Westfield Park Care Home

Westfield Park Nursing Home is a care home that provides accommodation for people who require nursing and personal care. The home can accommodate up to 111 people. One part of the home provides care to people living with dementia, and the other, to people requiring nursing care. At the time of this inspection 83 people were living at the home.

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

People and staff had access to, and support from, an experienced management team. The provider and registered managers were open and approachable, which allowed people to share their views and raise concerns. These were taken seriously.

We found improvements had been made to the quality of the service and running of the home. A second registered manager had been recruited, and along with the existing manager and provider, had driven up the quality of the service. Staff had worked hard to bring about the improvements.

There was an improved governance framework in place to allow for the quality and safety of the care provided to be monitored. The service used the framework to highlight and address issues, provide action plans and improve the quality of care provided to people.

The environment had undergone improvements with parts of the service being refurbished. This work was ongoing. The environment was clean and protected people from the risk of infection. It was tidy and well maintained.

Staff demonstrated caring values and showed positive regard for what was important to people in their care. Their relationships with people promoted good levels of wellbeing and independence, which supported some people to achieve positive outcomes.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff respected people’s privacy and dignity and their approach was caring and considerate. People were relaxed and happy. Staff addressed people by their names, took time to talk to them and ensured people were comfortable and included in conversations.

Support plans were person centred and captured people’s preferences and life histories. Staff tailored their support to how people liked it.

Medicines were managed safely. There were enough safely recruited staff employed so that people received care when they needed it. Staff were well-organized and well trained. People told us they felt happy and safe in the service. Relatives said they were happy their family members were living at the home.

People had access to a range of activities to keep them as active as possible both mentally and physically. Staff embraced new ideas for enhancing people's wellbeing and used technology for people to keep in touch with relatives.

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.

At the last inspection we gave the service a rating of requires improvement (published April 2018) and there was one breach of regulation. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulation.

Why we inspected.

This was a planned inspection based on the previous rating.

Follow up.

We will continue to monitor intelligence 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.

At our previous inspection in November and December 2015 the service was rated as Good. This is the first time the service has been rated Requires Improvement.

Westfield Park Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 111 people across two separate units. One unit provides nursing care and the other is home to people with dementia, this is known as ‘The Haven’.

At the time of the inspection 87 people were living at the home and receiving a service.

The home had a manager 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.

Audits that were in place to ensure guidance and processes to record the storage of people’s medicines were at the correct temperature were not effective. Temperature checks were not always completed which meant people’s medicines may not work. Protocols were not always available to enable staff to safely administer medicines prescribed to be given only as and when people required them, known as ‘PRN’. Because of our findings the provider implemented remedial measures to reduce the associated risks and these actions were on going.

Infection control audits had not been completed monthly in line with the provider’s guidance. Systems and processes in place had failed to identify and remedy all areas of the home that were not clean. An action plan was implemented to reduce some of the associated risks during our inspection and further actions were planned.

During our inspection we found that audits had failed to ensure that records maintained for people were always accurate, complete and detailed in respect of each person using the service.

Staffing was deemed to be sufficient to meet people’s individual needs. We observed people did not have to wait long when they required support from staff. A dependency tool to determine sufficient staffing was provided to meet people’s changing needs was in use but required updating.

Staff received appropriate induction training and supervision to carry out their role. Staff told us they felt supported by their seniors. However audits had failed to ensure that staff received annual appraisal. This meant staff did not receive the required support in line with the provider’s policy. The provider was implementing improvements to make this process easier for staff to complete.

We found checks to assess and monitor the service and maintain standards around the home had failed to ensure that the systems and processes in place were robustly completed following the providers guidance. These included the DoLS register, staff dependency tools, meal time arrangements and staff appraisals.

The provider had failed to ensure systems and processes were effective to communicate information and changes regarding people’s care and support to everybody who required that information. This meant staff did not always have up to date information to provide person centred care and support appropriate for people’s current needs.

People were supported with meal time arrangements. However we found checks the provider completed had failed to identify the concerns we found. For example, information was not always available regarding the food on offer. The provider informed us that menus were available for people in their rooms. We found that there were inconsistencies in the support staff provided to people to ensure they enjoyed the meal time experience.

Staff had received training and understood the principles of the Mental Capacity Act and supporting people who had a Deprivation of Liberty Safeguards in place. Improvements were required to ensure people’s records evidenced their consent to care and support.

People were supported to improve their fluid intake. Innovative ways to promote fluid intake by the provider evidenced a correlation between increased fluid intake and a 67% reduction in falls.

The provider encouraged people to personalise their rooms. Rooms in the nursing unit were spacious with en-suite facilities and access to pleasant comfortable communal areas. The provider had made The Haven environment friendly for people living with dementia.

People were supported with their religious beliefs and personal preferences. Assessments were carried out to ensure the service was suitable for people and this information was recorded in their care plans.

People told us they were happy living at the home. Staff had a good understanding of how to treat people with dignity and respect their values. A range of activities were provided to ensure people were supported both individually and as a group to live fulfilled lives and enjoy their interests.

Families and friends were encouraged to visit their loved ones at all times and take relatives out for meals and visits. Where this was not always possible (due to travelling distances) the provider had purchased virtual reality headsets that enabled individuals to experience family events. An example included one person viewing their son’s wedding from a pre-recorded 360 degree video.

A dementia pathways nurse visited the home every month and consulted with people regarding their end of life wishes and preferences. People’s wishes and preferences were recorded appropriately.

The provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17: Good Governance. You can see what action we told the provider to take at the back of the full version of the report.

People were supported to be able to eat and drink sufficient amounts to meet their needs. Everyone we spoke with said they received sufficient drinks and meals and one person said 'You only have to mention it to the staff and they will make you or any visitors a drink.'

There were clear processes in place for what should happen when a person moved to another service, such as a hospital, which ensured that the person's rights were protected and that their needs were met.

People were cared for in a clean and hygienic environment. Two people who spoke with us said they were satisfied with the cleanliness of the home and pleased with the laundry service.

We saw the service had an effective recruitment policy and procedure, which ensured staff working in the service had the right skills and qualifications to meet people's needs.

The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary. There was also a complaints system available, which people understood and were confident of using if needed.

Records about people who used the service enabled staff to plan appropriate care, treatment and support. The information needed for this was systematically recorded and kept safe and confidential.

People told us they were involved in the decisions about coming into the service and staff discussed their care and treatment with them. They were able to make choices and decisions about their daily lives, and the staff respected their wishes and supported their independence. One person said 'I like my own company and prefer to spend my time in my bedroom; the staff respect this. However they do ask if I want to go out on trips or take part in activities.'

People told us that they had a good choice of social activities to take part in and the meals provided at the service offered them lots of choice and variety. One person told us 'The food here is very good, with different things on the menu. If you don't like what is offered then the kitchen staff will do you something different.' Another person told us 'There are lots of things for us to do and I like completing the crosswords in the weekly newsletter.'

People said that they had good access to outside healthcare professionals and they were satisfied with the level of medical support given to them. They said staff were good at giving them their medication on time and when they needed it.