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Inspection carried out on 5 March 2018

During a routine inspection

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

The service provides accommodation for people who require nursing care. The service is registered to accommodate 27 people. At the time of the inspection 24 people were accommodated.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good. The service met all relevant fundamental standards.

A registered manager was in post. The registered manager had led the care team consistently for ten years.

The service maintained effective systems to safeguard people from abuse and individual risk was fully assessed and reviewed.

Medicines were safely stored and administered in accordance with best-practice and people’s individual preferences. Nursing staff were updated and trained in administration. The records that we saw indicated that medicines were administered correctly and were subject to regular audit.

We saw evidence that the service learned from incidents and issues identified during audits. Records were detailed and showed evidence of review by senior managers.

People’s needs were assessed and recorded by suitably qualified and experienced staff. Care and support were delivered in line with current legislation and best-practice.

The service ensured that staff were trained to a high standard in appropriate subjects. This training was subject to regular review to ensure that staff were equipped to provide safe, effective care and support.

We saw clear evidence of staff working effectively to deliver positive outcomes for people. People reviewed were receiving effective care and gave positive feedback regarding staff support.

We saw evidence that the service worked effectively with other health and social care agencies to achieve better outcomes for people and improve quality and safety. The professional that we contacted did not express any concerns about the quality and effectiveness of these relationships. We saw evidence in care records of appointments with GP’s, opticians and dentists and supporting professionals such as the palliative care team.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA).

People told us that staff treated them with kindness and respect. It was clear from care and incident records that staff were vigilant in monitoring people’s moods and behaviours and provided care in accordance with people’s needs.

Staff were clear about the need to support people’s rights and needs regarding equality and diversity. Care records contained information about people’s sexuality, ethnicity, gender and other protected characteristics.

We checked the records in relation to concerns and complaints. The complaints’ process was understood by the people that we spoke with. We saw evidence that complaints had been responded to in a professional and timely manner by the registered manager or a senior manager.

People spoke positively about the management of the service and the approachability of senior staff.

Westcliffe Manor had well developed quality monitoring processes and the registered manager had support from senior managers. Policies and procedures provided guidance to staff regarding expectations and performance.

People using the service and staff were involved in discussions about the service and were asked to share their views. This was achieved through daily contact by the managers and regular surveys. The most recent survey yielded a very positive response.

Further information is in the detailed findings below

Inspection carried out on 5 April 2017

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service in November 2016 when two breaches of legal requirements were found. We found a breach in regulation regarding people’s care planning as there was a lack of recorded detail to help ensure people’s health care needs were met. There was also a breach in respect of the home’s governance arrangements to monitor and improve the quality of the service.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 5 April 2017 to check that they had they now met legal requirements.

This report only covers our findings in relation to the specific area / breach of regulation. This covered two questions we normally asked of services; whether they are 'effective' and ‘well led’.’ The question 'was the service safe’, ‘was the service responsive' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westcliffe Manor on our website at www.cqc.org.uk.

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.

Westcliffe Manor provides accommodation for people who require nursing care. This may be on a permanent basis or for respite. Westcliffe Manor is situated in a quiet residential area of Southport with good transport links to the town centre, the sea front and other local amenities. The accommodation comprises of 27 single rooms and three double rooms. Bedrooms are situated on three floors with lift access. There are gardens to the rear of the property and parking at the front.

At this inspection the care plans and associated care records we viewed recorded sufficient information to enable staff to provide safe and effective care. This breach had been met.

At this inspection we found systems and processes in place to assure the service provision. This included a number of internal audits including senior management audits which looked at different aspects of the service. For example, care plans, medicines, maintenance, catering, dining experience and laundry. This breach had been met.

Inspection carried out on 2 November 2016

During a routine inspection

This unannounced inspection of Westcliffe Manor took place on 2 November 2016.

Westcliffe Manor provides accommodation for people who require nursing care. This may be on a permanent basis or for respite. Westcliffe Manor is situated in a quiet residential area of Southport with good transport links to the town centre, the sea front and other local amenities. The accommodation comprises of twenty seven single rooms and three double rooms. Bedrooms are situated on three floors with lift access. There are gardens to the rear of the property and parking at the front.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to care planning and the service’s governance arrangements.

We looked at people’s care documents. We found people’s care planning lacked sufficient detail to help ensure their care needs were being effectively recorded, monitored and evaluated. Clinical monitoring records were not always completed which meant that an accurate evaluation of care needs could not be made.

The organisation had systems in place to monitor the safety and quality of the service. Systems included audits (checks) on how the service operated. We found on inspection that the provider did not always ensure effective systems and processes were in place to consistently assess, monitor and improve the safety and quality of the service. This was because the shortfalls we identified on inspection for of care planning and around the management of medicines given ‘when required’ (PRN) and management of people who wish to administer their own medicines had not been picked up by the current auditing arrangements.

We found medicines were safely administered to people and people told us they received their medicines on time. We found some inconsistencies of practice to support people with PRN medicines and for people who wished to administer their own medicines. The registered manager took swift action to rectify this.

People said they felt safe living at the home and were supported in a safe way by staff.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. An adult safeguarding policy and the local authority’s safeguarding procedure was available for staff to access.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the local authority.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

Staff told us they felt appropriately trained and supported. Training records showed a programme of on-going training, supervision and appraisal.

People living at the home and staff told us that there were sufficient numbers of staff employed. The registered manager informed us that staffing was based on people’s dependencies and subject to review as required. The staffing rotas showed a consistent staff team.

Risks to people’s health and wellbeing had been assessed in accordance with people’s needs.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff made referrals to healthcare professionals for advice and support at the appropriate time.

People’s individual needs and preferences were known and respected by staff. People told us staff were kind, caring and respectful in their approach. We observed positive i

Inspection carried out on 6 January 2014

During a routine inspection

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to five people resident at the service, two relatives of people and two staff members. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

People said that they had no concerns about the home or the care that service users received, and that the staff were, “charming and very helpful.”

Relatives said that staff always had time to talk to them and that they were very pleased with the care that their relative received there. We saw that staff were attentive and caring, knew the service users’ needs and called people by name.

We saw that medicines were managed safely.

We saw that the numbers of staff on duty was matched to the assessed care needs of the people using the service and varied from time to time as dependency or needs changed.

Inspection carried out on 11 September 2012

During a routine inspection

We visited Westcliffe Manor on 11 September 2012.

On our tour around the home we noted that all the rooms, including the bathrooms, were extremely clean and fresh, the décor was bright and the home was generally in a very good decorative condition and the building was in a good state of repair. We observed that staff spoke to people politely and treated them with respect.

During our visit we spoke with the manager, three staff members, three visitors and two people who used the service. One of the visitors said of the home "you can't fault it" whilst another described it as "home from home". The visitors told us that they were always made welcome and that the staff and management were very approachable.

One person who used the service told us that they were "very happy" living there, whilst another said that they got on with all the staff and were "very well looked after.

We looked at a sample of records at the home and found that they were well maintained and comprehensive. There was evidence that records were frequently reviewed and updated and that the people who used the service, and their relatives, were involved in these reviews.

We saw minutes of meetings that showed a commitment to continual quality assurance assessment and monitoring. Feedback from people who used the service, and their representatives, was evidenced and acted upon.

Reports under our old system of regulation (including those from before CQC was created)