Westcombe Park Care Home

Westcombe Park Care Home is a nursing home that provides nursing and personal care for adults. It accommodates up to 45 people in one adapted building. At the time of the inspection 30 people were using the service.

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

People told us they were well looked after, and that staff were kind. We observed that staff followed safe infection control practices. A relative commented, “I would give them top marks for cleanliness and their Covid-19 measures.”

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. Changes had been made to address the way the home managed deprivation of liberty safeguards to ensure they complied with any conditions made.

The provider had improved their framework for staff training and support. Staff received training and a competency check across all aspects of the care provided. Staff had received training in areas we had previously identified such as end of life care and dementia.

The environment had been improved to offer more signage for people who may need to orientate themselves.

Improvements had been made to the system to oversee the quality and safety of the service to ensure any issues were identified and rectified.

People’s nutritional needs were met. Staff worked closely with health professionals to ensure people’s changing needs were considered and any risks reduced.

People received personalised care that reflected their current needs and wishes and addressed their age, gender, sexuality, disability culture and spiritual needs.

People told us there was enough to do and we saw improvements had been made to the availability of activities for people nursed in bed. Where appropriate people received end of life care that was responsive to their needs and wishes.

People and their relatives were positive about the new manager and their availability and approachability. The manager and provider looked to learn openly from any incidents or accidents to improve the quality of the care provided. They were looking to involve people more directly in their care and sought their feedback through a variety of means including meetings and surveys.

Staff were all positive about the impact of the new manager and changes they were introducing. They said the manager was driving improvements in people’s care, was supportive and encouraging of their development and had developed good team work practice across the home.

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 9 September 2019). We found a breach of regulations and some areas for improvement. 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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 and 16 August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the way they monitored deprivation of liberty safeguards.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements and addressed other areas identified as requiring improvement . This report only covers our findings in relation to the Key Questions Effective, Responsive and Well-led which contain those requirements and areas of improvement.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Westcombe Park Care Home provides accommodation and nursing, or, personal care for up to 45 adults over the age of 65 years. There were 29 people living at the home at the time of this inspection.

We found the following examples of good practice.

During our inspection we observed the home was clean and hygienic throughout and cleaning schedules were checked and monitored. The home had a team of housekeeping staff that had been trained on infection control. There was an enhanced cleaning schedule in place that ensured door handles, keypads, handrails and high touch areas were consistently cleaned. We found no concerns in relation to the cleanliness of fridges.

Procedures were in place for visits to the home to be carried out safely, in line with national guidance. All visitors, including health and social care professionals were screened for symptoms of Covid-19 before being allowed to enter the home. Visitors were supported to follow guidance, wear personal protective equipment (PPE) and to observe social distancing. Safe visiting spaces had been developed and these were cleaned thoroughly after each use.

People were also supported to maintain regular contact with their friends and family members using a range of audio and video technology.

The home had arrangements in place to test both people and staff for COVID-19, in line with the current guidelines on testing. Appropriate staff had been trained to carry out these tests.

Staff had received training in infection control which had been updated to include information on managing the risk of the spread of COVID-19 and the use of PPE. Staff had access to PPE to support people safely whilst minimising the risk of the spread of infection.

The registered manager and provider carried out checks to ensure infection control risks were monitored and managed safely. Staff had access to infection prevention and control policies in place which reflected current national guidelines to support them in their roles.

About the service

Westcombe Park Care Home is a nursing home that provides nursing and personal care for adults. It accommodates up to 49 people in one adapted building. At the time of the inspection 44 people were using the service.

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

At the last inspection we had found concerns in respect of medicines management, an absence of person-centred care records and care planning, consent to care and the quality assurance system. At this inspection we found improvements had been made in all these areas and the provider was no longer in breach of these regulations. However, some improvements were still needed in relation to people’s care records and the quality assurance system to ensure the improvements were consistently maintained and that the issues we identified at this inspection were acted on consistently.

We also found that people were not always protected from restrictive treatment. As they were not always supported in accordance with conditions included in Deprivation of Liberty Safeguards (DoLS) authorisations. DoLS are the authorisations to restrict people’s liberty where they may lack capacity to make a decision for their own safety.

Some improvements were needed to staff training and supervision, to ensure staff had support across all areas of their roles.

We have made a recommendation that the provider source suitable end of life training for staff.

People’s protected characteristics were identified but not always consistently assessed or planned for. Improvements were needed to be assured that people who were nursed in bed or in their rooms received enough stimulation and social interaction, in line with their needs.

People told us they felt safe and well looked after. Risks to people were assessed and staff had guidance to reduce risk. The home was clean throughout and staff understood how to reduce infection risks. People and their relatives told us they thought there were enough staff. Safe recruitment practices were in place and medicines were safely managed. Health professionals spoke positively about the way the staff worked with them.

People were complementary about the catering at the home and told us they enjoyed their meals. They told us their health care needs were met, that staff were warm, kind and caring, and that they were treated with respect and dignity. People’s communication needs were assessed and there were a range of activities for people to take part in. People were supported to have maximum choice and control of their lives; and in their best interests; the policies and systems in the service supported this practice

There was a new manager in place who was successfully registered after the inspection. People, their relatives and staff were positive about the manager’s impact and said they were approachable and motivated to provide good care. People told us they felt their views about the service were listened to and acted on. Staff told us, and we observed that they worked well together. Some aspects of the provider’s quality assurance system worked well to identify issues and improve the quality of the service.

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 October 2018). We found four breaches of regulations. 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 the previous regulations. However, some further improvements were required, and they were in breach of a new regulation. The rating for this service remains requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had 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.

We inspected Westcombe Park Care Home on 28 and 29 June 2017 and found significant shortfalls. We found multiple breaches of the fundamental standards and regulations. The service was rated requires improvement. Risks to people were not always identified and guidance regarding how to reduce risks was not always followed by staff. We found people’s care and treatment was not always appropriate to their needs or preferences. Systems to monitor risk and the safety and welfare of service users were not always effectively operated and feedback from relevant persons about the running of the regulated activity was not always acted on.

We took enforcement action and served a warning notice on the registered provider.

Following this inspection, we inspected the service on 14 November 2017 and found that the service had acted to comply with the warning notice. Regular checks were being conducted to test fire equipment to ensure they were in working order. The home had a fire risk assessment in place and any actions needed to be taken had been actioned. However, we found a continuing breach of legal requirements because people using the service were not being repositioned in accordance with their needs, which placed them at risk of experiencing discomfort and developing pressure sores. We recommended the home review its staffing levels to ensure people's needs were met appropriately. Following that inspection, the provider sent us an action plan showing how they planned to make improvements.

At this inspection, we found that the provider had made improvements. Staff completed risk assessments for every person and there was detailed guidance available regarding how to reduce risks, which staff followed. Although we received a mixed response from people, we found there were enough staff on duty to help support people safely in a timely manner.

Although the provider had made improvements, we found four breaches of the fundamental standards and regulations. Some aspects in people’s care plans were incomplete and out of date. Medicines were not always managed safely. Staff asked for people’s consent, where they had the capacity to consent to their care. However, staff showed a lack of understanding of the Mental Capacity Act (MCA) and the best interest decision making process. The provider had systems and processes to assess and monitor the quality of the care people received. However, some aspects of quality assurance process required further improvements.

Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training.

The service had a system in place to manage accidents and incidents, and to prevent them happening again. The service carried out comprehensive background checks of staff before they started working.

The provider planned to deal with emergencies and staff were aware of the provider’s infection control procedures and they maintained the premises safely.

The provider trained staff to support people and meet their needs. The provider supported staff through regular supervision and appraisal. Staff assessed people’s nutritional needs and supported them to maintain a balanced diet. Staff supported people to access the healthcare services they required, and monitored their healthcare appointments. The registered manager and staff liaised with external health and social care professionals to meet people’s needs.

People or their relatives, where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, caring, and respectful. Staff protected people’s privacy and dignity.

The provider recognised people’s need for stimulation and social interaction. People had end-of-life care plans in place to ensure their preferences at the end of their lives were met. Staff completed daily care records to show what support and care they provided to each person.

The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.

The service sought the views of people who used the services, their relatives, and staff to improve the service. Staff felt supported by the registered manager. The service worked effectively with health and social care professionals, and commissioners.

The service had a registered manager in post and they had notified CQC of notifiable events. The last inspection rating of the service was displayed correctly on their website.

The registered manager had knowledge about people living at the home, and made sure they kept staff updated about any changes to people’s needs. The registered manager held meetings with staff where staff shared learning and good practice so they understood what was expected of them at all levels.

You can see what action we told the provider to take at the back of the full version of the report.

We received concerns about staffing levels in the home and during this inspection wanted to check staffing levels were adequate to ensure people’s needs were being met.

We undertook this focused inspection, on 14 November 2017, to check that the provider had taken action to meet our legal requirements. This report only covers our findings in relation to the key questions safe and well led and breaches identified in the warning notice. We will follow up on the other breaches of legal requirements in relation to risk and care and treatment in relation to people’s needs and preferences at a later date. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Westcombe Park Care Home' on our website at www.cqc.org.uk.

Westcombe Park Care Home offers residential and nursing care for up to 51 people and is located in the Royal Borough of Greenwich. During this inspection, there were 44 people using the service.

There was registered manager in place. 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.’

At this inspection, we found that the service had taken action to comply with the warning notice. Regular checks were being conducted to test fire equipment to ensure they were in working order. The home had a fire risk assessment in place and any actions needed to be taken had been actioned. Staff had undertaken fire safety training and usage of fire equipment. Staff spoke positively about the training received.

During the inspection, we observed the atmosphere was calm in the home and staff were not rushed when responding to people’s needs. However we observed occasions where people were left unattended in the lounge areas. Feedback from people using the service and care workers also indicated that at times, there may not be enough staff in the home. The registered manager told us there were enough staff and that he would ensure they were deployed appropriately on each floor. The registered manager also told us they were in the process of recruiting additional staff to work in the home.

There were arrangements in place to manage people’s medicines. However we found prescribed topical creams were not stored securely and records were not completed fully to ensure people received topical medicines as prescribed. The registered manager told us this would be addressed straight away.

Records showed that people who were mainly bed bound were not being repositioned in accordance to their needs which placed them at risk of developing pressures sores and experiencing discomfort. Records showed this issue had been highlighted in a quality assurance audit conducted by the service but actions to address this was not yet being fully implemented.

Systems were in place to monitor the service. Checks and audits were carried out by the registered manager and provider. Records showed any action that needed to be taken to make improvements to the service were noted and actioned. However the checks and audits did not identify the issues in relation to repositioning people and the application and recording of topical creams.

We have made one recommendation about staffing levels.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The ratings for the key questions safe and well led at this inspection remain 'Requires Improvement' at this time as systems and processes that have been implemented have not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice.

At this inspection there was no registered manager in place. The previous manager was still registered at the service at the time of the inspection, but, no longer worked as manager of the home. A relief manager, who had previously managed the home, and, was therefore familiar with it, had been brought in to manage the home and register as manager until a new permanent manager was recruited. We had been notified about these changes as required. The relief manager was aware of their responsibilities as 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.

At this inspection on 28 and 29 June 2017, we found a breach of regulation as systems to monitor risk were not effective in ensuring recommendations from fire risk assessments were implemented in a timely way to ensure all staff had received relevant fire safety training.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found two other breaches of regulations as staff did not always follow the guidance in people’s care plans about how to monitor and support people effectively to reduce risk. People’s preferences and needs were not always identified or care provided in line with their care plan. People told us and we observed that their need for stimulation and social interaction were not always met.

The relief manager and regional manager took immediate action to address the issues we identified in relation to some specific risks and sent through an activities action plan following the inspection.

There were some good aspects about the way the home was run. People told us that they felt safe and well looked after, that staff were kind and caring and their dignity was respected. They told us staff knew them well and that they were responsive to their needs. Most risks to people were identified and assessed and staff were given guidance about how to reduce risks. Staff spoke with a sense of shared responsibility and enjoyment of their work and we observed some warm interactions between staff and people living at the home. People’s nutritional needs were met and they had regular access to health professionals. Night staff were involved in planned meetings to ensure they felt part of the team and were knowledgeable about people’s needs.

People had an assessed plan of care which they and their relatives told us they were consulted about and this plan was reviewed regularly to ensure it was accurate. There was an effective complaints process in place for people to use.

People’s views were sought about the running of the home and they told us the relief manager was very approachable and listened and acted on any issues. Staff also told us they felt well supported by the management team. There were a series of meetings to monitor the quality and safety of the service and audits were used to track quality and identified learning; some of these auditing systems worked well.

Medicines were safely managed.There were enough staff to meet people’s needs. Staff recruitment was managed effectively.

There were some areas for further improvement. Although staff worked within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards some improvement was needed to ensure that they always sought the consent of people before they provided care. Staff had also not received dementia training, even though some people at the home were living with dementia. Aspects of the quality monitoring had not identified the issues we found at the inspection, although action on the issues we identified was taken at or following the inspection. The system to record and monitor training needed some improvement to ensure it was effective. We will follow up on these issues at our next inspection.

At the inspection on 20 and 21 April 2016 we found the more serious breaches of regulations had been addressed. However, a breach of legal requirements was found as systems to monitor the quality and safety of the service in relation to staff training and recruitment were not always effective. Following the inspection we mutually agreed some conditions on the provider’s registration to help sustain the progress made.

After the comprehensive inspection on 20 and 21 April 2016, the provider sent us an action plan to say what they would do to meet legal requirements in relation to this breach. They told us they would complete the action required by 30 June 2016. We undertook this unannounced focused inspection on the 24 October 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to the focused inspection for one part of the key question is the service well-led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Westcombe Park’ on our website at www.cqc.org.uk.

Westcombe Park provides care and accommodation for up to 51 older people living with dementia who may have nursing, care and support needs. At the time of this inspection there were 29 people using the service. There was no registered manager in place. 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 home had been managed by a relief manager but a new manager had recently been appointed with a view to applying to be the registered manager. They had previous experience of being a registered manager.

At this inspection we found that the provider had made improvements to the systems to monitor staff training and recruitment. Staff records had been audited and staff recruitment records that had been missing at the previous inspection had been located or replaced. Staff training records were now being kept and there was a system to monitor and ensure staff training was refreshed when needed. However records to evidence assessed nurses’ competencies were not always consistently maintained either at the home or by the provider and these required some improvement.

The improvements found were relatively recent and we were not able to judge their consistency or the reliability at this inspection. Additionally, the management of the home was undergoing a further period of change. A new manager had only recently been appointed and was becoming familiarised with the home with the support of the previous relief manager and the recovery team. The previous deputy manager had recently left the service and we were told a new deputy manager was in the process of being recruited. We have therefore not changed the rating for the key question Well Led as we need to see consistent good practice over time. We will check on this at our next inspection. We will be in discussion with the provider about the mutually agreed conditions on their registration and report on this at the next comprehensive inspection.

We carried out this inspection on 20 and 21 April 2016 in line with our special measures policy. We checked what progress had been made in respect of addressing the breaches identified at the November 2015 inspection and also carried out a comprehensive ratings inspection.

At this inspection the home was providing nursing or residential care and support to 33 people. There was no registered manager in post. The home manager told us they had applied to become a registered manager with the Care Quality Commission. 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.

At this inspection we found significant improvements had been made in relation to people’s safe care and treatment. People and their relatives told us there were considerable changes in the home and were all positive about the new manager and deputy at the home. Health professionals told us there were improvements to people’s care and in staff engagement with them.

We found a breach of regulations as systems to monitor the quality of the service were not consistently operated. Staff recruitment and training records were not effectively organised or maintained to provide an accurate record of the induction and training carried out. You can see what action we told the provider to take at the back of the full version of the report.

There were some areas which required some further improvement. Staff had received recent training in a number of areas but the training the provider considered mandatory was not fully up to date and arrangements for future staff training were not in place at the time of the inspection. Care plan records required some improvement to ensure they were personalised, accurate and clear for staff to follow.

There were improvements in people’s safe care and treatment. Risks to people were identified assessed and monitored and there was guidance for staff to reduce risks. Staff knew what to do in the event of an emergency. There were enough staff to meet people’s needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported. People’s medicines were managed appropriately and they received them as prescribed by health care professionals.

Staff asked people for their consent before they provided care and demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People received a balanced diet and told us the food had improved substantially since the last inspection. People told us staff were kind and caring and treated them with dignity and respect and we observed this to be the case. They had access to appropriate health care professionals when needed.

People had an assessed plan for their care and told us they had been involved in drawing this up.

Regular residents and relatives meetings were held where people were able to talk to the manager about the home and things that were important to them. People told us they felt involved in decisions and they had representatives on the food committee. People and their relatives knew about the home’s complaints procedure and said they believed their complaints would be investigated and action taken if necessary. People told us there was enough to do to keep them stimulated and we saw improvements were being made to make activities more personalised.

Staff said there had been a number of improvements and they enjoyed working at the home. They were positive about the manager and deputy and felt well supported in their roles. They told us they wanted to provide a caring good quality service and they felt confident they were heading in the right direction

In view of the significant improvements made across a number of areas the home is no longer rated Inadequate in any key question and is no longer in special measures. However the improvements were recent in origin and needed time to become embedded. We discussed these issues with the provider and we have mutually agreed some conditions on the provider’s registration to help sustain the progress made. These include the recovery team remaining to support the service until a new registered manager is in post.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. Staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications were required to be submitted, proper policies and procedures were in place to prevent people from being unlawfully restricted. Relevant staff were trained to understand when an application should be made, and how to submit one. We found that staff had a good understanding about adult safeguarding and they told us they would always escalate any concerns. A safeguarding policy was in place and staff attended an annual training session.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us. "The home is alright. The staff are excellent. The nurses come if I ring my bell to help me.' Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care support workers were patient and gave encouragement when supporting people. We observed this at lunch time when we saw staff assisting people at their pace and were not rushed. One person told us 'they look after me, I am happy here." A visitor told us "I have no concerns about the care here; staff are very caring.' Another relative said 'all the staff are brilliant.'

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us they were happy with the care they received. Records confirmed people's preferences, history and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities and people told us they enjoyed the social events organised by the home. We spoke to relatives who told us that the home had been responsive to feedback one relative said 'they keep me informed and communicate with me if there are any changes.'

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in an annual customer satisfaction survey. We found this had resulted in an action plan to work on improving the variety of menus and activities offered in the home. Staff told us that the acting manager had an open door policy and they could raise any issues with her. They said they had regular team meetings and they were asked for their feedback. In the annual staff survey 2013 staff rated the overall leadership effectiveness at Westcombe Park at 60%.

We found that people's care was planned and delivered in a way that was intended to ensure their safety and welfare and that they were cared for by staff who were supported in their roles through training and supervision. Records maintained in the home were fit for purpose and could be located promptly when requested. People were offered a choice of nutritious food and appropriate support to ensure they ate and drank sufficient amounts to meet their needs. We also found that medicines in the home were administered safely and stored securely.

We found that people were supported in promoting their independence and were cared for with dignity and respect. The provider had taken steps to identify and prevent abuse from happening within the home and peoples' needs had been assessed individually.

However, we also found some gaps in staff training and a lack of regular staff supervision. We noted concerns in the way records were maintained relating to people's care and to the administration of medication and found that care was not always being planned in line with people's assessed needs.