The Westcliff Care Home

The Westcliff Care Home is a residential care home providing accommodation and personal care to up to 33 people. The service provides support to older people and people living with dementia in one adapted building. At the time of our inspection there were 29 people using the service.

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

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; the policies and systems in the service supported this practice.

Improvements had been made in the infection control procedures in the service and in the environment. We found the service to be clean and hygienic and risks to people mitigated. Improvements had been made in people’s care plans and risk assessments to guide staff in the support they required to reduce any risks to their safety and wellbeing. This included improvements in how people’s capacity was recorded, and decisions made to keep people safe in their best interests. The governance and monitoring systems had improved to ensure the management team could independently identify shortfalls and address them.

People received their medicines, as required, safely. People were supported by staff who were available when they needed them. However, we have recommended the provider review their staffing levels at night to reduce risks. Staff were recruited safely in line with the provider’s policies and procedures.

Staff were trained to meet people’s needs. People had access to health care professionals where required and the service worked well with other professionals involved in people’s care. People had access to enough food and drink and records were maintained to monitor people’s dietary and hydration needs.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 July 2022). We had found breaches of regulation in relation to safe care and treatment and governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider considered reviewing and updating their policy relating to COVID-19 to reflect the most current government guidance and to provide staff with updated training in moving and handling. At this inspection we found the provider had acted on any recommendations and had made improvements.

Why we inspected

We carried out unannounced comprehensive inspection of this service on 13 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve around safe care and treatment, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.

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

Recommendations

We have recommended the provider review their staffing levels at night alongside people’s needs.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Westcliff Care Home is a residential care home providing accommodation and personal care to up to 33 people. The service provides support to older people in one adapted building. At the time of our inspection there were 22 people using the service, some people were living with dementia.

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

The governance systems in place were not robust and fully established to support the management team to independently identify and address shortfalls.

Infection control processes and procedures were not always thorough enough to reduce the risks of cross contamination. The systems in place to assess and mitigate risks to people were not always effective. We observed unsafe moving and handling practice when staff were supporting one person to mobilise. This practice did not support the person’s dignity.

People’s records did not always identify the most up to date risks to people and how they were reduced. People’s care plans were not always dated to show they were up to date and reflected people’s current needs. Some care plans which were dated were written in 2020 and 2021, therefore they were not always up to date. People’s records did not always include their decisions, such as where they wished to be cared for if they were unwell or needed end of life care.

People’s were supported to access health professionals, where required and the service worked with other professionals to achieve good outcomes for people. People received enough to eat and drink and they were complimentary about the choices of food they were provided with.

People were generally supported to have maximum choice and control of their lives and staff sometimes supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we observed a person having a lap belt placed on them whilst in a wheelchair. It was not clear if other less restrictive methods had been explored.

The environment was accessible and people had access to shared spaces. We identified some areas in the service which required action, following our visit, we were told these had been addressed.

There was a system in place to provide staff with training and support. Staff meetings updated staff on the requirements of their role and any changes in the service.

People received their medicines when they needed them. There were staff available to support people where needed. Recruitment processes were safe. There were systems in place designed to reduce the risks of abuse. Checks were in place on the safety of the environment, including fire safety and equipment used.

There was a complaints procedure in place and complaints were being responded to.

People told us they were happy with the service. The atmosphere in the service was fun and there was lots of laughter. People were provided with the opportunity to participate in social activities. People received visitors from their relatives.

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 17 March 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to safety, visiting and care provided. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led. We inspected and found there was a concern with Deprivation of Liberty Safeguards, so we widened the inspection and included the key question effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

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

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.

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

Enforcement and Recommendations

We have identified breaches in relation to safety, infection control and governance at this inspection.

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

We have recommended that the provider considers reviewing and updating their policy relating to COVID-19 to reflect the most current government guidance and to provide staff with updated training in moving and handling.

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 local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service was clean and hygienic. There were no unpleasant odours. Cleaning schedules and checks by the management team were in place to ensure the service was clean and infection control risks were reduced.

Staff had received training in infection control and the COVID-19 pandemic. There was personal protective equipment (PPE) available around the service for staff to use, and we observed staff were wearing PPE appropriately. Staff had received training in donning and doffing PPE and there were notices around the service reminding staff how to don and doff PPE and wash their hands effectively.

There was routine testing of both people using the service and staff, in line with government guidance. The management team understood their responsibilities if any test results were positive for COVID-19. This ensured action could be taken promptly to reduce the risk of exposure of the virus.

The management team had a system to check that staff were not working in other care settings to reduce the risks of the spread of infection.

Risk assessments had been completed to reduce the risks to people living in the service and staff. Where risks had been identified, for example people and staff who may be at higher risk of contracting COVID-19, measures were in place to mitigate the risk.

The environment had been adapted to support social distancing. This included additional areas for staff to take breaks and communal seating had been spaced so people were not sitting too close together.

The management team had identified how zoning and cohorting in the service would be used in the event of a COVID-19 outbreak. Systems were in place to admit people into the home safely, and notices reminded staff of when people were isolating and the PPE that must be used.

There were systems to reduce the risks of exposure to COVID-19 from individuals entering the service. This included the staff entrance and exit, where they were required to wash hands and put on PPE. There was a dedicated entrance for others, including visiting professionals. This included temperature checks, donning PPE, completion of a questionnaire and hand washing. People’s friends and family were not currently entering the service, they had visits with their family members in an external building with systems in place to reduce risks of cross infection.

At our last inspection of 18 January 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. However, improvements had been made in Responsive, which is now rated as Outstanding.

There was a registered manager in post. 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 service provided an extremely responsive service to people. People received care and support which was assessed, planned for and delivered to meet their specific individual needs. People were supported to participate in meaningful activities, which were creative and met people’s needs and preferences. Social inclusion supported people to live a full life as possible. A complaints procedure was in place. People were actively to give their views about the service and these were used to drive improvement. There were systems in place to support people at the end of their life.

The service continued to provide a safe service to people. This included systems designed to minimise the risks to people in their daily living. People were provided with their medicines safely. Staff were available when people needed assistance. The recruitment of staff was done safely. The service was clean and hygienic.

The service continued to provide an effective service to people. People were supported by staff who were trained and supported to meet their needs. 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’s dietary needs continued to be assessed and met and people had access to health professionals when needed. The environment was suitable for the people living there.

The service continued to provide a caring service to people. People had good relationships with the staff. Staff interacted with people in a caring manner. People were consulted about the care and support that they received.

The service continued to provide a well-led service to people. The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

Further information is in the detailed findings below.

There were 26 people living in the service when we inspected on 18 January 2016. This was an unannounced inspection.

There was a registered manager in post. 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.

There were procedures and processes in place to ensure the safety of the people who used the service. Risk assessments provided guidance to staff on how risks to people were minimised. There were appropriate arrangements in place to ensure people’s medicines were stored and administered safely.

Staff were trained and supported to meet the needs of the people who used the service. Staff were available when people needed assistance, care and support. The recruitment of staff was done to make sure that they were suitable to work in the service.

The service was up to date with the Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People were provided with personalised care and support which was planned to meet their individual needs. People, or their representatives, were involved in making decisions about their care and support.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.

To enable us to assess people's wellbeing, we spent time sitting with them observing the care they received and the level of staff interaction. We observed that the staff were attentive to people's needs. Staff interacted with the people who used the service in a friendly, respectful and professional manner.

We saw that people were provided with suitable and nutritious food and drink and that, if they needed extra support to maintain their weight, people had been referred to the dietitian and that their advice had been followed.

We looked the recruitment records of three members of staff. They contained the information required to establish that the person concerned was suitable for the role for which they had been employed and that safeguarding checks had been carried out before they started work.

All the records we looked at were complete, up to date and stored securely.

We saw a staff member doing an art activity with a group of people. One person said, "(The staff member) is very good, you should see us playing hockey with our sticks."

The purpose of this inspection was to check that improvements had been made with infection control which we identified at our last inspection of 28 December 2012. We found that improvements had been made and people were provided with a clean and hygienic environment to live in.

Suffolk Fire and Rescue Service had found that there were shortfalls in the fire safety arrangements in the service. They had issued an action plan which identified the improvements that needed to be implemented. During our inspection we found that improvements were being made. We wrote to the provider to ask for the dates of when the work was to be completed. The provider responded and provided the information requested. We were satisfied that the provider had taken swift and reasonable action to implement the improvements.

We saw that staff interacted with people who used the service in a respectful, caring and professional manner. Staff were attentive to the needs of people and responded to requests for assistance promptly.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

We noted shortfalls in the infection control in the service which needed to be addressed.