• Care Home
  • Care home

Archived: Westmead - Care Home Physical Disabilities

Overall: Good read more about inspection ratings

Westmead Close, Saunton Road, Braunton, Devon, EX33 1HD (01271) 815195

Provided and run by:
Leonard Cheshire Disability

Important: The provider of this service changed. See new profile

All Inspections

9 June 2018

During a routine inspection

This comprehensive inspection was unannounced and took place on 9 and 11 June 2018.

At the previous comprehensive inspection completed in March 2017 we rated the service as overall requires improvement and issued a warning notice in relation to staff recruitment and a requirement in relation to staffing. Following this the service sent us an action plan showing how they intended to be fully compliant.

We completed a focussed inspection in October 2017 and found the service had met the warning notice and had taken steps to ensure their recruitment processes and policies across the organisation were updated and robust. They also met the requirement in relation to staffing and ensuring there were sufficient staff to meet people’s needs in a timely way.

At this inspection, we found that the improvements to staffing and recruitment had been sustained.

Westmead 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 care home) accommodates up to19 people in one adapted building. People living in the home have complex physical needs and some have learning disabilities.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support because it is registered for more than six people. However, it does follow best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

Since the last inspection the service had a new registered manager, who had been in post for a few months when we completed this 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 said they felt safe and well cared for. Two people mentioned the use of agency staff but felt that the continuity of having the same agency staff had helped. Two people mentioned the home had been in a “turmoil” as there had been some tensions between some individuals living there. This had caused “disruption and a tense and difficult atmosphere.” This had been resolved because one person had left the service.

There were sufficient staff with the right skills and understanding of people’s needs and wishes. This meant outcomes for people had improved. People said staff were kind and helpful. Our observations showed staff respected people’s dignity and privacy and worked in a way which showed kindness and compassion.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to care and treatment was sought. Staff used the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and understood how these applied to their practice.

Care and support was person centred and well planned. Staff had good training and support to do their job safely and effectively. Activities were beginning to be tailored to meet individual’s needs. The use of volunteers had helped to ensure people had regular opportunities to get out and about.

Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People received their medicines safely and on time most of the time. There was a high number of medicine errors. An action place had been developed to ensure staff had further training and to reduce the number of errors. Accidents and incidents were carefully monitored, analysed and reported upon.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

People enjoyed a wide and varied choice of meals. Mealtimes were relaxed and enjoyable for people.

Quality assurance processes and audits helped to ensure that the quality of care and support as well as the environment was closely monitored. This included seeking the views of people and their relatives.

19 October 2017

During an inspection looking at part of the service

We completed a comprehensive inspection of Westmead in March 2017 where we found the safe domain to be requires improvement with breaches in regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014- safe recruitment. This was the second breach of this requirement so we issued a warning notice. We also found staffing levels were not sufficient to ensure people’s safety. We issued a requirement in relation to regulation 18- staffing. The provider had sent us updated action plans to show how they had changed recruitment processes to ensure this was robust. They also showed what actions they had taken to employ more staff and in the interim to ensure agency staff were being used to keep people safe.

We completed this focussed inspection on 18 October 2017 to check the service was meeting the warning notice and requirements in relation to recruitment and staffing levels being appropriate and safe for people. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westmead on our website at www.cqc.org.uk.

Westmead is a care home without nursing which is registered to accommodate up to 19 people with physical and learning disabilities. At the time of the inspection there were 16 people living at the service.

There was a manager at Westmead, who had worked for the provider for a number of years and been a registered manager for one of their other services. She was awaiting an interview with CQC to become the registered manager for 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. The provider had informed us that another manager had been recruited who will eventually take over from the current manager. The plan was for there to be an extended handover between the two managers. This would help to ensure the service did not go for a further long period without a registered manager in situ.

People said they felt safe and well cared for. Two people said there were new staff and there had been lots of changes in staffing, but believed their needs were being met in a timely way. One person said they had been trying out more activities including Thai-chi, music sessions and going out more. One person spoke about how much they had enjoyed a recent local event hosted by Westmead called 'Westfest', which was held locally. This was a full day of music, crafts and food and drink open to the public as well as people living at the service.

Staffing rotas showed staffing levels were being maintained at the providers preferred levels. They had introduced a tool to review people’s dependency levels and look at staff hours needed to ensure the assessed needs of people, were being met.

Recruitment practices had been changed to show that potential new staff members were asked to declare if they had any convictions or cautions prior to being offered employment. Recruitment files showed safe recruitment practices were taking place.

Since the last inspection there had been three safeguarding alerts raised. These were discussed with the manager. We saw these had been handled appropriately and people were kept safe by measures put in place. These included adjustments to risk assessments for one person and staff being asked to complete further training in understanding safeguarding processes and when to report issues of concern.

24 March 2017

During a routine inspection

This inspection took place on 24 and 28 March 2017 and was unannounced. When we inspected this service in September 2015 we found recruitment practices did not fully protect people. We therefore rated Safe as requires improvement and issued a requirement. We did not receive a provider action plan. At this latest inspection we found the service had not met this requirement. This was because we found one staff member had been recruited and started work before all their checks and references had been obtained.

Westmead is registered to provider accommodation and support for up to 19 people with physical disabilities. At the time of the inspection there were 15 people living at the service.

Since the last inspection the registered manager has left this post to take up another post within the same organisation. A new manager had been appointed who was in the process of registering with CQC. He was new to this type of service but had a mentoring and support network set up by the provider.

We found that in recent months there were not always sufficient staff available to meet the needs of people in a timely way, or to ensure their social needs were being fully met. This was because of staff sickness and annual leave. Some people who lived at the service said they were unhappy with the staffing levels and had made their concerns known to the manager. We were assured these issues were being addressed and any gaps in staffing rotas would now be filled with agency staff where possible. We also heard there had been a recruitment drive to ensure there were sufficient staff to cover sickness and leave in the future.

People said they felt safe and were confident staff knew their needs. Relatives were also confident people’s needs were being met and that staff were kind caring and compassionate towards people. Dignity and privacy were respected, although we made one recommendation about ensuring people’s dignity was maintained at all times.

Staff had the right skills training and support to do their job effectively. They understood how to protect people’s human rights, offer choices and ensure people’s preferred routines were honoured. Risks had been fully considered and reviewed on a regular basis to ensure care and support was delivered safely.

Staff understood what may constitute abuse and how and to whom they should report any concerns to. Complaints were investigated and resolved, with actions taken clearly recorded.

Medicines were well managed and kept secure. People received their medicines in a timely way and where errors were noted, staff acted quickly to ensure people were not at risk. People were offered pain relief and received their medicines on time.

People were offered a variety of meals and snacks to ensure good health. Where people were at risk of losing weight due to their health condition, staff monitored what they ate closely. Mealtimes were seen as important social events and staff offered support in a relaxed and unhurried way.

People, visitors and staff were all able to voice any concerns or suggestions to help improve the quality of the service provided at Westmead. Systems were in place to monitor and review the quality of the service, as well as to ensure the environment and equipment was well maintained and safe.

There were two breaches of regulation. You can see what action we told the provider to take at the back of the full version of this report.

30 September and 2 October 2015

During an inspection looking at part of the service

An unannounced inspection was completed at this service on 30 September and 2 October 2015. Westmead is registered to provider accommodation and support for up to 19 people with physical disabilities. At the time of the inspection there were 18 people living at the service.

When we last inspected in March 2015 we found there were not always enough staff on duty for the number and needs of people living at the service. We also found people were not being offered activities and outings as often as they would like due to there not being enough staff available to facilitate this. We gave the service a requirement in respect of staffing. We received an action plan showing how they were intending to meet this requirement. In June 2015 we met with the provider and interim manager as the service had been non-compliant over a long period and did not have a registered manager in place. They shared with us how they intended to improve the service.

At this inspection we found the service had met the requirement in relation to staffing levels. There was enough staff on duty most of the time, to meet people’s needs. There had been some gaps due to staff sickness, but efforts had been made to cover the gaps with existing staff and/or agency staff. The gaps could not have been planned for. The service was in the process of recruiting more staff to ensure they had a bank of workers to cover all shifts, leave and sickness.

A new manager has recently been appointed in post and was in the process of registering with CQC. The manager has previously been a registered manager for one of the other services run by the same provider and had many years of experience. 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 2014 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection there was no one who was subject to this type of safeguard.

Recruitment processes were not as robust as they should have been. Not all checks were in place to ensure new staff were suitable to work with vulnerable people. This did not follow the provider’s policy on recruitment.

People said they felt safe and well cared for. Staff knew people’s needs and preferences and had the right training and support to enable them to deliver care safely and effectively. One person said ‘‘Most staff know how to help me and those who are new (staff) are getting used to how I like to be helped. Some staff are better than others, but we do get a choice usually.’’

Care and support was well planned with individuals. This process was starting to include more goals and aspirations for the future. Risks were identified and actions put in place to minimise these.

People reported more activities and trips out were being offered. One person said they had enjoyed several trips out to local cafes and pubs. Several people said they were enjoying the computer room and one person said they had been involved in some cooking sessions.

People were supported to eat and drink in a relaxed and unhurried way. Respect and dignity were upheld in the way staff worked with people. Staff made sure people had support given at their pace and staff checked with people if they wanted more to eat or drink. One person felt the meals did not reflect their needs. This was fed back to the cook who explained what options they had been providing for people, including and ensuring individual likes and dislikes were catered for.

Healthcare professionals said people’s healthcare needs were being well met and the staff team were proactive in seeking advice in a timely way to ensure this. Relatives confirmed people’s needs were well met and they were kept informed of any changes in healthcare needs.

People felt their views were listened to and they could make their concerns and complaints known and were confident these would be dealt with. One person said they had been involved in the interviewing of new staff recently. They said this was important to them. Relatives confirmed their views were considered and there were opportunities to have their say via meetings or they could speak with the manager at any time. Any complaints or concerns were dealt with swiftly and comprehensively.

Medicines were managed safely and effectively. People received their medicines at a time which suited them and was as prescribed.

Staff knew how to protect people from potential risk of harm and who they should report any concerns to. They also understood how to ensure people’s human rights were being considered and how to work in a way which respected people’s diversity.

The provider ensured the home was safe and audits were used to review the quality of care and support being provided, taking into consideration the views of people using the service and the staff working there.

We found a 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.

19 March 2015

During a routine inspection

This inspection took place on 19 March 2015 and was unannounced. At the time of the inspection there were 19 people living at Westmead.

Westmead is registered to provide support and personal care for up to 19 people. It is not registered to provide any nursing care. They provide care and support for people who have physical disabilities and learning disabilities.

The service does not have a registered manager in place. 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. The last manager deregistered in March 2015 due to the fact she was also managing a children’s service with the same provider and the children’s regulator OFSTED were not satisfied with the management arrangements. The provider had put in an interim management arrangement of having one of their other registered managers overseeing this and their own service. This manager splits their time equally between the two services. The operations manager said they were interviewing for a manager on the day of the inspection and hoped to have a new one in place very quickly.

Following the previous inspection carried on 15 April 2014 we found areas of improvement were needed in staffs understanding of the Mental Capacity Act 2005 (MCA) and how this translated into practice, their understanding of reporting any safeguarding concerns. The service did not have systems to check that care plans were being kept up to date. The service sent us an action plan about what they intended to do to ensure they would make these improvements. At this inspection it was clear staff had received additional training in MCA and safeguarding protocols. Care plans and reviews were taking place on a regular basis and this was being checked as part of the registered provider’s monthly checks.

At this inspection we found improvements were needed to ensure there was sufficient staff on duty at all times to meet people’s needs, including their social and emotional needs. People said they did not always feel safe as there were times there were not enough staff on duty. Comments included “When they are fully staffed I feel safe, when there are only three staff you know they are on their feet all day and they haven’t got time. In January and February I had to keep waiting for a drink, I was told I had to wait because they were busy.”

Staffing levels have affected the quality of activities and access into the local community. People reported there were often limited opportunities for them to leave Westmead to go into the community. Plans were being put in place for people to go swimming and some people had been assisted to have some short breaks, but others had not been offered opportunities to go out for weeks, despite this being part of their goals within their care plan.

Although there were interim management arrangements in place, the provider needed to ensure a new registered manager was recruited, as this service has a long history of having no manager or managers who do not stay in post for very long. This has been unsettling for people and staff working there.

Whilst there was sufficient equipment for people to ensure their physical and communication needs were being met, people were still reliant on staff to open and close their bedroom door for them. There was no assistive technology being used to support people to enable them to open and close their own bedroom doors to enhance their dignity and privacy.

People said staff were supportive and understood their needs. One person said “They are very nice caring staff. If my door is closed staff will knock and wait until I say they can come in.’’ Observation showed people were assisted in a caring and respectful way, although there were two examples of staff assisting people to eat where there was very little communication between the care staff and the person.

Staff were knowledgeable about people’s needs wishes and preferred routines and received support and training to do their job effectively and safely. Staff said their views were listened to and they felt part of a team. Staff recruitment processes were robust and ensured staff were only employed once checks and references had been obtained.

Risks were being managed appropriately, assessments were in place and these identified how to reduce risks. Risk of falls, pressure damage, poor nutritional intake and moving and handling were risk assessed and kept under review on a regular basis and as people’s needs changed. Where a risk had been identified, measures had been put in place to reduce risks.

People were supported to maintain a balanced diet and where needed special diets were catered for. People’s health care needs were closely monitored and staff worked closely with healthcare professionals such as physiotherapists.

Systems ensured the views of people and staff were included as part of the overall quality monitoring and checks were completed on records, environment, medicines, training, accidents and incidents so ensure the service was safe and effective.

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.

15 April 2014

During an inspection

15/04/2014

During a routine inspection

Westmead is registered to provide care and support for up to 19 younger adults with physical and learning disabilities. It is situated in Braunton, North Devon. At the time of our visit there were 18 people living at the home.

The home does not have a manager registered with the Care Quality Commission. However, the current manager, who had been in post for four months, was currently applying.

People we saw and spoke with confirmed that they felt safe and supported by staff at Westmead and had no concerns about the ability of staff to respond to safeguarding concerns. Comments included: “I feel safe here” and “I feel safe with the staff.” They felt their human rights were upheld and respected by staff. Staff demonstrated a good understanding of what might constitute abuse and knew where they should go to report any concerns they may have within the organisation. However, staff were less sure about who outside the organisation they could contact, such as the local authority. This posed a risk that staff would not respond appropriately to concerns in a timely manner outside of the organisation to protect the people in their care.

People said that staff were supportive and helpful. Staff knew how to respond to specific health and social care needs and were observed to be competent. Staff were able to speak confidently about the care practices they delivered and understood how they contributed to people’s health and wellbeing. On the whole, care plans reflected people’s health and social care needs.

People felt that they needed different solutions to help them open their bedroom doors to maintain a greater degree of independence.

On one occasion we saw that a person was due to have a mental capacity assessment due to their ongoing health needs. Health and social care professionals felt that the person did not understand the risks that were apparent. In light of this, we did not find any risk assessment and the care plan for skin care was lacking in detail and was not up to date in light of the concerns identified. Staff were aware of this person’s risks and how they needed to manage them. However, there was a risk that a newer member of staff would not know this and when accessing information about this person’s needs through their risk assessments, they would not necessarily be able to determine how best to support them in a safe and effective way.

We did not find up to date evidence of care plan reviews being undertaken. The manager explained that it was the key workers responsibility to complete reviews with people, but they acknowledged that this was not being done on a regular basis. They had already recognised that this needed to be improved and was in the process of addressing this as part of staff supervision.

Staff informed us that they received a range of training, which enabled them to feel confident in meeting people’s needs and flagging up any concerns/changes in health. However staff supervision was not undertaken on a regular basis in order for staff to feel supported in their roles and to identify future professional development training needs.

Staff adopted a positive approach in the way they cared for people and respected their independence. We heard and saw staff working with people and they demonstrated empathy through their actions, in their conversations with people they cared for and in their discussions with us. Activities were encouraged at Westmead. People engaged in trips in the local community, games within the home, information technology and holidays.

To date, no applications for a Deprivation of Liberty Safeguards (DoLS) authorisation had been made by staff at Westmead. The Deprivation of Liberty Safeguards require providers and managers registered in respect of hospital and care homes (‘managing authorities’) to apply to the relevant ‘supervisory body’ for authorisation to deprive an adult of their liberty. Supervisory bodies are the local authority with social services responsibilities or NHS primary care trust for the area where the care home or hospital is located. The Mental Capacity Act gives the Care Quality Commission the duty to monitor activity under the deprivation of liberty safeguards.

Staff could not consistently demonstrate an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied to their practice. We spoke with the manager about this and they recognised that staff would benefit from specific training on the Mental Capacity Act. This posed a risk that people were not being assessed appropriately by staff and protected from their liberties being deprived unlawfully.

We saw the home’s complaints procedure. It provided people with details about how to make a complaint. It set out the procedure which would be followed by the manager and organisation. However, the complaints procedure was not displayed in a communal area for people to refer to.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We saw involvement of the local authority safeguarding team and where necessary disciplinary action taken.

We saw that the premises were adequately maintained. We saw that health and safety checks were completed on a daily, weekly, monthly and annual basis by staff employed by the organisation and external contractors to ensure the safety of both people living at Westmead and staff.

25 April 2013

During a routine inspection

We brought forward this planned inspection as we had received some information of concern about people's needs not being met. We had checked with the commissioning team and found that they were visiting regulalry and had no concerns about care and support people were receiving.

During this inspection we spoke with eight people who live at the service, four staff and looked at some key records. These included care plans, daily records, risk assessments, staff training records and minutes of meeting with staff and people living at the home. This helped us better understand how well the home was being run.

People we spoke with told us that in the last 12 months they have felt that there has been more activities and that their views were being listened to. Comments included, ''I feel really positive about living at Westmead. I feel there have been a lot of good things happening such as the Christmas ball, new staff and we are going to have the place redecorated.'' ''I would say things are fantastic. We have more staff, lots of new ones and we are doing more.''

We saw that people were supported in a kind and respectful way. Staff were supported to gain the skills and knowledge required to do their job safely and effectively.

Systems were in place to review the quality of care and this included seeks the views of people living at the home and the staff group who supported them.

17 May 2012

During a routine inspection

We carried out this unannounced inspection on 17 May 2012 as part of our planned inspection programme. We brought forward this inspection as a result of receiving some information of concern around staff issues, as well as a lack of respect and dignity towards people living at the home. We did not find any information to support the concerns during this inspection, but we have passed the details of the concerns to the manager for her to investigate further.

We spent time at the home talking with six people who currently live there, as well as with six members of staff and the new manager for the service. At the time of this inspection, there were 18 people living at the home with six care staff per shift, as well as ancillary staff.

We observed how care and support was delivered through different times of the day. We looked at some of the key records kept by the home. These included care plans, risk assessments and staff training records. This helped us to better understand how well the home was run.

People we spoke with who were able to share their experiences of living at the service were very positive. Comments included 'The home has a much friendlier, better atmosphere, new staff are brilliant.' 'Things are changing with the new manager, we are making plans to get out more. I am attending my work once a week and am busy as we are planning a Christmas ball and I am chairman. I am happy here I would score it eight or nine out of ten.'

We spoke with one visiting health care professional following the visit. They felt that the service met people's needs in a timely way and referred onto health care teams for advice and support as needed. One professional commented 'The new manager needs time to get staff to come on board with a new way of working, so that people are able to get out more and have more choices in their lives. Good progress is being made.'

We looked at how well care and support was planned and reviewed. The plans contained good basic information about what personal, health and emotional care needs people had and how staff should meet these needs. Risk assessments were in place to show how the home identified, managed and minimised any risks for people. We saw that plans were in the process of being updated. People have a copy of their own plan in their bedroom.

We observed staff providing care and support in a kind and sensitive manner and we were told by staff that they felt well trained and supported to do their job, but that some staff were unhappy with changes to the staff rota and that the service had had a period of staff leaving and no permanent manager in post. This has now been resolved. We heard that the new manager was changing rota patterns so that staffing was more flexible to enable people in the service to be able to access activities and the local community more frequently.

We saw that the home was clean and reasonably well maintained, but that some areas were looking shabby, for example the entrance hall. We have received comments from funding authorities that they also felt that some parts of the home were in need of refurbishment and were institutional in appearance. The older areas of the home were dark because of lighting and decoration. Parts of the home showed signs of wear and tear. For example there were scuff marks and plaster missing in some areas where wheel chairs had caused damage.

Bedroom doors did not have any assisted technology that would allow people independence. If for example someone wanted to have privacy their bedroom door would need to be shut by staff. If then they wished to come out of their bedroom they would need to call staff to open their door for them. This did not promote independence for people with reduced mobility and restricted movements.

22 November 2011

During a routine inspection

We brought forward this planned inspection as a result of receiving some information of concern relating to staffing levels being low and people not getting the care and support they require.

We visited the home on 22 November 2011 and spent five hours talking with the people who live at the service. We also spent time talking with seven members of staff including the interim manager, senior carers, carers, physiotherapist assistant and chef. We also looked at some records including care plans, medication records and records of how individuals' monies are managed on their behalf.

Five of the people we spoke with expressed concerns about not being informed about why members of staff have recently left the service. Some people felt strongly that senior staff at Westmead and Leonard Cheshire had not kept people living in the home informed of important decisions that affect the running of the home. Comments included 'we have lost a lot of staff, the place seems to be going down the hill and we are not told why people are leaving.' and 'they don't always tell us what going on. When I first came here it was such a nice place, good atmosphere but this seems to have gone now.' and 'I am really angry we have not been told what's happening.'

We have fed the level of discontent back to senior operations staff. We have been made aware that for human resource reasons, they had not been able to discuss why staff had left or been asked to leave, but we have been assured that people were told when staff had left the service.

We heard from people using the service that there had not always been enough staff available to have their needs met especially any needs that relate to accessing the community and activities that are meaningful. One person told us for example that it had not always been possible to get to their job, due to staff shortages. Another person told us that they had often been told that there was no staff available to go shopping with them.

We checked staffing levels and saw that there had been some difficulties with filling all the shifts, despite having used agency workers to supplement their own staff. We have been told that new staff have now been recruited and that this should no longer be an issue. We heard for example that there was now sufficient staff to have six care workers on per shift, plus they had recently employed a full time activities co coordinator, and a physiotherapist assistant.

The home have recently employed a new chef who showed us how he has tried to involve people in changing menus and offering more choices. We saw that he had been experimenting with new soups and had brought some for people to taste. People we spoke with said that there had been a significant improvement with the meals provided.

We observed two examples of poor practice in terms of respect and dignity, and we passed this information onto the registered providers, who have addressed this as part of their disciplinary processes. We also saw some really respectful and involving practices from staff. We saw staff that were skilled at involving people in making choices about their everyday lives. We also saw that dignity and privacy was upheld in the way staff worked with and supported people. People were asked discretely if they needed assistance with their personal care needs for example.

Care plans we looked at give good information about how staff should meet individuals' needs. We heard that staff had good training and experience of working with people with complex needs and understood peoples needs well.

We looked at audit trails relating to the handling of individuals monies and saw that this had not been clearly audited for the last seven months. We are aware that this was addressed immediately following the inspection. We have asked the registered provider for more information about how they review the quality of care and support they provide to people.

This service has not had a registered manager in place for over six months and both people who live in the home and staff have expressed their alarm about this and feel that Westmead needs strong leadership to be implemented. There is an interim manager overseeing some of this work, but they were part time, and the service needs a permanent full time manager. We have been informed by the registered provider that this is their major priority.