We carried out a review of the data available to us about Westergate House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Westergate House, you can give feedback on this service.
We found the following examples of good practice -
All staff had received up to date infection prevention and control training, which included the use of Personal Protective Equipment (PPE). Staff received regular testing and we observed staff wearing appropriate PPE in the areas we visited. The deputy manager explained how staff wore additional appropriate PPE in line with current guidance when supporting people with tasks such as personal care.
The management of the service were well supported with regular infection prevention and control (IPC) meetings, updates and information from the provider’s wider internal management and quality teams. There were regular (IPC) audits and spot checks of staff IPC practice by management. Actions had been taken in a timely manner in response to IPC audits identifying areas of improvement, which had helped manage and reduce the spread of infection.
Staff worked well with local health professionals to manage IPC issues. During a historical COVID-19 outbreak, effective partnership working with local healthcare professionals has meant resources such as specific medicines had been made quickly available to treat people who had been seriously unwell. This had resulted in people not having to go to hospital while they recovered.
Information about increased use of PPE had been provided for people using the service in a variety of different formats according to people’s support individual needs, including verbal, written and pictorial guidance and watching video resources. This helped people understand the need for staff wearing more PPE and reduce any anxieties this may cause.
There were three living areas within the service. All staff were assigned to work exclusively in one of the three living areas, included cleaning and activity staff. This was an on-going policy to help to reduce the transmission of infection. People were supported in their rooms for the required period if needing to isolate, to help prevent spreading infections. Staff provided additional 1:1 social and activity support for people who were isolating.
Visitors were advised of expected IPC processes on or prior to arrival. Lateral flow testing for all visitors took place at the service on the day of the visit. Contractors were provided with a designated testing area that was accessible via a separate entrance to the main building. Visitors were provided with personal protective equipment (PPE) and used regular alcohol hand gel and handwashing facilities.
Shielding and social distancing guidelines were complied with. Changes had been made to facilitate social distancing inside the service, including introducing socially distanced seated arrangements in communal living and dining areas. The provider had adapted a existing room by building a wall with a large Perspex screen and intercom that was accessible for visitors from outside the service. The service had arranged for several outside spaces with tables and chairs at a safe distance apart to be available, so people could see visitors outside. This had allowed people to see visitors safely throughout the pandemic.
For occasions where no physical or real-time virtual visiting was possible for people, staff took time to look at photographs and helped them to send postcards and letters as an alternative means of maintaining contact with important people in their lives. To help reduce the emotional impact of adhering to increased infection prevention and control measures, including visiting restrictions and social distancing, staff worked with people on an individual basis to ensure they could maintain normal routines whilst keeping safe. People were supported to have virtual visits to take part in activities they would usually have enjoyed doing together with visitors. For example, watching sporting events with friends and family members via pre-arranged video calls.
Staff were supported to be risk assessed to see if they required any support with IPC and occupational health needs. This process considered any individual vulnerabilities, including those related to any protected characteristics as defined by the Equality Act. The provider had made adjustments to protect staff’s well-being, such as arranging for some staff to work from home. When staff had been required to isolate, management maintained regular check-ins and other support such as sending food parcels for staff who lived alone.
Managers maintained a visible presence in the service on a day to day basis. Throughout a historical COVID-19 outbreak, the General Manager had worked every weekend to support the staff team, together with the Deputy Manager who had provided regular support with care delivery along with their managerial duties as a means of alleviating pressure on their staff teams. There were wider and more structured reflection processes for staff arranged by the management, including meetings and face to face catch ups to talk about the impact of the COVID-19 pandemic and to offer emotional support. These meetings also offered a supportive environment for staff to discuss and identify any IPC practice improvements and good practice examples.
A registered manager was 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 and associated Regulations about how the service is run.
Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.
People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.
Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.
Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.
People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.
Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both supervision meetings with their manager, and formal personal development plans were in place.
People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.
People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.
People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, bingo, exercise, quizzes and themed events, such as reminiscence sessions and visits from external entertainers People were also encouraged to stay in touch with their families and receive visitors.
People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.
Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.
The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.
There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.
At the last inspection undertaken on the 2 June 2015 we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the principles of the Mental Capacity Act 2005 (MCA) not being adhered to. The provider sent us an action plan stating they would have addressed all of these concerns by July 2015. At this inspection we found the provider had made improvements and was now meeting the requirements of the regulation.
Staff demonstrated good knowledge and understanding of the Mental Capacity Act (MCA 2005). Decision specific mental capacity assessments were now in place which considered a range of decisions. Documentation reflected where best interest decisions had been made. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people's consent before they helped them.
People were supported to maintain their nutrition and hydration. People felt that they had enough food and drink and observations confirmed that drinks and snacks were offered throughout the day. People could choose what they had to eat and drink and felt that the food was good. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received drink supplements. Foods (where required) were fortified with cream, milk and cheese to increase their calorie intake. People's dining experiences throughout the home was mostly positive . Staff supported most people to have a positive dining experience. They were supported in a sensitive and respectful way according to their needs.
People had access to relevant health professionals to maintain good health. Records confirmed that external health professionals had been consulted to ensure that people were being provided with safe and effective care. People's clinical needs were assessed and met. People received good health care to maintain their health and well-being.
Systems were in place for the safe storage, administration and disposal of medicines. People told us they received their medicines on time and in their preferred manner. We identified minor concerns regarding two people’s medicine regime and lack of access to prescribed medicines. The provider was responsive to our concerns and took action. In response, they also completed a clinical incident analysis to explore why the incidences had occurred.
Arrangements were in place for the provision of meaningful activities and stimulation. The provider employed two dedicated activity coordinators and was in the process of recruiting a third activity coordinator. There was a homely, friendly and relaxed atmosphere within the home. Staff and the registered manager was committed to enabling people’s voices to be heard and listened to. Community meetings were held monthly and every month a range of actions were taken based on people’s feedback. Links with the local community had been established and the registered manager continually strived to improve the running of the home. There was a sense of community at the home, complete with dogs as people were able to move to the home with their pets.
Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the service. The registered manager had a range of tools that supported them to ensure the quality of the service being provided. Staff received training and support to deliver effective care to people.
People were treated with dignity and their rights and choices were respected. Observations showed people being treated in a respectful and kind manner. People's privacy was maintained; when staff offered assistance to people they did this in a discreet and sensitive way. People confirmed that they were treated with dignity and their privacy was maintained.
The inspection took place on 2 June 2015 and was an unannounced inspection.
Westergate House provides accommodation and nursing care for up to 76 people. The home is set in gardens and consists of a main house connected to a newer building, known as the annex. The annex, is home to the ‘memory lane community’ which cares for people living with dementia. At the time of our visit there were 68 people living at the service. The home also offers respite care.
The service has a registered manager. 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.
Where people lacked capacity to make decisions, records did not clearly evidence the process that had been followed. As a result the service was unable to demonstrate that people’s rights under the Mental Capacity Act had been respected. Where people may have been deprived of their liberty, proper processes had been followed that met the requirements of the Deprivation of Liberty Safeguards.
There was a sense of community at the home, complete with three dogs as people were able to move to the home with their pets. There was a regular staff team who knew people well. New employees spent a minimum of two weeks shadowing experienced staff so that they could get to know people and the service opted for their own staff working additional shifts rather than using agency staff. One staff member said, “Staff are good, care is good, and teamwork is good. We are working our level best for the residents here”.
People felt safe at the home. One said, “My daughter and son think it is lovely here too. They don’t worry about me, they know I’m happy here”. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely and at the right time.
Staff received training and support to deliver effective care to people. Every member of staff working at the home had attended dementia awareness training. The home had its own trainer who was rolling out a further eight week programme to staff. Staff felt supported and were able to approach their seniors for advice or guidance. There was a system of supervision and appraisal in place where staff could discuss professional development and training needs.
The service was caring. Staff were available and were quick to anticipate people’s needs and wishes. Staff engaged with people on an individual basis. They shared positive relationships, based on friendship and respect.
Mealtimes were a sociable experience and people spoke highly of the food. The chef provided a choice of menu and was clear on people’s dietary needs and preferences. People received support and staff ensured that they received enough to eat and drink.
People were involved in planning their care and were supported to be as independent as they were able. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This included the involvement of healthcare professionals, such as the GP, Dietician, Community Psychiatric Nurse (CPN) or Tissue Viability Nurse (TVN).
The home was well-led. The registered manager had a system to monitor and review the quality of care delivered and was supported by monthly visits from a representative of the provider. The registered manager received regular feedback from people, their relatives, staff and visitors. They took prompt action to address any concerns. Where improvements had been identified, action plans were in place and used effectively
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.
We spoke with staff who told us they felt confident in their role. They said that they had regular training and felt very supported by the manager. During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence.
We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.
They told us about the care and treatment provided. They confirmed that they had given consent to the care and treatment they had received and were very satisfied. One person told us, 'The home is very friendly and has been well run.' A relative commented, 'On the whole I think the home is very good and people are well looked after.'
We also asked people if they knew how to make a complaint. They confirmed that they would take up any concerns they had with the manager. We were informed they found the manager was approachable and people we spoke with believed their concerns would be taken seriously.
We spoke to the relatives of two people who live at Westergate House. They confirmed that their relatives' needs had been assessed prior to admission. They also confirmed that care plans had been discussed with them, but not in detail.
We also spoke to three members of staff who were on duty. They told us about the level of care they provide to people at Westergate House. They also told us about the support and training they have received to enable them to provide good quality care.
We spoke to the manager about the systems that were in place to assess and review the needs of each person. We also spoke to the manager about how the quality of service provision is assessed and monitored.
When we arrived we advised the manager that we are visiting as a result of information we have received which includes an allegation of abuse. We informed the manager that the purpose of our visit was to ensure Westergate House is compliant with the essential standards and not as part of the ongoing investigation being conducted by the West Sussex safeguarding team into the allegations made.