Archived: Westroyd Care Home

Westroyd Care Home is a residential care home providing care and support for up to 55 older people. Accommodation is provided across two building referred to as the House and the Lodge. The lodge supports people living with dementia. At the time of our inspection there were 37 people using the service.

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

Consistent numbers of skilled and knowledgeable staff were not always deployed to keep people safe and meet their needs in a timely manner.

Improvements were needed in managing potential risks of infection for people. Staff were not always adhering to safe practices in doffing and donning personal protective equipment when moving between buildings or administering medicines. Areas of the environment did not support effective cleaning of high risk areas, such as toilets. The premises required re-decoration and review to ensure the environment was able to support staff to meet people's needs effectively.

Oversight of the service required improvement to ensure systems and processes were effective in bringing about timely improvements. Not all concerns found on inspection had been identified in audits and checks.

People were happy with the support they received and felt safe living at Westroyd. Staff knew what to do to keep people safe and were confident any concerns would be taken seriously. Risks to people's well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively. People received support to take their medicines safely.

Staff felt they required further training to provide them with the skills and knowledge they needed to support people living with dementia and distressed behaviours effectively. Staff felt well supported by their line managers and the registered manager.

People were supported to maintain their health and well being through a balanced diet, sufficient hydration and access to appropriate healthcare.

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.

People, relatives and staff spoke positively about the registered manager and the changes they had made to improve the quality of the care and support provided.

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 27 June 2019).

Why we inspected

The inspection was prompted in part due to concerns received about care and support. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. 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. The overall rating for the service has changed from good to requires improvement. 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westroyd Care Home 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 reinspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Westroyd Care Home had a calm and friendly atmosphere in both the house and the lodge. People felt safe living there although they did not always feel like there were enough staff. Staff knew how to keep people safe whilst supporting them and risks associated with people’s care were assessed appropriately. People were supported to take their medicines in a timely and safe way.

We recommend that environmental safety checks were completed regularly to protect people from risk of harm.

People were supported to eat and drink well. Staff sought support from healthcare professionals when required to meet people’s needs. People were supported by staff who were appropriately trained.

People felt staff treated them with kindness and cared for them in respectfully. We observed positive interactions between staff and people.

People’s plans of care were personalised, and staff had the information to provide care and support in an individualised way. People felt that activities were limited. People had the opportunity to give feedback and make suggestions at resident’s meetings and via surveys.

People felt staff and management were approachable and concerns were dealt with appropriately. The registered manager had systems in place to monitor the quality of the service and were aware of their duties.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published on 25 April 2018).

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

Follow up: We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern, we may inspect sooner than scheduled.

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

At our last comprehensive inspection on 19 and 20 July 2017, we rated the service as inadequate and identified breaches of legal requirements. The provider was asked to complete an action plan to tell us what they would do to meet legal requirements in to breaches in Safe care and treatment, Safeguarding service users from abuse and improper treatment, Premises and equipment, Dignity and respect and Good governance. The service was also in breach of the registration regulations failing to notify the Commission of events affecting people.

We carried out a focused inspection on 5 December 2017 to review the actions taken by the provider to meet the legal requirements. You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Westroyd Care Home on our website at www.cqc.org.uk.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The inspection took place on the 27 February 2018 and was unannounced.

A registered manager was not in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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. The registered manager had left the service and there was a temporary manager in place. Following our inspection the provider confirmed the manager had been offered the position on a permanent basis and would be applying to register with CQC. We will continue to monitor this.

We made two recommendations in relation to ensuring environmental checks were carried out at all times and information about people’s dietary needs being written down and available to staff who work in the kitchen.

People received safe care. There were risk assessments in place, which ensured identified risks were mitigated. Staff were appropriately recruited and there were sufficient staff to meet people’s needs. Although people worried the staffing levels were not always correct due to sickness or absence of staff. The manager explained staff recruitment was on-going and wherever possible staffing levels were maintained through the use of agency to cover any sickness.

People were protected from the risk of harm. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People's health and well-being was monitored by staff and they were supported to access health professionals. Some people felt they were not always supported to do this in a timely manner.

People were cared for by a staff team who were friendly, caring and compassionate. Positive relationships had been developed between people and regular staff. People were treated with kindness.

People's care and support needs were monitored and reviewed to ensure care was provided in the way they needed. People or their representative had been involved in planning and reviewing their care. Plans of care were in place to guide staff in delivering consistent care and support in line with people’s personal preferences and choices. End of life wishes were discussed and plans put in place.

Staff had access to the support, supervision and training they required to work effectively in their roles. However, some staff felt the training needed to be more detailed. Development of staff knowledge and skills was encouraged. People were supported to maintain good health and nutrition.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. There was a variety of activities available for people who lived in the Lodge to participate in if they wished to. People who lived in the House were not always offered activities as the recruitment of an activities coordinator was on-going. Family and friends were welcomed to visit.

The provider had a positive ethos and an open culture. People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored through the regular audits carried out by the management team and provider.

The service was run by a manager who had the skills and experience to do so. The manager led a team of staff and was developing their commitment to high standards of care and vision of the type of home they hoped to create for people.

People knew how to raise a concern or make a complaint and the provider had effective systems to manage any complaints they received.

We carried out an unannounced comprehensive inspection of this service on 19 and 20 July 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider was asked to provide an action plan to tell us what they would do to meet legal requirements in relation to breaches in Safe care and treatment, Safeguarding service users from abuse and improper treatment, Premises and equipment, Dignity and respect and Good governance. The service was also in breach of the registration regulations failing to notify the Commission of events affecting people. We did not receive the action plan.

We issued two warning notices to the provider in relation to safe care and treatment and Good governance. We undertook this focused inspection to check that the provider was compliant with the warning notices by the date we had asked them to be. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westroyd Care Home on our website at www.cqc.org.uk.

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.

People felt safer with the support the received. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

Risks to people were assessed and monitored regularly. However, records relating to risks associated with malnutrition were not completed consistently. The risks to people could not be effectively managed to ensure people who were at risk of malnutrition had enough to eat and drink.

The premises were maintained, however some checks to ensure the property was safe had not been completed when the maintenance person was off work for a period of six weeks.

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place.

Medicines were managed in line with the prescriber’s instructions. The processes in place ensured the administration and handling of medicines was suitable for the people who used the service. Medicines had not all been dated when opened. Action was taken to address this during our inspection.

Systems were in place to ensure the premises were kept clean and hygienic.

There were arrangements in place to identify when action was required and learning took place when things went wrong to improve safety across the service. Tis had not always happened.

People, their relatives and staff felt confident to approach the registered manager and felt they would be listened to.

Quality assurance systems had been improved to monitor and review the quality of the service which was provided. Notifications of events which had happened were made when necessary.

We made one recommendation in relation to a second nominated individual to carry out environmental checks.

We could not improve the rating for Safe above requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Throughout May and June 2017 we received a number of concerns about the service. This inspection was carried out in response to the concerns that had been raised. These included a lack of staffing, staff not being fully trained, people being got up very early against their wishes, poor maintenance of equipment in the premises and concerns that people were not being kept safe.

At our last inspection on 7 February 2017 we found a breach of regulation 12 safe care and treatment. After this inspection the provider wrote to us to say what actions they would take to meet legal requirements in relation to this failure to provide safe care and treatment. At this inspection we found the provider had made most of the required improvements in relation to this breach. However we found that further improvements were required and additional breaches of the regulations were identified.

Westroyd Care Home provides care for up to 55 people who require residential care without nursing. The home had two separate buildings; the House and the Lodge. The House provides care to people who have needs associated with older age. The Lodge provides care to people who are living with dementia. Each building had two floors. There was a communal lounge, dining room and kitchen in each building. At the time of inspection there were 44 people using the service.

The service had 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.

People were not consistently protected from the risk of abuse at the service because incidents had not always been reported appropriately so they could be investigated. Staff had received training in safeguarding adults and knew how to report concerns.

People were not consistently protected from risks relating to their health and safety. Assessments of people's needs had not been completed fully. There was a lack of consistency in the information that had been recorded in assessments of need, care plans and risk assessments. Risks associated with some people's care needs had not been fully assessed. Guidance for staff was not detailed to ensure staff knew how to meet people's needs safely.

Medicines practices had improved. Staff were trained and deemed competent to administer medicines. However, a concern about inhaled medicine had not been identified, and charts to record where cream needed to be applied were not used consistently.

Equipment people used had been checked to make sure it was safe. Equipment that was used as part of the service such as a washing machine were not maintained appropriately and were not always fixed in a timely manner. Areas of the service people did not access were not kept clean. Appropriate infection control measures were not always used.

There were not enough staff to meet people’s needs. People had to wait for support and staff left people to ensure others remained safe. Staffing levels had been assessed. This was not based on all people’s actual needs as these had not all been identified.

People were supported to access healthcare services. People had a choice of meals. Where people needed a specific diet such as low sugar or soft this was not always identified or provided. Records to ensure people at risk of dehydration were not always completed correctly.

The provider had safe recruitment practices. They checked staff for their suitability before they started their employment. Where this had not happened it had been identified and measures put in place to carry out relevant checks.

Staff received support through a structured induction and supervision. There was an on-going training programme to provide staff with guidance and update them on safe ways of working.

The registered manager had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Assessments of mental capacity had been completed. However, the information that had been recorded was not based on the specific decision.

People were asked to make choices about their care and staff asked people for consent before they supported them.

People told us that staff were caring. However we observed a number of interactions where staff did not show this behaviour. People were not always treated with dignity and respect.

People had most of their needs assessed and a care plan developed from this. The information in these was not always consistent. Care plans had been reviewed monthly. These had not always been reviewed in response to an incident which could identify a change in a person’s needs.

People took part in some activities that they enjoyed. Activities were not always provided in the House due to the availability of the member of staff who provided these.

There was a complaints procedure in place. People and their relatives felt confident to raise their concerns. Some relatives felt that their concerns were not listened to.

The provider had systems and processes in place to identify and reduce risks to people who used the service. These had not been used effectively. We found concerns during this inspection that had not been identified by the registered manager and had not been picked up through the processes in place.

People had been asked for their feedback of the service and had attended meetings with the provider to discuss concerns. The most recent meeting had been held at short notice and relatives felt they were not given opportunity to attend.

People and staff felt they had received a good service until recently. The service was led by a registered manager who understood most of their responsibilities under the Care Quality Commission (Registration) Regulations 2009. Staff did not always feel supported by the registered manager.

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

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

Services in special measures 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 could 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.

Westroyd Care Home is registered to provide care for up to 55 people who require residential care without nursing. The home is split in to two units, the House and the Lodge. The House provides care to people who have needs associated with older age, whilst the Lodge provides care to people who live with dementia. Each unit provides care on two floors, has its own lounge and dining rooms. At the time of our inspection there were 42 people using the service.

A manager had been in post since October 2016 and was in the process of applying for registration. It is a requirement that the home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 a comprehensive inspection in August 2016 the overall rating for this service was Requires Improvement with one breach of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 was identified. We asked the provider to make improvements to ensure the safe management of medicines.

The provider sent us an action plan stating they would have addressed the breach of Regulation 12 by September 2016.

During this inspection we found the provider was continuing to breach this regulation. Medicines were still not managed in a safe way. People could not be assured they would get their medicines when they were prescribed.

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

People said they felt safe at the home. Staff understood how to report any concerns and were confident these would be dealt with by the manager. People did not always think there were enough staff on duty to support them. Staff had been recruited in a safe way to make sure they were suitable for their role.

People received support from staff who had the appropriate skills and knowledge to support people living at the service. Staff had received regular training in areas relevant for the people they supported.

People and relatives told us staff were kind and caring. Staff were respectful and helpful when supporting people. Staff were able to develop good relationships with the people who lived at Westroyd Care Home.

Relatives felt the activities in the Lodge were good but people living in the House still felt they needed to improve.

Staff understood the requirements of the Mental Capacity Act (2005) and understood how to obtain people’s consent before they offered care and support. Staff knew how to support people to make decisions for themselves. Where people may have lacked the capacity to make their own decisions, the provider had followed the requirements of the Act.

People enjoyed the food that was offered to them and received the right support with their nutrition and hydration needs. People could choose what they ate and their preferences and requirements were known by staff.

People had access to healthcare professionals to maintain good health.

The provider has systems in place to enable people to make a complaint or comment on the service and where comments were received these were acted upon. Relatives and staff felt they could talk with the manager at any time and said they were approachable.

Staff were clear about their roles and responsibilities. They knew how to raise concerns if they had needed to about the practice of a colleague. Staff were able to make suggestions for how the service could improve.

The manager understood the requirements of their roll, including informing CQC of any incidents or accidents.

The provider’s quality assurance systems were not always effective in making sure people received a safe and good quality service. For example, the provider’s checks had not identified shortfalls in the safe management of medicines.

Westroyd Care Home is registered to provide care for up to 66 people who require residential care without nursing. The home is split in to two units, the House and the Lodge. The House provides care to people who have residential needs whilst the Lodge provides care to people who live with dementia. Each unit provides care on two floors, has its own lounge and dining rooms. At the time of our inspection there were 38 people using the service.

The service had 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.

Systems for the safe management and storage were not being followed. The medicines room was not secure and procedures to monitor the use of pain relief patches was not always being followed.

Recruitment practices were not always followed. Risk assessments had not been completed before staff with spent convictions commenced work.

Complaints procedures were not being followed. People may not have their complaints investigated and receive information about any action taken.

Quality assurance systems were not robust or effective enough to identify all the shortfalls in the service. These included lack of some risk assessments and not all records being up to date and accurate.

People on respite were not always supported to retain their skills for returning home.

People told us they felt safe living at Westroyd Care Home

There were sufficient staff to provide people's care needs but the deployment of staff had an impact on the personalised support provided. Although staff were provided in the numbers that had been assessed as needed by the registered manager, staff were very busy, responding and providing care tasks such as personal care to people.

We found that staff were knowledgeable about people's needs and risks and what action to take to protect them from these risks. However new care staff or agency staff did not have this knowledge or access to up to date information to provide appropriate and safe care to people.

People were supported to have sufficient to eat and drink to maintain good health. People had mixed views about the quality of the food. Information in care plans did not always reflect the dietary support people received.

Suitable arrangements were in place for people to receive on-going support from healthcare professionals.

Some staff and people who used the service did not have confidence in the registered manager as they did not feel they managed the service in the best interest of people living there.

Mental Capacity Act (MCA) 2005 and best interest decisions were general and did not reflect the person's needs. The registered manager had not made to apply for a Deprivation of Liberty Safeguard authorisation when they were required. This meant people were being deprived for their liberty without due authorisation.

People were cared for by caring staff. People's privacy was respected and promoted. We saw examples of caring practice from staff. People's preferences, likes and dislikes were not always recorded in their care plans. Which meant that new or agency staff would not be aware of how people preferred to receive their care.

The environment in the Lodge was not dementia friendly and there was a lack of directional signage to communal areas and the stairs, lift or bedrooms.

The business contingency plan that was in place to minimise the risk to the home in the event of an emergency such as fire, adverse weather conditions, power cuts or flooding was significantly out of date.

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

We found people experienced care and support that met their needs and protected their rights. A relative told us: 'This was previously a good home, now it is a very good home. It is very homely and the staff are very caring.' Care and support was delivered in a way that met people's needs and ensured their safety and welfare. We saw that when people required medical attention this was arranged promptly.

We found that there were sufficient numbers of staff on duty to ensure people were safe and their needs were being met. One member of staff told us: 'It's [Westroyd Care Home] a lot better now. We have a new manager who is approachable, pleasant and a big help. The staffing levels are now good, with no short staffing.'

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping. Systems were also now in place to audit the quality of the care records on a weekly basis.

We spoke with nine people using the service and six relatives visiting their family members. We also spoke with nine members of staff, and a health care professional visiting Westroyd Care Home. One person told us: 'I can't find fault with it. There is a lot of food and the place is comfortable. The people are pleasant." The majority of relatives we spoke with had positive comments. For example, one relative told us: 'This is a good care home. The staff work really hard. I would recommend this care home.' However, some relatives we spoke with did have some concerns.

We looked at the care records of six people who were using the service. We found that Westroyd Care Home did not always seek medical advice and assistance in a timely manner, to meet people's changing needs. This meant that people's care and welfare needs were being put at risk.

We found that there were not always sufficient numbers of staff on duty to ensure people were safe and their health and welfare needs were met at all times.

The records seen on this occasion were not all up to date as required by regulation. We found the records did not include all the information that staff needed to ensure that people's needs were being met.

We looked at the records belonging to eight people who were using the service. We assessed whether improvements had been made with regard to people's care and welfare, and the appropriate completion of records. We also assessed whether improvements had been made with regard to the suitable handling and management of infection control, and the safe handling of medicines.

We found that staff members were not always following instructions from within the care plan documentation. This included the weighing of people who had been identified as at risk of losing weight. This meant that people's care and welfare needs were being put at risk.

We looked at the provider's infection control procedures and found that staff members were following the procedures in relation to infection control.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had put in place robust systems relating to the management of medicines.

The records seen on this occasion were not all up to date as required by regulation. We found the records did not include all the information to evidence that people's needs were being met.

Not all the records seen on this visit were up to date or accurate. These included people's care plans and medication records.

We checked the medication and found that there were inconsistencies within the medication records. There were issues with the dispensing and recording of medication. This meant that people were not protected against the risks of inappropriate administration of medication.

During our visit we also looked at the services infection control procedures. We found that staff members were not following the provider's policy in relation to infection control.

Not all the records seen on this visit were up to date or accurate. These included people's care plans and medication records.

We found that staff members were not always following instructions from outside professionals or from within the care plan documentation. This meant that people's care and welfare needs were at risk of not being met.

We checked the medication for some of the people we spoke with and found that there were inconsistencies within the medication records. There were issues with the dispensing and storage of medication. This meant that people were not protected against the risks of inappropriate administration of medication.

A complaints log had been developed and people knew who to go to if they had a concern of any kind.

During our visit we spoke with seven people who were using the service. They told us that they were happy with the support they received. One person told us: 'It is excellent, the food is good and the staff are very nice.'

We spoke with seven visitors, eight staff and one professional to gather their views on the service. A visitor explained: 'The staff are very nice, they always look after her [her relative] and she always looks well cared for.'

We were told that people had been asked for their consent to the care and support that they received before they moved into the service.

We looked at some care plans and found that although they were comprehensive, they hadn't always been reviewed as often as they should and some had inconsistent advice in them.

We checked the medication for some of the people we spoke with and found that there were some inconsistencies within the medication records and medication had run out of stock.

Everyone spoken with told us that they felt safe. One person told us: 'I feel quite safe thank you.' A relative explained: 'I can go away and not worry; it is a weight off my mind.'

Some of the people we spoke with knew what to do if they had a complaint to make, others were not so sure. One concern raised by one person we spoke with, hadn't been addressed and no record of this concern had been made.

We were told that the staff were supportive and we observed them carrying out their duties in a kind and patient manner.