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Inspection Summary


Overall summary & rating

Good

Updated 21 September 2017

Westbury Lodge is a small care home providing accommodation which includes personal care for up to eight people. At the time of our visit, six people were using the service. The service supports people with a range of needs including learning disabilities, mental health, physical disabilities and sensory impairment. The provider Parkcare homes (No.2) Limited is part of the wider Priory group. The home is arranged over two floors and does not have a lift in place. For this reason the home does not accept any placements where the person has mobility difficulties above the ground floor.

At the last comprehensive inspection in November 2016, we identified the service was still not meeting four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one further breach of the Regulations had been identified. We served a positive condition on the provider’s registration in which the service had to submit monthly reports so we could be assured the concerns were being addressed and monitored. The service remained in special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. The Local Authority placed an embargo on admissions to the home, whilst they made the required improvements and this remains in place.

A registered manager was in post at this service however at this inspection the registered manager was not present and was on a period of planned leave. 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. An acting manager had been recruited and was responsible for running the service during this time. The acting manager was available throughout this inspection.

At this inspection we found the service had made the necessary improvements to be meeting all of the previously identified breaches of Regulations. No further breaches were found at this inspection. The service is no longer in special measures but will continue to be monitored to ensure the improvements are sustained.

At this inspection we found that there were still some areas of improvement needed in the safe management of people’s medicines. People who had been prescribed medicines to take ‘As required’ (PRN) did not always have a protocol in place. We saw that some PRN protocols had not been reviewed monthly as stated. During the time medicines were being administered, staff would interrupt the staff member administrating to ask unrelated questions, which had the potential for errors to be made.

Although the service had sufficient levels of staff in place there was still a high use of agency staff. During our inspection five staff were on duty. In the morning three members of staff were agency. This then dropped to two agency and three permanent staff in the afternoon. The management team had changed the rotas to ensure consistency of permanent staff was maintained across the home including at weekends.

Staff told us they were confident in knowing how to respond if they saw an incident or heard an allegation of abuse and discussed how to identify if someone who could not speak was being abused. One member of staff said they would look for physical signs of abuse such as bruises. Another member of staff said “I know the people here so well, all their quirks and everything, I would notice any slight change in their behaviour and instantly know something was up.”

Mealtimes were a dignified and pleasant experience for people. There was clear teamwork and coordination between the staff to ensure mealtimes ran smoothly and were enjoyable for people. A new way of working had been introdu

Inspection areas

Safe

Requires improvement

Updated 21 September 2017

The service was not always safe.

Medicine management had areas of improvement needed around protocols and the review of these. The administration process was often interrupted making it hard for the staff concerned to concentrate.

Although the service had sufficient levels of staff in place this was still being maintained by the use of agency staff.

Staff had received training on how to protect people from abuse and were knowledgeable in recognising signs of potential abuse.

Effective

Good

Updated 21 September 2017

The service was effective.

The mealtime experience had improved and people were supported appropriately by staff to meet their specific dietary needs.

Staff had suitable skills and received training to ensure they could meet the needs of the people they cared for.

People’s health needs were assessed and staff supported people to stay healthy. Staff worked with community nurses and GP’s to ensure people’s health needs were met.

Caring

Good

Updated 21 September 2017

The service was caring.

People received support in a caring and sensitive manner. Positive interactions were observed between people and staff.

People were encouraged to remain independent and care was provided in an unrushed manner.

Staff took account of people’s decisions and choices were promoted and upheld.

Responsive

Good

Updated 21 September 2017

The service was responsive.

People’s needs were assessed and care plans were personalised and reflected the care and support they needed.

People were encouraged to participate in activities that matched their interests.

People's concerns and complaints were encouraged, investigated and responded to in good time.

Well-led

Good

Updated 21 September 2017

The service was well-led.

The service had, and was continuing to receive support from senior management to support the home to develop.

A management team was in place who was striving to achieve the best outcomes for people and create a positive and open culture.

Systems were in place to review incidents and audit performance, to help identify any themes, trends or lessons to be learned. Quality assurance systems involved people who use the service, their representatives and staff and were used to improve the quality of the service.