Archived: Westcott House Nursing Home

We found the following examples of good practice.

Staff were seen wearing their personal protective equipment (PPE) correctly and relatives informed us they were provided with PPE when visiting the service and always saw staff wearing theirs. A dedicated visiting area had been established with a staff member available to carry out visitors’ lateral flow tests, provide PPE and clean between visits. There was a one-way system operating so visitors did not have to enter the premises or pass anyone when leaving at the end of their visit.

Staff told us they felt very supported and there was good teamwork. This had enabled them to maintain good infection control systems. Housekeeping staff were given additional tasks to help reduce the risk of the spread of infection. We saw the service looked clean and hygienic and there were numerous sanitising and PPE stations located around the premises.

When people tested positive for COVID-19 they were isolated in one part of the service. The registered manager cared for these people herself and told us, "I was here from seven in the morning until seven at night caring for them and it was so rewarding to see people getting better."

The registered manager followed the national guidance on testing both people and staff. Staff confirmed they were tested regularly. This included ensuring Best Interests decisions were made for people who lacked capacity. The registered manager was proud to tell she, the staff and people living at the service had received both of their vaccinations.

Westcott House is a residential home providing personal and nursing care for up to sixty older people with a past or present mental illness including people living with dementia. People’s accommodation is provided in several different areas including a purpose-built single storey building as an annexe. There are individual lounges and dining areas provided for people as well as a separate day activity centre. On the day of inspection there were 57 people living at the home.

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

People were kept safe by staff who knew about safeguarding people from harm. There was enough staff to ensure safety was not compromised and people’s complex needs were met. Improvements had been made, since the last inspection, with infection control practices and with increased staff knowledge of the risks people faced.

People’s relatives told us of the safe care they saw and the reassurance they felt. One said, “We don’t hear enough about the good news, about good care, places like Westcott House.”

Staff provided a good standard of care for people, working well as a team and with good communication. Action was taken promptly to identify any new health issues people had and to get specialist support. New roles in the staff team had been developed, proving effective in ensuring all staff were kept up to date. People had enough to eat and drink and this was well monitored. Some new adaptations had been made in building to help people living with dementia.

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. Policies and systems in the service supported this practice.

People were cared for by staff who were both professional and kind. Staff showed compassion in their interactions with people and knew what each person needed. Dignity and respect were shown to people regardless of their abilities and needs. Relatives were involved and welcomed at the home.

People were cared for in a personal way. Important information was recorded about people, their preferences, interests, communication and physical needs. People had access to activities that suited them, and staff engaged, one to one, with those who needed this, including people nursed in their room. Relatives told us of the responsive approach by staff and the registered manager. There was a complaints policy and process in place and recording of complaints and responses had been improved. People received personalised care at the end of their life.

The service was well led by a very experienced and caring registered manager. Since the last inspection they had sought advice and brought in support to ensure that improvements were made. People’s care plans were being reviewed and changed over to a new electronic format. There were new staff roles and delegation of responsibility which supported the delivery of good quality care and teamwork. There was good governance in place so that any issues were dealt with quickly.

The registered manager had extended the reach and involvement of the service with local improvement projects and research. People benefitted from good relationships with a wide range of professionals and services in the local community.

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 requires improvement (published June 2018).

There were no breaches of regulations, but we made three recommendations. At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating and to check whether improvements had been made.

You can read the report from our previous comprehensive inspection, by selecting the ‘all reports’ link for Westcott House Nursing Home on our website at www.cqc.org.uk

Westcott House provides residential and nursing care for up to 60 people living with dementia or who have mental health needs. Westcott House 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 accommodation at Westcott House is spread over three floors and includes a purpose-built single storey building as an annexe. There are two dining rooms and several lounge areas in both the buildings. The buildings are joined by a short outside walkway and there is a separate day activity centre at the service. On the day of our visit there were 59 people living at the home and one person who moved in that day.

The majority of people living at the home had cognitive impairment and six people had complex mental health needs. Six people were nursed in bed due to the advanced nature of their dementia

There was 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.

At our last inspection, we recommended that care plans should be written in a format to make them easier for staff to follow. However, at this inspection we found that care plans were still in the old format and that some were providing staff with out of date information about people’s needs and risks. We highlighted where this had impact on people’s safety and explored how the risks to people were managed.

We also previously recommended improvements to the range of activities and social interaction provided throughout the home to people living with dementia. On this visit, staff engaged with people in the communal areas. They were using some of the new equipment that the registered manager told us they had purchased to improve stimulation for people living with dementia.

The risks people face, due to their health conditions, were identified. There were good examples of risk management. However, some staff were not aware of the risks people faced or confident in managing some of these. We made a recommendation about increasing staff awareness and their learning on how to respond to certain risks.

There were also some poor hygiene practices that needed to be addressed. We have made a recommendation about staff refresher training in infection control.

People were protected from the risk of abuse and systems were in place to ensure that concerns were identified and reported to the registered manager.

People were cared for by sufficient numbers of trained staff. There was good recruitment and retention of permanent staff. We could see that staff were working in every part of the building and supporting people in the communal areas.

People were receiving their medicines safely. The use of medicines for individuals was appropriate and under regular review. Medicines were stored safely and the recording of medicines given was being done accurately.

People were supported to maintain their health and to get treatment when they needed it. The service had developed effective relationships with health and social care professionals.

People were supported to eat and drink enough. Their nutritional needs had been assessed and there were systems in place to monitor people’s fluid and food intake.

The environment was adapted to meet people’s needs and premises were being kept clean. Improvements had been made in the last year, such as Wi-Fi being installed, and new dining room furniture purchased. The need for further improvements was recognised.

The Mental Capacity Act and the Deprivation of Liberty Safeguards were understood and legal requirements were applied. Any decisions made, or restrictions to people, were done in the person's best interests following a mental capacity assessment.

Staff communicated in a caring way. They demonstrated concern and warmth in their interactions with people. People’s privacy was respected. Staff understood how vulnerable people were due to the progress of their dementia, their level of cognitive impairment and physical needs.

Relatives we spoke to told us they were able to visit whenever they wanted. They felt included in the care of their loved ones, but also trusted the staff to look after their relative when they were not there.

People and their relatives said they could complain by speaking to the registered manager and they were confident that any concerns would be dealt with. The registered manager worked with relatives and representatives to resolve complaints quickly.

There was a culture of openness. People and their relatives could communicate with the registered manager and the staff. There was a good working partnership with families and professionals. Staff worked well together and the registered manager was well- respected.

However, staff did not use the information held about people, including their needs, wishes and risks, routinely. Care records were not always accurate and kept up to date.

Although we received positive feedback from people, relatives and partners about the service, we were unable to give the service a Good rating. This is because of some inconsistent practice by staff, and management oversight needed to be improved. The registered manager has agreed to take action and changes need to be embedded with the service.

The registered manager/provider was present for the duration 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 and associated Regulations about how the service is run.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

There were sufficient numbers of staff on duty to meet people’s care needs. Staff recruitment procedures were safe. Employment files contained all the relevant checks to help ensure only appropriate staff were employed in the home.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the registered manager had good management oversight of the home.

Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

People were encouraged and supported to be involved in their care as much as possible. People had individual care plans. These were informative and updated regularly. They also contained information for staff to enable them to be able to respond to people’s needs effectively.

People and staff interaction was relaxed. It was evident staff knew people well and understood people’s needs and aspirations. Staff were very caring to people and respected their privacy and dignity.

People were provided with a range of nutritious foods to maintain a healthy diet. People told us the food was very good and home cooked. We saw people had access to drinks and snacks throughout the day and staff provided support for people to eat and drink when required.

People had risk assessments in place for identified risk of harm. The registered manager logged any accidents and incidents that occurred and put measures in place for staff to follow to mitigate any further accidents or incidents.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain good health. They had access to a wide range of health care services and the input of health care professionals.

Staff received a good range of training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

The registered manager operated an open door policy and we saw several examples of this throughout the day when staff, relatives and people who used the service sought their support and advice.

If an emergency occurred people’s care would not be interrupted as there were procedures in place to manage this.

Systems and audits were in place to monitor the service provision and best practice, in order to improve outcomes for people who used the service.

A complaints procedure was available for any concerns. This was displayed in the home. People and relatives had been provided with a copy of this when they were admitted to the home.

People and their relatives were encouraged to feedback their views and ideas into the running of the home.

Information was provided to people who used the service and their relatives prior to being admitted to the home to help them make an informed choice.

People who were able to told us that they were happy living in the home. Relatives told us they were extremely satisfied with the care provided. They also felt the provider and the staff team were very supportive to them and kept them informed of any change to their relative's needs.

We found the standard of cleanliness in the home was good and the premises and garden were well maintained.

Staff told us they were well supported by the management structure in place and they had undertaken all the relevant training to enable them to undertake their roles efficiently.

We looked at the provider's quality assurance systems and found that there was a range of monitoring processes in place to enable the provider to respond to issues of quality

People told us that they were happy living in the home and that everyone was friendly and kind. Two people told us that they had been living in the home for several years and had become good friends.

We were told that there was a good activity programme in place and we were able to talk with people in the day centre who were watching a black and white film and enjoying a glass of sherry.

We saw that the people who were being nursed in bed looked comfortable and well cared for.

We saw staff interacted with people in an inclusive and engaging way. They offered sensitive support to people who needed help to walk to the bathroom or their bedrooms.

There was good feedback regarding the food. We were told that the meals were home cooked and that there was always something available that people liked to eat. We saw people enjoying fish and chips for lunch.

Staff told us that they enjoyed working in the home. They felt that they had sufficient training and support to undertake their roles and responsibilities effectively.