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Westerlands Care Village Good

Reports


Inspection carried out on 23 November 2020

During an inspection looking at part of the service

About the service

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

Inspection carried out on 9 January 2018

During a routine inspection

Westerlands care village is a ‘care home’ set across two separate buildings. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Westerlands Care Village comprises of: Elloughton House and Brough Lodge. Brough Lodge is split into three floors The Garden Suite, Humber Suite and The Ridings Suite. Together the two buildings provide a total of 62 places to older people requiring personal care, some of whom may be living with memory impairment. The Garden Suite primarily cares for people with needs that may challenge.

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 lea

Inspection carried out on 25 January 2017

During a routine inspection

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: a 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. At the time of this inspection there were 16 people living at Elloughton House and nine people living at Brough Lodge. All 25 people required residential care.

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 communicate

Inspection carried out on 16 August 2016

During a routine inspection

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 predominantly 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 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

Inspection carried out on 21 March 2016

During a routine inspection

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

Inspection carried out on 10 December 2015

During a routine inspection

This inspection was unannounced and took place on the 10 and 11 December 2015.

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 th

Inspection carried out on 7 April 2015

During a routine inspection

The inspection of Westerlands Nursing Home (known as Westerlands Care Village) was on 7 April 2015 and was unannounced. At the previous inspection on 26 June 2014 the regulations we assessed were all being complied with.

Westerlands Care Village provides a service to a maximum of 62 older people who may have nursing needs or who may have a health diagnosis that means they live with dementia.

We found that some records weren’t always sufficiently well maintained to ensure accuracy of information about people and their care or healthcare needs. While these did not impact majorly on people there may have been times when people did not receive the care, treatment or support they required. We observed this during our visit. There were other records on recruitment, medication, monitoring charts, accidents and staff training that were inadequately maintained and while impact on people was minor there were too many areas of the service affected which meant that inadequate record keeping was systematic in the service.

This was a breach of regulation 17 of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014. Regulation 17 refers to good governance. You can see what action we have asked the provider to take at the end of the full version of this inspection report.

We found that most of the staff were trained in safeguarding adults from abuse, but not many were trained in management of medicines and moving and handling. There were satisfactory numbers of the staffing complement that had been trained in dementia awareness. The nursing staff employed did not have evidence of the training courses they had completed and one nurse did not have evidence of their Nursing and Midwifery Council personal identification number. Some improvement was required in this area.

We found that there were suitable arrangements in place to ensure safeguarding incidents were tested against the East Riding of Yorkshire Council Safeguarding Adults Team thresholds for referral, were referred when they crossed these thresholds and were dealt with internally when they did not. Staff understood what constituted abuse and were able to tell us the signs and symptoms they would look for. They also understood their responsibilities regarding reporting and handling information, either of an allegation of abuse or actual abuse that has taken place.

The premises were safe and adequately maintained, but decoration and furnishings did not assist in the care of people living with dementia. This was discussed with the registered manager and regional director – northern. They undertook to research some of the excellent work being done around the country on dementia care. This was so that the service could be adapted to incorporate signage, make use of appropriate colour and décor and move towards providing meaningful activity / occupation for all of the people living with dementia at Westerlands Care Village.

From looking at the staffing rosters, observing staff providing support and speaking with people and their visitors about staffing levels we found that numbers of care staff were sufficient to meet people’s needs if they did not have to carry out ancillary duties. However, the deployment of staff could have been improved to ensure people’s needs were met more effectively and in a timelier manner regarding their medication, assistance with getting ready for the day and engaging in more occupation.

Recruitment of staff followed appropriate policies and procedures but implementation of the systems required tightening up to ensure they were more effective at evidencing staff were suitable and appropriately trained to work with vulnerable people.

We found from speaking with staff, observing staff giving out medication and assessing the systems for management of medication that medicines were safely handled, but recording in this area needed to be more carefully undertaken to ensure accurate records were held.

The service appropriately managed the use of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards legislation which ensures people’s rights are upheld and they are legally represented at times when they are unable to exercise capacity decisions.

The service provided people with adequate nutrition and hydration and while the meals weren’t always to everyone’s liking they offered some choice and were plentiful. People had mixed views about the provision of nutrition and we judged that breakfast could have been offered at a more appropriate time, but we found there were no concerns about the quantity and quality of food people received.

We found that staff were caring with regard to the physical care needs people presented but were not always attentive to people’s emotional and mental health care needs. This was not as a result of lack of compassion, more a result of the deployment of staff which meant they had insufficient time to enquire how people were and spend time with them providing quality conversations.

Confidentiality and privacy were adhered to so that people knew their intimate details would not be passed among other people that used the service and they received support with personal care in private. Dignity was adequately upheld but there were isolated situations that could have been thought about more carefully. Where possible people were encouraged to be independent in thought and deed.

People had care plans in use to record their assessed needs, inform staff how best to meet those needs and to show changes to care provision and support following changes in needs. Care plans followed a uniform format, were reflective of people’s needs and were kept up-to-date.

Complaints were appropriately listened to, recorded, investigated and managed. Complainants received appropriate written responses and efforts were made to improve situations for people. Staff were not always fully informed of the best way forward following a complaint, which meant their practice was slow to change and so sometimes people and their visitors felt complaining was ineffective.

The service cooperated well with other organisations, care providers and health care professionals, so that people received optimum care wherever possible when more than one care provider was involved.

The service has had a newly registered manager in post since 20 March 2015. There have been some changes in the staff group over the last 12 months and new staff were being recruited when we made our inspection visit. Information we obtained from the registered manager, staff, people that used the service and their visitors showed there was a tentative confidence in the new management team, though we judged that the registered manager needed to have a more visible presence.

Prime Life Limited still operated a quality assurance system in Westerlands Care Village, which required further development with regard to collating and analysing information and presenting its findings to people. There was evidence that audits had been carried out in June 2014, but there were gaps in their action planning. We were shown some new satisfaction surveys that were to be issued to people, visitors and stakeholders. These needed to be used to obtain people and stakeholder’s views of the service they received.

Inspection carried out on 26, 27 June 2014

During a routine inspection

Our inspector visited the service to carry out a scheduled inspection and the information they collected helped answer our five questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 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.

Inspection carried out on 9 October 2013

During an inspection looking at part of the service

We carried out an inspection on 30 April 2013 and found that while the provider was compliant with five of the outcomes we assessed, they were not compliant with three outcomes. These were Regulation 9: �care and welfare�, Regulation 22: �staffing� and Regulation 10: �monitoring the quality of the service'. On 20 May 2013 our Pharmacy Inspector carried out an inspection and found that the provider was not compliant with the Regulation 13: �management of medicines�. Compliance actions were made in respect of these four outcomes. We received the provider's action plan when we asked for it.

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'.

Inspection carried out on 31 July 2013

During an inspection looking at part of the service

At our last inspection on 30 April 2013 we had found that the service was non-compliant with regulations 9, 11 and 22 and at our last pharmacy visit on 20 May 2013 we found the service was non-compliant with regulation 13.

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.

Inspection carried out on 20 May 2013

During an inspection looking at part of the service

Most people living in the home did not know, or were unaware of what medicines they were prescribed. This meant that they were unable to talk to us about their medicines in a meaningful way. However we found that not everyone living in the home was being given their medicines correctly.

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.

Inspection carried out on 30 April and 1 May 2013

During a routine inspection

A team of two compliance inspectors, an �expert by experience� and a �specialist professional advisor� visited the service.

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.

Inspection carried out on 6 February 2013

During an inspection in response to concerns

We visited Westerlands Care Centre in response to information of concern sent to the Care Quality Commission (CQC) via the whistle blowing system and also following information received from the East Riding of Yorkshire Council who had visited to investigate safeguarding adult's concerns with regard to medication handling, care and staffing levels.

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.

Inspection carried out on 2 January 2013

During an inspection looking at part of the service

In October 2012 we had visited Westerlands Nursing Home to carry out a scheduled inspection. We had found that three regulations were not met; regulations 9 'care and welfare of people that used the service', 11 'safeguarding people that use the service from harm' and 22 'staffing'. Compliance actions were made for these. We had received an 'improvement plan' from the provider, which told us how the regulations would be met. We visited the service today to monitor the progress made to ensure the service was compliant.

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.

Inspection carried out on 12 October 2012

During a routine inspection

People spoke highly about the skills of the staff group and we observed that there were good interactions between the staff and people who lived at the home, with friendly and supportive care practices being used to assist people in their daily lives. A person who lived at the home said, "Staff have done their upmost to help me" and a relative told us, "Staff are really good".

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.

Inspection carried out on 5 March 2012

During an inspection looking at part of the service

We did not speak to people living at the home as part of this review.

Inspection carried out on 5 December 2011

During a routine inspection

We spoke with three people regarding their care and welfare. Everybody spoke highly of the service and how friendly the staff were. One person said �I didn�t want to be here, I wanted to be at home, but they do look after me.� Another person said �The food is good, plenty of it.�

Inspection carried out on 21 December 2010

During an inspection in response to concerns

We spoke to four or five people in the home who said they are given choice in most areas of their lives, personal care, food, where to sit, what to do etc. They are generally quite content with the assistance they receive and with their choices in life. One person with her visitor was quite clear that she did not wish to be receiving care and expressed the desire to go home, but due to cognitive impairment and physical illness she needs to be cared for. Other people were much more settled and resigned to accepting of the care they need. They went about their daily lives as well as they could and called for assistance as necessary.

The people we spoke to told us the care they receive is how they wish it to be and that it meets their needs. One person said she liked living in the home though she couldn't remember how long it had been. Also that her room was very nice and she enjoyed staying in it except to come down for lunch. Another told us she chooses her own clothes and comes and goes when she pleases. A visiting relative told us that they were happy with the care given to their spouse, that the place was pleasant, the food was good and the way their spouse was spoken to was very acceptable. Other people said they were well cared for and the staff were very helpful.

The people we spoke to who said they have choice when it comes to food, that the food is usually good and that meal times are flexible. One visiting relative said they had eaten a meal with their spouse once or twice and that the food was very acceptable. People said they enjoyed their meals and did not have any problems with the food provision. We also spoke to three people in the day centre who were equally satisfied with the food provided.

The people we spoke to did not express any concerns about the way they are treated, spoken to or cared for. A visiting relative said their spouse is always treated well and does not have any complaints.

People in the home spoken to were asked if they were comfortable and warm. One was asked if they required extra clothing as she was only wearing a short sleeved blouse. She said she was fine and did not need anything else. Other people were wearing body warmers or jumpers and had blankets over their laps. No one said they were cold.

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