Westminster House Residential Care Limited

Westminster House Residential Care Limited is a residential care home providing the regulated activity of accommodation and personal care to up to 12 people. The service provides support to adults who are living with dementia and/or have a mental health diagnosis. At the time of our inspection there were 12 people using the service.

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

The delivery of care for people was not always safe. Not all risks to people’s safety and wellbeing provided enough detail as to how identified risks should be mitigated. Suitable arrangements were not in place to ensure the proper and safe use of medicines. The deployment of staff was not always suitable or safe to meet people's care and support needs and improvements were required to the provider’s recruitment practices. People were not always protected by the prevention and control of infection. We have made recommendations about staffing levels, recruitment practices and infection, prevention, and control. Lessons were not learned, and improvements made when things went wrong.

Staffs' training was not embedded in their everyday practice and staff did not receive a robust induction. Although staff received supervision, information had not been examined to ensure where issues were highlighted these were escalated and addressed. We could not be assured if people’s hydration needs were being met as people’s fluid targets were not always met or monitored. The premises did not meet people's needs, particularly for people living with dementia and those people who had mental healthcare needs. We have made a recommendation about the premises.

The leadership, management and governance arrangements did not provide assurance the service was well-led. There was a lack of understanding of the risks and issues and the potential impact on people using the service. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when needed. People were happy with the quality of meals provided. Relatives were happy with the care and support provided for their family member. Staff felt supported and valued.

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 23 July 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about safeguarding people from harm and abuse. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to risk, medicines management, safeguarding, staffing, governance, and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the Local Authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Westminster House is a residential care home providing personal care without nursing for up to twelve people. At the time of inspection twelve people were using the service. The service is set over two floors in a residential area.

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

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Medication was dispensed by staff who had received training to do so.

People were cared for and supported by staff who had received the appropriate training.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 were supported to eat and drink enough to ensure they maintained a balanced diet. People's health was monitored and referrals to other health professionals was made when required. The environment was well maintained and suitable for people.

Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff worked hard to promote people’s independence through encouraging and supporting people to make informed choices.

People, their relatives and advocates were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The manager responded to complaints received in a timely manner. People were supported to make plans for the end of their life.

The registered manager had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Rating at last inspection: The last rating for this service was Good (last report published 9 July 2017).

Why we inspected: This was a comprehensive inspection.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Westminster House provides accommodation and personal care for up to 12 people some of whom may be living with dementia. At the time of our inspection 12 people were living at the service.

At our last inspection the service was rated as Good. At this inspection we found the service remained Good.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

The service was caring. Staff cared for people in a empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. Staff, people and their relatives spoke very highly of the registered manager. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

We saw that people's needs were assessed and that care and treatment was planned and delivered safely and to meet the needs and wishes of people who were using the service.

We saw that there were arrangements for identifying and minimising risks to the health and safety of people who were using the service..

We saw that medicines were stored safely and securely. Staff were trained to handle and administer medicines safely. From records we saw that people received medicines as prescribed as part of their treatment.

The service had suitable equipment for supporting people and the safe running of the service. We saw that equipment was maintained in good working order, checked, maintained and replaced as needed to ensure that all equipment was safe and fit for purpose.

There were arrangements in place for supporting and training staff to deliver care and treatment safely and to an appropriate standard.

There were appropriate arrangements for receiving, investigating and responding to complaints.

We saw that people's needs were assessed and that staff cared for people properly, taking into account individual's preferences for how they wished to be treated and cared for.

Staff we spoke with had a good knowledge of the needs of people living in the home and we saw that staff supported people in an appropriate and sensitive way.