Archived: Westwood Lodge

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. All rooms are for single use. 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 the inspection, 56 people were using the service.

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

Medicines were managed safely, however there were some discrepancies in the recording documentation for some people. We have made a recommendation in relation to the management of people's medicines.

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.

There were sufficient numbers of trained staff to support people safely. Recruitment processes were robust and helped to ensure staff were appropriate to work with vulnerable people.

People's needs were assessed before starting with the service. People and their relatives, where appropriate, had been involved in the care planning process. Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible.

Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively. Staff received regular supervisions.

Staff worked with other agencies to provide consistent, effective and timely care.

We observed many caring and positive interactions between staff and people throughout the inspection. Staff had formed genuine relationships with people and knew them well and were seen to be consistently caring and respectful towards people and their wishes.

The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home.

The service had an open and supportive culture. There was evidence of improvement and learning from any actions identified. Staff spoke positively about the management team.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 24 December 2019).The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 October 2019. A breach of legal requirements was 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.

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 and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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.

Follow up

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

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. 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 the time of the inspection, 65 people were using the service.

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

Medicines were not always managed safely which placed people at risk of harm.

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.

The service had an open and supportive culture. Systems were in place to monitor the quality and safety of care delivered. There was evidence of improvement and learning from any actions identified.

There were sufficient numbers of trained staff to support people safely. Recruitment processes were robust and helped to ensure staff were appropriate to work with vulnerable people.

People’s needs were thoroughly assessed before starting with the service. People and their relatives, where appropriate, had been involved in the care planning process.

Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively. Staff received regular supervisions.

Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible. Staff supported people to access other healthcare professionals when required.

Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people’s assessed needs.

We observed many caring and positive interactions between staff and people throughout the inspection. Staff had formed genuine relationships with people and knew them well and were seen to be consistently caring and respectful towards people and their wishes.

People were supported to express their views. People we spoke with told us they had choices and were involved in making day to day decisions.

The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service, however at the time of the inspection, these had not rectified the issues we found with the management of people's medicines.

The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home where people could move around freely as they wished.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 October 2018) and there were three breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of one regulation. This is the second time the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

Enforcement

We have identified breaches in relation to safe care and treatment. Please see the action we have told the provider to take at the end of this full 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.

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 home for end of life care did not have a completed initial assessment or end of life care plan. A second person also had no end of life care plan, preferred place of care or advanced care plan in place.

We found the lack of completed documentation and poor communication between different staff roles was negatively affecting the provision of end of life care. People’s care plans did not contain adequate information regarding their end of life wishes and plans for end of life care were not consistently recorded, which meant people may not receive essential support in accordance with their preferences and choices.

The service failed to ensure plans were consistently in place to ensure the people were enabled to make decisions about their end of life wishes.

The manager completed regular audits of all aspects of the service and there was evidence of learning from these audits. Medicines audits were carried out each month, with an associated action plan to meet any requirements. However, we found that although a system of auditing was in place, audits had not identified the issues we found with the safe management of medicines and gaps in care planning information in relation to end of life care.

The service had failed to effectively assess, monitor and improve the quality and safety of the services provided.

People we spoke with told us they felt safe living at the home. Care and support was provided in a person-centred way and considered the individual requirements of each person. The service had a safeguarding procedure in place which offered guidance to staff on how to effectively raise a concern and staff knew how to do this.

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). People’s nutritional requirements were assessed by the home and nutritional and hydration risk assessments had been undertaken. People had a choice of food each day.

The provider had a business continuity management plan which identified the action to be taken for an unforeseen event such as loss of utilities.

Staffing levels were adequate to meet the needs of the people using the service, however agency nursing staff were still being used which affected continuity of care.

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.

Staff told us they had received the training and support they needed and confirmed they received supervision from the manager.

The service was working in accordance with the Mental Capacity Act and Deprivation of Liberty Safeguards (MCA/DoLS). Care files contained consent to care and treatment forms which were signed by the person or their relative/representative.

Support was provided to people in a caring way and people who used the service made positive comments about the staff. People told us they were treated with dignity and respect and were encouraged to be as independent as possible. People were well presented and looked clean and well-groomed and there was a friendly atmosphere between staff and people living at the home. We observed staff were respectful and friendly towards the people who used the service when supporting them.

We saw a range of activities were offered to people which included group activities as well as more personalised one-to-one sessions. Activities were displayed on notice boards throughout the home.

There was a system in place for people to make complaints and a complaints file was in place.

Staff told us they were supported by the manager and could put their views across to the management. 'Flash' meetings were held daily between the manager and general staff group and this provided an opportunity to discuss people’s on-going issues.

We saw evidence of regular staff meetings being undertaken. Resident and family meetings were also held regularly.

There was a service user guide and statement of purpose in place. A statement of purpose is a document which includes a required set of information about a service.

We saw the ratings from the previous inspection were displayed in the reception area of the home, which is now a legal requirement.

The service worked alongside other professionals and agencies in order to meet people's care requirements where required.

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 that they received supervision from their line manager.

At this inspection we found that the nursing assistant role had commenced but was at an early stage of development. This role was designed to provide support to the nursing staff team and to address the shortage and difficulty in recruiting registered nurses.

The service was working in accordance with the Mental Capacity Act and Deprivation of Liberty Safeguards (MCA/DoLS). Care files contained consent to care and treatment forms which were signed by the person or their relative/representative.

Individual nutritional needs were assessed and planned for by the home and nutritional and hydration risk assessments had been undertaken by the service.

At this inspection we found that further improvements had been made to the environment with changes to colour schemes and different coloured grab rails and toilet seats in bathrooms in addition to a range of ‘dementia friendly’ signage throughout the home that would help a person living with dementia to better orientate around the building.

We observed the delivery of care was compassionate and caring. People who used the service were complimentary of the staff that cared for them. We saw people were encouraged to take pride in their appearance to help promote independence and boost self-esteem. Every person we spoke with told us they were treated with dignity and respect and addressed by their preferred name. Everyone told us they were encouraged to be as independent as possible.

Everyone we spoke with on all the units of the home told us the staff always knocked before entering bedrooms and that doors were closed when personal care was being carried out, which we observed to happen during the course of the inspection. People looked clean and well groomed. Staff knew people well and there was a friendly atmosphere between staff and people living at the home.

People's care files contained end of life care plans, which documented people's wishes at this stage of life where they had been open to discussing this. At the time of the inspection no-one was on receipt of end of life care.

People's care files identified that individuals and their relatives were involved in the planning of their care and personal preferences were discussed. The service had a clear process for new admissions and used a range of detailed assessment formats to ensure they could meet the person's needs.

We observed staff were respectful and friendly towards the people who used the service whilst supporting them.

We saw a range of activities were offered to people which included group activities as well as more personalised one-to-one sessions. Activities were displayed on notice boards throughout the home.

The service had effective systems in place for people to use if they had a concern or were not happy with the service provided to them. A complaints file was in place and these were also captured on the provider database and monitored by the complaints team.

People who lived at Westwood lodge and their relatives felt able to express their views about the service on an on-going basis by having conversations with the staff and completing satisfaction questionnaires.

Staff told us they felt the new manager was doing a good job and that the home had made positive changes since the date of the last inspection. Staff told us they felt they were able to put their views across to the management, and felt they were listened to.

The manager was very visible within the home and actively involved in the provision of care and support to people living at Westwood Lodge. We saw an extensive range of audits and checks were now undertaken by the home. ‘Flash’ meetings were held daily between the manager and general staff group and this provided an opportunity to discuss on-going issues.

We saw evidence of regular staff meetings being undertaken and a list of upcoming staff meetings was displayed in several areas within the home.

Resident and family meetings were also held regularly and we noted previous discussions had included staffing, food, laundry, maintenance, management, funding, sensory garden development, activities.

There was a service user guide and statement of purpose in place. A statement of purpose is a document which includes a required set of information about a service.

We saw the ratings from the previous inspection were displayed in the reception area of the home, which is now a legal requirement.

The service worked alongside other professionals and agencies in order to meet people’s care requirements where required.

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 used the service.

We saw people had risk assessments in place, which included falls, pressure sores, mental capacity, choking and malnutrition.

The service was able to demonstrate that staff providing End of Life (EoL) care had the necessary qualifications, competence, skills and experience to do so.

We looked at the supervision planner and policy. Though policy stated that there should be at least two supervisions a year for each member of staff, this was not reflected in records we looked at.

We found appropriate DoLS (Deprivations of Liberty Safeguards) applications had been made by the manager, where people had been deemed to lack capacity to make decisions. Staff had also received training in this area and had an understanding of the legislation.

We have made a recommendation about seeking guidance on ‘dementia friendly’ environments.

People told us their overall impression with the home was good and that staff were kind and caring.

Throughout our inspection, where we observed interaction between staff and people who used the service, it was kind and caring. We witnessed a very caring environment where people were well cared for.

People who used the service told us that their dignity and privacy was always respected by staff.

People and relatives told us they were involved in making decisions about their care and were listened to by the service.

Care files were well organised and contained care plans that covered a range of health and social care support needs.

On the second floor nursing unit, the nurse told us that everybody sat in the lounge should be on a pressure cushions. We found this was not the case.

During our examination of turning and fluid charts, we found examples of where data had not been record accurately or was missing.

We have made a recommendation about opportunities for people to take part in activities they enjoy and meet their personal preferences.

During this inspection we found that although improvements had been in the way the home monitored and assessed the quality of service provision, there were still concerns about the effectiveness of auditing systems, especially in light of the concerns identified around the safe administration of medicines.

Staff told us they believed the home together with staffing had improved with the new provider and management team.

Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service. We saw the ratings from the previous inspection were displayed in the reception area of the home, which is now a legal requirement.

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.

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 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.

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 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.