Westacre Nursing Home

Updated 9 April 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Westacre Nursing Home is a ‘care home’. 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.

The service had a manager registered with the Care Quality Commission. A registered manager, along with the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection was unannounced

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and clinical commissioning group. This information helps support our inspections. We used all of this information to plan our inspection.

The provider had not been asked to complete a Provider Information Return. This is information providers are required to send us with key information about the service, what it does well and improvements they plan to make.

During the inspection

We spoke with 13 people who used the service, the clinical lead and the registered manager.

We reviewed ten people’s care records. The electronic medicines administration records, five staff files and a variety of other records relating to the management of the service.

After the inspection

We received feedback from five relatives about the care provided and spoke with 11 members of staff including day and night staff, permanent and agency staff. We continued to seek clarification from the provider to validate evidence found.

Updated 9 April 2021

Westacre Nursing Home is a care home. The home is registered to provide accommodation and nursing care for up to 55 people. At the time of the inspection there were 41 people living at the home. Accommodation at the home is spread over three floors with interconnecting lifts and stair wells. People have their own rooms and access to communal areas such as lounges, dining areas and a conservatory. There is a garden accessible to people. Westacre Nursing Home is owned by Nursing Home Services Limited who, throughout this report, are referred to as the provider.

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

We found no evidence during this inspection that people were at risk of harm. People and their relatives overall described the care provided as person centred, although the registered manager had identified that this was an area where further improvements could be made, and they were taking action to address this.

This inspection found that the governance arrangements in place were not yet being fully effective at driving improvements throughout all areas of the service. The new leadership team were working hard to address this.

Our last inspection had highlighted some concerns regarding the management of risks relating to people’s care and how these were to be mitigated. This inspection found some similar concerns.

We have made a recommendation about how competency assessments might be used to provide assurances that staff understand the training provided and are able to confidently put their learning regarding nutritional risks into practice.

Staff demonstrated an understanding of what abuse might be and how it might manifest itself in a care environment. They demonstrated a commitment to share any concerns they might have about a person’s safety and they were confident that the leadership team would act on these.

Arrangements continued to be in place for the safe management of medicines. Robust auditing processes were in place and the eMARs were checked daily for gaps or omissions.

We were assured that the provider was preventing visitors from catching and spreading infections and was meeting shielding and social distancing rules. People were admitted safely to the service and systems were in place to manage outbreaks appropriately.

There were systems in place to learn from safety related events.

There were systems in place to engage with people and their families about the care provided. Although some relatives felt that communication was an area which could be improved further.

The leadership team understood the importance of developing an empowering and inclusive culture amongst the staff team. This was still a work in progress and some staff felt that morale and teamwork were areas which needed to be improved.

The registered manager and clinical lead worked effectively together and shared ideas which helped them to perform well and achieve their best. Concerns were investigated, and systems were in place to ensure lessons were learnt and apologies offered when the provision of care fell below that expected.

The service worked in partnership with other organisations to meet people’s needs and develop its staff.

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 12 August 2019). There was one breach of the legal requirements in relation governance. This is the fourth consecutive inspection that the service has been rated as ‘Requires improvement’ or worse. Whilst there was evidence of improvements in some areas, we continued to also find some concerns and therefore could not improve the rating to good at this time.

Why we inspected

The inspection was prompted in part due to concerns we had received about some people’s safety. As a result, we undertook a focussed inspection to review the key questions of safe and well led only. We found no evidence during this inspection that people were at risk of harm from this concern, but the registered managers investigation into the concerns did identify some concerns regarding night shifts, specifically that staff were sometimes more focussed on the completion of tasks rather than on the delivery of person centred care. They are taking action to address this and will keep this under careful review.

We also undertook this inspection to see if the provider had made the required improvements following our last inspection in August 2019 when we found a breach of the legal requirements. The provider completed an action plan after that inspection to show what they would do and by when to improve the governance arrangements within the service. We checked whether they had followed their action plan and whether they now met legal requirements.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a continuing breach in relation to good governance.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.