Archived: Westgate Residential Home

People’s experience of using this service: People felt safe and supported by staff who were kind and caring. Staff and the management of the home were approachable and knew people well. People were encouraged and supported to maintain their independence.

• The provider had a lack of systems in place to monitor water temperatures, the recording of medicines, the environment and decoration and infection control. The service was clean and tidy.

• Care plans were personalised and included specific information relating to people’s likes and dislikes.

• Recruitment procedures ensured staff had relevant checks in place prior to starting work.

• People spoke positively about the food provided at the service.

• Visitors were asked to sign in and people had personal evacuation plans in place in case of an emergency.

• Feedback was sought from people and positive comments had been gained.

• Staff had received training and supervision and an annual appraisal.

• People felt comfortable in raising any concerns or issues.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (November 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will review the report on actions the provider intends to take following the inspection. We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

Westgate residential home provides accommodation and personal care for up to ten people who do not have nursing care needs. At the time of this inspection there were eight people living at the home. Westgate residential home has eight bedrooms, a kitchen, dining room, two lounges, office, laundry room, deputy manager flat, staff flat and front garden.

There was two registered managers in post who was also the provider. 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 communal bathrooms had areas of dust on ledges and skirting. Extractor fans were dirty and hot water checks were not being undertaken to identify where people were potentially at risk of scalding because of temperature of the water.

People had detailed care plans that were personalised to them but not all risk assessments had been undertaken to identify the risk and ensure guidelines were in place for staff to follow.

People’s personal evacuation plans had details of what support the person might require in an emergency. People were supported by staff who had checks completed prior to commencing their employment. People felt safe and staff were able to demonstrate what action they would take should they have concerns about people’s safety.

People were supported by staff who received regular supervision and training to ensure they were competent and skilled to meet their individual care needs.

People received their medicines from staff who had received training. One person's medicine was not administered when required and medication administration charts needed to identify medicines that should not be taken with specific fruit juices.

People were supported by adequate staffing levels and staff supported people in a kind and caring manner. Staff demonstrated they knew people well and felt supported and able to raise any concerns with the registered manager.

People had positive relationships with their care workers and felt able to make decisions about the care they received. Changes in people’s needs were identified and their care package amended to meet their changing needs.

The service was flexible and people and relatives views were sought so that improvements could be made. People were happy with the care and felt able to raise a complaint if they had one.

People had unrestricted access and were able to come and go as they pleased. Visitors were able to visit as often as they liked.

The quality assurance system to monitor the quality and safety of the service was not always effective at identifying any areas for improvement. We recommend that the provider reviews audits in relation to health and safety and infection control.

The people we met had lived at the home for at least 20 years. They told us they were able to make their own decisions about how and where they spent their day. Comments included 'I come and go as I please. There are no restrictions here. They just like you to tell them when you go out and when you are back' and 'this is my home. It is a happy place to live. I am never made to do something that I don't want to do.'

The staff we spoke with demonstrated a good understanding of how to support people to make decisions and of the procedures to follow should an individual lack the capacity to consent to their care and treatment. This meant that staff knew about the arrangements to ensure that people's rights were protected.

The home followed appropriate procedures for the management and administration of medicines. This meant that people received their prescribed medicines when they needed them.

Procedures for the recruitment of staff were robust which meant that risks to people who used the service were minimised.

Systems were in place to monitor and improve the quality of the service people received.

We read two care plans which had insufficient information about people's assessed needs or how these should be met. We saw risk assessments relating to people smoking had insufficient detail to reduce the risk to a safe level.

We judged this to have a moderate impact on people who used the service and we issued a compliance action.

We found that people were not protected against the risk associated with the inconsistent administration of medicines prescribed on an 'as required' basis. There was no system to reduce the risk of errors where hand written entries had been made on medication administration charts.

We have judged that this has a minor impact on people who used the service and we issued a compliance action.

We received a provider action plan on 18 October 2012 and visited the service on 10 January 2013 to follow up the compliance actions.

We found that the provider had taken action to ensure that the service was compliant. We saw that care plans told staff how people should be supported including protocols for the use of 'as required' medication. We found that people had been risk assessed individually to be able to smoke in their own rooms.

We noted the provider had changed the medication policy so hand written entries on medication administration charts were not used.

We judged the service was now compliant for these outcomes.

When we visited we were able to speak with five of the nine people who lived at the home. All confirmed that they were 'happy' living at Westgate. One person told us 'this is the first home I have settled in. They are really good and they listen to me and involve me in making decisions.'

Each person had a plan which described the care and support they required and how staff should provide it. Detail was lacking in two care plans that we looked at.

We were informed that people were able to smoke in their private bedrooms if they wished. We were shown the risk assessments relating to this. We found that information not sufficient to ensure that risks could be appropriately identified, managed or reduced.

The home had policies and procedures for staff about recognising and reporting abuse and whistle blowing. Staff spoken with were aware of issues of abuse and knew how to report any worries or concerns.

People had access to a spacious lounge and dining area. There was also a smaller sitting room part of which had a payphone for people to use. Communal areas had been comfortably furnished and were well maintained. The environment promoted a homely feel for the people who lived there.

People spoken with were positive about the staff that supported them. Comments included 'I like all the staff here' and 'they are all lovely.'