Westacre Nursing Home

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.

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 28 people living at the home. Accommodation at the home is spread over three floors with interconnecting lifts and stair wells.

What life is like for people using this service:

People told us they felt safe and happy living at Westacre Nursing Home. However, we found further improvements were required to ensure people consistently received safe, effective, high quality care.

People and family members spoke positively about staff and we observed positive interactions between people and staff. However, on occasions staff did not always treat people with consideration.

The provider had recently moved from paper-based care records to a computer-based system; however, this had led to discrepancies and inaccuracies in people’s care records, which had the potential to compromise people’s safety.

Recruitment procedures had not been followed fully to ensure that only suitable staff were employed to support people.

The home was clean and staff had been trained in infection control. However, hand washing facilities in the laundry and sluice room were not adequate.

Best practice guidance was also not followed when people sustained head injuries. We have made a recommendation about this.

People’s dietary needs were met, although food and drink choices were not offered in a supportive way for people with cognitive impairment.

Although staff knew how to reduce the risk of people becoming dehydrated, personalised care plans were not in place to help ensure this was done consistently.

Quality assurance systems were in place, but these had not always been effective. They had not identified concerns we found during the inspection.

The provider did not provide written information to people or their relatives, as required, when people came to harm.

However, people’s needs were met by staff who had been suitably trained and knew people well. Medicines were managed effectively, in accordance with best practice guidance.

Staff protected people from the risk of abuse.

People were empowered to make decisions and were involved in the development of their care plans.

Staff respected people’s privacy, protected their dignity and upheld their rights and freedoms.

People felt listened to and knew how to raise concerns.

Staff were committed to supporting people to have a comfortable, dignified and pain-free death.

The registered manager had worked hard to develop and promote a positive culture within the staff team. Staff told us this had been effective and felt people had benefited from the calmer atmosphere now prevalent in the home.

We identified a breach of Regulation 17 of the Health and Social Care Act (Regulated activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this full report.

The service has been rated Requires improvement as it met the characteristics for this rating in four of the five key questions. More information is in 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 14 June 2018). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

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 and commissioners of the service to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we found the registered provider had made substantial improvements in the standard of care provided at the home. They were compliant with the fundamental standards set out by law although further actions were required to embed good working practices in the home. The home has now been removed from ‘special measures’.

The home provides accommodation and personal care for up to 55 older people, some of whom live with mental health problems or dementia. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 33 people lived at the home.

Whilst a registered manager was in post they were planning to deregister and return to their previous role of finance manager for the home. The general manager had made an application to CQC to take on the role of registered manager for the home. 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 management team in the home promoted and open and transparent culture. This meant people, their relatives and staff felt supported and had a good understanding of the concerns which had been raised about the home and how these were being addressed.

Staff had a good understanding of their roles and responsibilities in maintaining the safety and welfare of people who lived in the home.

There were sufficient staff deployed in the home to meet the needs of people. Immediate staff training needs had been met to ensure people received safe care and a further training programme had been identified to ensure staff had all the required skills to meet people’s needs.

Risk assessments had been completed to support staff in mitigating the risks associated with people’s care. Care records held information on people’s needs and preferences although further work was required to ensure these were fully person centred. This work was in progress and included seeking the involvement of people and their relatives.

Systems were in place to support staff in recognising and reporting signs of abuse and these had been used effectively by staff.

People were valued and respected as individuals. Staff knew people well and could demonstrate how to meet people’s individualised needs. Most care staff cared for people in a kind and empathetic way, and staff were prepared to challenge other staff if they observed poor care.

The level of activities available had improved however we have made a recommendation about the introduction of more dementia friendly activities in the home.

Where people could not consent to their care, staff had sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

There was a robust system of audit in the home to monitor and review the quality and effectiveness of the service provided at the home.

The registered provider had failed to; identify the risks associated with people’s care needs, ensure people were safeguarded from harm by sufficient staff who understood how to meet their needs; ensure people consented to their care and were not unlawfully deprived of their liberty; provide person centred care in line with people’s needs and preferences; ensure people were treated with dignity and respect at all times; respond to complaints in a timely and effective manner; provide effective leadership and overall management of the home.

The registered provider had failed to be compliant with all of the fundamental standards set out by law. You will find further information on the breaches of regulation we found in the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The home provides accommodation and personal care for up to 55 older people, some of whom live with mental health problems or dementia. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 43 people lived at the home.

At the time of our inspection a new registered manager had been in post since January 2018. The previous registered manager remained working in the home but in the role of clinical manager. The clinical manager left the home on the second day 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 2008 and associated Regulations about how the service is run.

On the first day of our inspection a new general manager had been in post for two weeks and told us they were planning to become the registered manager for the home. The current registered manager was planning to deregister and return to their previous role of finance manager. During our inspection we found there was a serious lack of guidance and leadership in the home to ensure all staff had a good understanding of their roles and responsibilities in maintaining the safety and welfare of people who lived in the home.

Whilst there were safe recruitment practices in the home, there were not sufficient staff with suitable skills, knowledge and experience deployed in the home to meet the needs of people.

Risk assessments had not always been completed to support staff in mitigating the risks associated with people’s care. Care records were not always available, accurate and lacked up to date information to ensure staff had information on how to meet people’s needs. This was of particular importance with the high use of agency staff in the home.

Whilst systems were in place to support staff in recognising signs of abuse, they had not identified any concerns about the safety and welfare of people in the home as we found during our inspection. There were a number of incidents of alleged abuse in the home during our inspection and we had received a high number of concerns before our inspection. These concerns were substantiated during our inspection and had not been raised in line with the registered providers policies and procedures to safeguard people.

People were not always valued and respected as individuals. Staff did not always know people well and could not always demonstrate how to meet people’s individualised needs. Whilst some care staff cared for people in a kind and empathetic way, we observed some very poor practices which did not always show respect and dignity for people. These practices were not challenged by other staff or the registered provider. The training staff had received was not always reflected in the care some staff provided.

People did not always receive care which was person centred and individual to their specific needs. There was a lack of meaningful activities and interactions in the home to reduce the risk of social isolation for people.

Where people could not consent to their care, staff had not sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

Whilst there was a system in place to allow people to express any concerns or complaints they may have, these were not managed effectively. There was a lack of robust and effective audit in the home to monitor and review the quality and effectiveness of the service provided at the home.

Whilst people received foods in line with their preferences and choices, they did not always have a good dining experience.

The home was clean and maintenance was completed in a timely way.

We provided feedback of our findings following the inspection to the owners of Westacre Nursing Home (and registered providers), the nominated individual for the registered provider and another senior manager for the home. We requested immediate action be taken. In addition, we referred the concerns we found to the local authority responsible for safeguarding.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

Westacre Nursing Home is a care home that is registered to provide care with nursing for up to 55 people. The people they support have varying needs and live with dementia. At the time of our visit, 38 people were using the services. The home is a detached modernised Edwardian property situated within a quiet residential area of Winchester. People had their own bedrooms and use of communal areas that included enclosed private gardens.

The home does not have a registered manager, but has two managers who work full-time. They have applied to the Care Quality Commission to become the registered managers of the 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.

People’s safety was promoted within the home. There were robust processes in place to monitor safety when giving people their medicine. The recruitment and selection process helped to ensure staff of good character supported people. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse. The provider’s whistleblowing policy was being reviewed. This was to be more user friendly and accessible for staff. There were risk assessments that identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising any risks.

Westacre had refurbishment plans in place to improve the environment. Some improvements had already taken place, which included the replacement of a lift to the first and second floors. The managers on reflection during our visit to the service were reviewing the environment to enhance the lifestyle and independence of people who live with dementia.

People were provided with effective care from a dedicated staff team who had received regular supervision to identify their development needs. Staff induction and training was provided by external sources and electronic processes. This made sure staff were supported to receive the training and development they needed to meet people’s individual needs and to pursue further learning and development opportunities.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people and their care.

Staff were held in high esteem by people and their families. They treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

Meals were nutritious and varied to meet individual needs and were being reviewed to promote choice.

People were encouraged to live a fulfilled life with activities of their choosing that were structured around their needs and individual to each person. People told us that they were very happy with the care and support they received. They benefitted from living at a service that had an open and friendly culture. There were opportunities for people to be involved in decisions about the home through formal methods such as surveys and reviews. The provider had an effective system to regularly assess and monitor the quality of service that people received.

We spoke with four people who lived at Westacre and with six relatives during our visit. We also received written feedback from seven visitors after our inspection. People and their relatives were happy with the care, treatment and support received. People we spoke with were satisfied with their care. Nearly all relatives and visitors gave positive feedback about the service. Representative comments were "attention given to my wife is of a high standard," "excellent in all respects" and "my mother is very content at Westacre and the carers are attentive to all residents' needs". We observed many positive interactions between staff and people who lived at the home during our visit.

We found that people received good personalised care, treatment and support. The service cooperated well with other providers to ensure that people who had dementia had their health and care needs met. There were clear systems in place to ensure that the service was monitored effectively.

Our observations told us that people's individual wishes were considered and through observation and discussion we saw that people were respected and supported to make choices in their care.

From talking to people, their relatives and observing care we found that people were happy with the care that they received and that staff were friendly, caring and respectful and they liked the way the home was organised. We saw people receive effective and appropriate care, treatment and support.

People we spoke with said that they felt safe in the home and that they would "have no problem" to speak to a member of staff if they felt concerned. Staff were knowledgeable on safeguarding matters and recognised that many of the people they cared for were vulnerable and relied on them to protect them.

Care was delivered by sufficient number of skilled staff that understood and were trained to care for people with a variety of nursing and care needs including dementia. Relatives told us that they felt 'staffing was more settled."

Systems and procedures were in place to monitor the quality of the care. People told us that although their views of the service were not formally requested they would be happy to raise concerns.