorough and comprehensive and lessons learned were reflected upon and recorded. This meant that the likelihood of future similar incidents was reduced.

The service was clean and infection control measures were in place. The manager and senior care workers had robust audits in place to monitor the risk and spread of infection.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. There were no active complaints at the time of the inspection.

There was a range of quality audits in place completed by both the manager and provider. These were up to date and completed on a daily, weekly and monthly basis. All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns. Staff told us they enjoyed working at the home and enjoyed their jobs.

This inspection was unannounced and was carried out on 25 January 2017. The inspection was to check that the registered provider was now meeting legal requirements we had identified at inspections in April 2015, December 2015, April 2016 and August 2016. We asked the registered provider to take action to improve: Person-centred care; safe care and treatment; consent; nutritional and hydration needs; dignity and respect; safeguarding people from abuse; staffing; medicine management and good governance.

During this inspection we found that the registered provider had taken action to improve practices within the service in line with their action plan from October 2016. We found these improvements were sufficient to meet the requirements of Regulation 9, 10, 11, 12, 13, 14, 17, 18. This meant the service had met the breaches of regulation imposed at previous inspections.

There was a registered manager in post at the time 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 told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes. Improvements had been made to the deployment of staff. They did not appear rushed, had time to spend chatting with people and there was a good atmosphere in the service.

Improvements had been made to the medicine practices in the service. Medicines were administered safely by senior care staff and the arrangements for ordering, storage, administration and recording were robust.

Improvements were made to the control and prevention of infection systems within the service and we found the service to be clean and hygienic. Staff followed good hygiene practices and regular audits of the infection prevention and control system resulted in better cleanliness within the service. Action had been taken to reduce odours by replacing furniture and furnishings with easy to clean items.

Improvements had been made to staff training. The registered provider had an induction and training programme in place and staff were receiving regular supervision. However, the supervision meetings needed to be more robust.

Improvements had been made to how the service applied the principles of the Mental Capacity Act 2005. People gave consent to their care and their opinions and viewpoints were listened to and acted on. However, we found staff skills and understanding of this legislation was basic and would be enhanced by more in-depth training.

Improvements had been made to the dining experience of people living in the service. We saw that appropriate support with eating and drinking was provided to people who used the service and we saw that people received good quality meals and plentiful drinks throughout the day.

Improvements had been made to the way staff communicated with each other, with people who lived at the service and with relatives. People felt more included in decisions about their care and we saw that appropriate care and support was being offered to people who used the service. We observed a number of positive interactions between the staff and people they were caring for. We were told by people and relatives that oral hygiene care, pressure care and contact with external health care professionals were much better.

Improvements had been made to the way that care and treatment of people who used the service was provided. We saw that staff were more attentive and people received appropriate care and support in accordance with their wishes. Calls for assistance were answered in a timely manner and staff were visible on the units and seen attending to people’s needs.

Improvements to staff practice had been made to ensure that people were treated with respect and dignity by the staff. There was a formal complaints system in place to manage complaints if or when they were received.

Improvements to the recording and documentation of care had been made. The registered provider had introduced a new format for the care plans and this was in place at the time of our inspection. The new paperwork was well organised, detailed and person-centred and systems were in place for monthly reviews of the care files. We noted that staff were able to tell us about people’s care needs and demonstrated an improved knowledge of their health care conditions.

Activities within the service remained low key and there was further room for improvement to ensure everyone enjoyed stimulating and meaningful occupation during their stay in the service.

Improvements had been made to the quality assurance system including the safety of the service, the risks relating to the health, safety and welfare of people who used the service and the way feedback from people who used the service and staff was obtained. The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We received positive feedback from people who used the service, visitors, relatives and staff about the changes taking place in the service.

We carried out an unannounced inspection of this service on the 16 and 17 July 2016. This was to check that the registered provider was now meeting legal requirements we had identified at inspections in April 2015, December 2015 and March 2016.

There was a registered manager in post at the time 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.

At the time of our inspection the registered manager was on long term leave and an acting manager was in post covering their duties. We have referred to the acting manager as ‘the manager’ throughout this report.

Following our inspection of April 2015 the registered provider was found to be in breach of regulations pertaining to good governance. At the comprehensive inspections of the service in December 2015 and March 2016 we found the registered provider had failed to achieve compliance with this regulation. During this inspection, although there were signs that slight improvement had taken place, there was sufficient evidence to confirm the registered provider remained in breach. Effective systems were not in place to monitor assess and mitigate risk to people who used the service or ensure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the comprehensive inspections of the service in December 2015 and March 2016 we found the registered provider was in breach of regulations pertaining to providing person centred care. During this inspection although there were signs that slight improvement had taken place there was sufficient evidence to confirm the registered provider remained in breach. Care plans were not appropriate and did not meet the needs of the people who used the service or contain accurate information.

At the comprehensive inspections of the service in December 2015 and March 2016 we found the registered provider was in breach of regulations pertaining to providing safe care and treatment. During this inspection we found there was a further breach of this regulation in relation to medicine management. People who used the service did not receive safe care and treatment and avoidable harm or the risk of harm was not prevented. We found the service was failing to provide safe care and treatment by the proper and safe management of medicines. Clear and accurate records were not being kept of medicines administered by care workers. Quantities of medicines did not match what was administered which meant we could not be sure people were given their medicines as prescribed. Risk assessments did not support the safe handling of people's medicines and care staff did not have sufficient knowledge of how to safely administer people’s medicines.

At the comprehensive inspections of the service in December 2015 and March 2016 we found the registered provider was in breach of regulations pertaining to meeting people’s nutritional and hydration needs. During this inspection although there were signs that slight improvement had taken place there was sufficient evidence to confirm the registered provider remained in breach. People were not supported to have adequate nutrition and hydration to maintain good health and reduce the risks of malnutrition and dehydration.

At the comprehensive inspection of the service in March 2016 we found the registered provider was in breach of regulations pertaining to treating people with dignity and respect. During this inspection although there were signs that slight improvement had taken place there was sufficient evidence to confirm the registered provider remained in breach. We found staff actions did not always ensure people received respect and were treated with dignity.

At the comprehensive inspection of the service in March 2016 we found the registered provider was in breach of regulations pertaining to consent. During this inspection although there were some signs that slight improvement had taken place there was sufficient evidence to confirm the registered provider remained in breach. We found that instructions in people’s care plans failed to ensure the principles of the Mental Capacity Act 2005 were followed and best interest decisions were not in place as required.

At the comprehensive inspection of the service in March 2016 we found the registered provider was in breach of regulations pertaining to safeguarding people from abuse. During this inspection although there were signs that slight improvement had taken place there was sufficient evidence to confirm the registered provider remained in breach. We found evidence that staff practices left people at potential risk of harm and that on one occasion the manager’s investigation into an allegation of abuse was not robust.

At the comprehensive inspection of the service in March 2016 we found the registered provider was in breach of regulations pertaining to staffing. During this inspection although there were signs that slight improvement had taken place there was sufficient evidence to confirm the registered provider remained in breach. Staff were not provided with the skills and knowledge to carry out their roles effectively.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service remains in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider’s registration of the service, will be inspected again within six months. The expectation is that registered providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Westerlands Care Centre comprises of two buildings: Elloughton House and Brough Lodge. Brough Lodge is split into three units: The Garden Suite, Humber Suite and The Ridings Suite. Together the two buildings provide a total of 62 places to older people requiring nursing or personal care. Some people may have memory impairment and one unit in Brough Lodge cares particularly for people with needs that challenge the service. All rooms are single with en-suite facilities: toilet and a shower. There is a large accessible garden with decking area, patio furniture and space to walk. There is ample car park space available at the side of the property.

We carried out an unannounced inspection of this service on 21 and 22 March 2016. This was to check that the registered provider was now meeting legal requirements we had identified at inspections in April and December 2015.

There was a registered manager in post at the time 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.

Following our inspection in April 2015 the service was found to be in breach of regulations pertaining to good governance. At the comprehensive inspection of the service in December 2015 we found the registered provider had failed to achieve compliance with this regulation. During this inspection we found evidence to confirm the registered provider remained in breach. Effective systems were not in place to monitor assess and mitigate risks to people who used the service or ensure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the comprehensive inspection of the service in December 2015 the service was found to be in breach of regulations pertaining to providing person centred care. During this inspection we found evidence to confirm the registered provider remained in breach. Care plans were not appropriate and did not meet the needs of the people who used the service or contain accurate information.

At the comprehensive inspection of the service in December 2015 the service was found to be in breach of regulations pertaining to providing safe care and treatment. During this inspection we found evidence to confirm the registered provider remained in breach. People who used the service did not receive safe care and treatment and avoidable harm or the risk of harm was not prevented

At the comprehensive inspection of the service in December 2015 the service was found to be in breach of regulations pertaining to meeting people’s nutritional and hydration needs. During this inspection we found evidence to confirm the registered provider remained in breach. People were not supported to have adequate nutrition and hydration to maintain good health and reduce the risks of malnutrition.

During this inspection we also found evidence to confirm the registered provider was in breach of regulations pertaining to treating people with dignity and respect. We found staff actions did not always ensure people received respect and were treated in a dignified way.

During this inspection we also found evidence to confirm the registered provider was in breach of regulations pertaining to consent. We found that instructions in people’s care plans failed to ensure the principles of the Mental Capacity Act 2005 were followed and best interest decisions were not in place as required.

During this inspection we also found evidence to confirm the registered provider was in breach of regulations pertaining to safeguarding people from abuse and improper treatment. We found evidence that staff were using unauthorised physical interventions/restraint without the skills and knowledge to do so safely. We reported two pieces of evidence we found during the inspection to the local authority safeguarding team to investigate due to the nature and seriousness of the evidence.

During this inspection we also found evidence to confirm the registered provider was in breach of regulations pertaining to staffing. Staff were not provided with the skills and knowledge to carry out their roles effectively.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found multiple breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

The last inspection took place on 7 April 2015. At that inspection we asked the registered provider to take action to make improvements to Regulation 17: Good Governance. After the comprehensive inspection on 7 April 2015 the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breach of regulation.

This inspection found that the registered provider had made sufficient improvements to indicate that the level of impact on people who used the service was reduced from moderate to minor impact, but there remained a breach of Regulation 17.

Westerlands Care Centre comprises of two buildings: Elloughton House and Brough Lodge. Brough Lodge is split into three units: The Garden Suite, Humber Suite and The Ridings Suite. Together the two buildings provide a total of 62 places to older people requiring nursing or personal care. Some people may have memory impairment and one unit in Brough Lodge cares particularly for people with significant anxiety problems. All rooms are single with en-suite facilities: toilet and a shower. There is a large accessible garden with a decking area, patio furniture and space to walk. There is ample car park space available at the side of the property.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. 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 that the recording and administration of medicines was not being managed appropriately in the service. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

We had a number of concerns about the skills and knowledge of the staff on duty. We saw examples of extremely thoughtful, well executed personal care. However, we also saw interactions with people that appeared ill considered and unskilled. We found there was a general lack of understanding in how to manage people with significant anxiety problems. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3)

During our inspection we found that although people had access to sufficient meals and drinks, people said there was a lack of quality and choice of foods. The dining experience and how people were supported with their nutrition and hydration needs was not always appropriate and people’s nutritional and hydration needs were poorly monitored. This was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

People were not consistently treated the way they wanted to be treated. We observed some good interactions between staff and people living in the service. However, we also saw some evidence of poor care practices. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3)

We found that people who used the service had little or no input to the development of their care plans and we found that people’s care plans did not always clearly describe their needs. We saw evidence that some people were not receiving the care they required, and noted that when appropriate care had been given this information was not well recorded. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3)

We saw that the registered provider had a policy and procedure for complaints and people/relatives were aware of it. However, those people who spoke with us said they lacked confidence that their complaints were listened to or acted on appropriately and there was evidence that people were not using this process. We have made a recommendation about the management of complaints.

We saw that the registered provider had made some improvements to the service and there was work on-going in the service to continue with these changes. There remained a breach of regulation in quality assurance although sufficient improvements had taken place to move the impact rating from moderate to minor. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

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

People told us that they felt safe living at the home. We found that staff understood how to keep people safe from harm and staff had been employed following robust recruitment and selection processes. The registered provider had an induction and training programme in place and staff were receiving regular supervision.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and 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?

People were cared for and received support from staff that had been assessed and planned for. This was recorded in peoples' care plans so that staff knew how best to care for and support them.

People that used the service received a safe service of support, because staff adhered to risk assessments which meant peoples' needs were appropriately met in a way that minimised the risk of harm.

The service had measures in place to ensure peoples' 'best interests' were always considered.

We found that there were systems in place for handling safeguarding concerns, staff were knowledgeable about making referrals or handling information and staff understood their responsibilities for preventing abuse from happening. This in turn meant people that used the service were kept safe and the risks of harm or abuse were reduced.

People were protected from the risks of receiving their medication inappropriately because staff had been trained in medication administration and there were systems in place to ensure its safe storage, recording and administration.

People were safely cared for because there were sufficient staff on duty to meet peoples' needs once those staff that had not turned in for work had been replaced by substitute, additional staff.

Is the service effective?

We found that people received effective care that was in line with their care plan documents and their needs were met in a consistent way.

Staff had opportunities to gain qualifications and to complete training that enhanced their skills. We saw that the service had reviewed the staff training needs and this had increased the training opportunities of the staff group which improved the care and support to people that used the service. Staff received supervision to ensure they had the opportunity to air any concerns, discuss development and progress and receive instructions from the manager. This meant people received care and support from well supported staff.

Is the service caring?

We saw that staff were generally kind and polite when providing people with the assistance they required. Staff spoke calmly and encouragingly when supporting people with mobility, comfort or occupation. Staff used distraction techniques to prevent people from becoming distressed or agitated. This promoted peoples' wellbeing and kept them safe.

Is the service responsive?

We saw that staff responded to peoples' needs and requests for assistance with their care, in a timely manner. We saw that changes in peoples' needs were monitored, reviewed and recorded and those needs were met in line with their new care plans.

Is the service well led?

We saw that there was a new manager in post who had only been managing the service for two weeks prior to our inspection visit. Therefore we acknowledged that the service was in a state of transition with regard to changes in staffing personnel, staffing levels and training opportunities, changes in documentation and records held and changes in activities and stimulation for people that used the service. The manager had already identified these areas as requiring improvement in order to improve the service of care for people.

New care plans had been implemented for some people and others were still in the process of being changed. Staff were aware of the need to monitor and review peoples' care needs on a monthly basis and we saw this had been done within those care plans we looked at.

The new manager had continued with Prime Life's quality assurance systems to improve the service performance and had used it effectively to determine the most important areas for action. We saw that overall improvement in the service had been seen since they came into post. We will continue to monitor the quality assurance system.

We carried out an inspection on 31 July 2013 to check the provider's progress in meeting these regulations and we found that significant improvements had been made in all areas. We judged three of the four as compliant but Regulation 22: 'staffing', remained non-compliant. Though improved, we required that the provider demonstrated to us a period of sustained and continued improvement in staffing levels, especially at night. We received regular updates of the action plan and copies of the provider's rosters as evidence to support the progress made and evidence of staffing numbers on duty.

On 29 August and 24 September 2013 we visited the service late in the evening and on 9 October 2013 we visited the service early in the morning to check on staffing levels. These three visits have been reported on in this inspection report.

We briefly looked at the safety and suitability of the premises and record keeping and found that the home was compliant with these outcomes.

During our inspections in August, September and October 2013 we spoke with people that used the service, the regional director, the acting manager, the new clinical lead and staff. We observed people being supported by staff and we looked at some documentation: rosters, monitoring charts and action plan updates.

People we spoke with told us how they were being cared for and we were able to observe some interactions between them and the staff. Our judgement of peoples' care was mixed according to their individual needs, presenting conditions and the staffing deployment at the time of the visits. Mostly we saw that people were supported and reassured by understanding staff.

From information we gathered through observation of staffing numbers and documentation, across the three visits, we found that the provider was compliant with Regulation 22: 'staffing'. We were also able to remove the outstanding 'requirements' on 'safety and suitability of premises' and 'records'.

At this inspection visit on 31 July 2013 we found that there had been much improvement in the way care needs had been met. This related to care plans having been updated, external dementia support services having been accessed and in particular, how staff had made improved efforts to meet peoples' needs.

We found that there had been an increase in the numbers of staff having completed safeguarding training. The manager showed us evidence that staff had begun to complete an extensive programme of training, which included safeguarding training. We found staff understood their responsibilities to report safeguarding concerns.

We found that improvements had been made with the management of medication systems.

We found that while there had been improvements in the staffing levels, there had been times when people that used the service had to wait for their needs to be met and there had been times when the staffing numbers declared on the rosters had not been adhered to.

At our inspection in February 2013 we found that the provider was not compliant with regulation 13 in respect of the recording, safe keeping, safe administration and disposal of medicines. At this inspection in May 2013 we found that the provider was not compliant with the regulation in respect of obtaining, recording, handling and using of medicines. While nearly all the elements of the compliance action made in February had been met, new elements were identified in May. Therefore a new compliance action has been made at this inspection.

We found people were treated respectfully though not everyone had their individual care needs fully met. People were experiencing improvements in the food provision.

People were not always safeguarded from abuse and not all staff had been trained in safeguarding people from harm. Staff were employed following safe recruitment procedures.

We were given staffing rosters for four weeks and we observed staff availability. We found there were insufficient staffing levels.

We were given a current staffing list which showed 53 staff names (25 care staff and 13 bank care staff). We were also given a staff training matrix containing staff names. We found the names on the staffing list did not match those on the training matrix. While staff received training for their roles there were some gaps in numbers of staff trained.

There were systems in place to monitor and assess the quality of care and these were being improved.

Throughout this report the two buildings at Westerlands Nursing Home, Brough Lodge and Elloughton House, will be referred to as BL and EH. All reference to the manager means the 'acting' manager.

The outcomes we looked at on this visit related to safeguarding people who used the service from abuse, management of medicines and supporting workers. We spoke with five people that used the service, the acting manager, the nurse on duty, the area manager and two care staff. We looked at the medication handling systems and we viewed some of the documentation maintained by the service.

We found that the service handled information of a safeguarding nature appropriately and that the person responsible for the overall running of the home understood their safeguarding responsibilities. We found that the service did not manage medicines adequately to ensure peoples' safety and so action was required. We also found that the service adequately supported staff to carry out their roles though there was some concern that staff performance did not always reflect this.

People we spoke with were unhappy about the fact that they needed care, but did not make any negative comments about the care they received.

We found that all three regulations had been complied with, as care plan documentation had been reviewed and updated, safeguarding training had been completed, referrals had been made to the safeguarding team and staffing levels had improved. We found that the provider was still monitoring the levels of staffing required and that there was a determination to ensure levels continued to increase with the rise in numbers of people that used the service. We expected staffing levels and deployment of staff to change with this rise.

People told us they were adequately cared for and that staff were helpful and available when needed. We saw staff supporting people and spending time with them. One person said, "I get the help I need when I need it though I am quite independent. The staff are polite. I can do as I please and I am satisfied even though this is not really home." People were comfortable, warm and satisfied with food that the service provided.

Although we saw that people received good care and support, information in care plans did not always reflect this and was not always up to date. We also saw that there were insufficient numbers of staff on duty overnight to ensure that people received safe care and supervision.

Staff told us that they understood the different types of abuse and the action they needed to take should they observe poor practice. However, there had been some incidents at the home that should have been referred to the local authority safeguarding adults team for investigation and this had not occurred.