Westlands Care Home

Westlands Care Home is a residential care home providing accommodation and personal care to up to 28 people. The service provides support to people living with dementia, physical disabilities, mental health conditions and sensory impairments. At the time of our inspection there were 24 people using the service.

People’s experience of the service and what we found:

The provider’s systems and processes to assess, monitor and improve the quality and safety of the service needed further development.

We found areas for improvement in relation to the adaptation and decoration of the home in supporting people living with memory or cognitive impairments and to support them to orientate to time and place, such as no personalised signage on bedroom doors.

There was a positive and open culture at the service. People spoke positively about the experiences of care they received. Further development was needed to ensure people and their relatives had the opportunity to provide feedback for improvements to be identified and actioned.

People told us they felt safe. Risks to people's care and safety was assessed and regularly reviewed to ensure measures were in place to mitigate such risks where possible and keep people safe. Staff demonstrated they knew how to raise safeguarding concerns.

There was enough staff to meet people’s needs in a safe and timely way. Staff followed safe infection prevention and control procedures to prevent the spread of infection. The administration of medicines was managed in a safe way and people received their medicines as prescribed.

Staff had been provided with training to ensure they had the relevant skills and knowledge to carry out their roles effectively. People were supported with their meals and drinks and staff contacted healthcare professionals when concerned about people’s health and wellbeing.

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.

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 13 December 2019).

Why we inspected

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

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

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

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

Follow Up

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

We found the following examples of good practice:

• People were supported to maintain contact with family members and friends using telephones and video calling. There was a separate visitors’ area with a designated entrance so people could visit when it was safe to do so.

• Staff were observed to wear the correct Personal Protective Equipment (PPE) in line with government guidance. PPE was accessible throughout the service.

• Cleaning schedules had been increased to ensure high touch surfaces such as door handles were cleaned regularly.

• The service had an up to date infection control policy.

• People were safely admitted to the service in line with government guidance.

• People and staff were regularly tested for COVID-19.

Westlands is a residential care home, registered to provide accommodation and personal care to 28 people, aged 65 and over. At the time of the inspection 26 people were living in the home.

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

Staff understood their roles and responsibilities to safeguard people from the risk of harm. People were supported to access relevant health and social care professionals.

People’s medicines were managed in a safe way. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care, which mitigated these known risks.

People received care from staff they knew. Staff had a good understanding of people's needs, choices and preferences. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. Staff gained people's consent before providing personal care.

People were involved in the planning of their care which was person centred and updated regularly. People were supported to express themselves, their views were acknowledged and acted upon. There was a complaints system in place and people were confident, complaints would be responded to appropriately.

Staff were recruited using safe recruitment practices. Staff received training to enable them to meet people’s needs and were supported to carry out their roles.

The management team continually monitored the quality of the service, identifying issues and making changes to improve the care.

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.

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 14th June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

There was a registered manager in post. 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.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. All staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from staff unsuited to the role.

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People had been involved in planning and reviewing their care.

People were supported to have sufficient amounts to eat and drink to maintain a balanced diet. Staff monitored people’s health and well-being and ensured people had access to healthcare professionals when required.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with staff, who provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

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 by the audits regularly carried out by the manager and by the provider.

Westlands Care Home provides a service for up to 28 people who have a range of care needs including dementia, mental health, sensory impairment and physical disabilities. There were 18 people living in the home on the day of this inspection. The service is also registered to provide a domiciliary care service to people in their own homes, but this was not happening at the time of this inspection.

At our last comprehensive inspection on 19 February 2015, we found that the service was in breach of legal requirements in a number of areas. We followed up on these areas at another inspection on 29 September 2015 and found improvements had been made. Although we found that the service was no longer in breach of legal requirements at that time, we did not change the overall rating for the service because to do so would require consistent good practice over a sustained period of time.

We therefore checked all the areas where legal breaches had occurred previously during this inspection, and found that the improvements had been sustained.

Although we did identify some new areas for improvement during this inspection, the area manager was able to demonstrate that she had already identified these through a recent internal audit, and confirmed she had a plan in place to address these.

A registered manager was not 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. A new manager had been appointed who was planning to take up their post the following month. Appropriate managerial support and oversight was being provided by the area manager in the interim.

Risks were managed so that people’s freedom, choice and control were not restricted more than necessary. We did find some anomalies in terms of how risks were managed and reviewed however, which meant people were at risk of not having identified risks managed in a consistent way.

There were sufficient numbers of suitable staff but improvements were needed to ensure people got the right support at key times of the day such as meal times.

The provider carried out robust checks on new staff to make sure they were suitable to work at the service. However, not all legally required checks were in place.

Systems were in place to ensure people’s daily medicines were managed in a safe way and that they got their medication when they needed it. Improvements were required however regarding the recording of PRN (as required) medication.

People received personalised care that was responsive to their needs. However, some care records needed reviewing; to ensure the care and support being provided to people was still appropriate for them.

People felt safe living at the service. Staff had been trained to recognise signs of potential abuse and keep people safe.

People received effective care from staff that had the right skills and knowledge to meet their needs.

We found that the service worked to the Mental Capacity Act 2005 key principles, which meant that people’s consent was sought in line with legislation and guidance.

People had enough to eat and drink. Support was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

People’s healthcare needs were met.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

People’s social needs were provided for and they were given opportunities to participate in meaningful activities.

People were given opportunities to be involved in making decisions about their care and support.

People received personalised care that was responsive to their needs. Staff encouraged people to be as independent as possible.

People were supported to raise concerns about the service and these were responded to appropriately.

There were effective management and leadership arrangements in place.

Systems were also in place to monitor the quality of the service provided.

We saw that new staff received an induction when they started working in the home and that this was followed up with an ongoing programme of training. We saw that the training included areas such as moving and handling and dementia care which were relevant to the care that staff provided.

Staff told us that they received regular supervision sessions. We looked at the records for a selection of these and saw that the manager had given staff feedback on their performance, discussed their training needs and given them an opportunity to discuss any issues that they wished to talk about. We saw that staff were also able to give feedback via a six monthly staff survey.

We spoke with three members of staff who told us that they felt supported to do their jobs. They all told us that they found the manager approachable and could go to her for support and advice.

We received positive feedback about the home from a visiting health professional.

The provider is registered to provide the regulated activity "personal care" to people who live in their own homes as well as providing 'Accommodation for persons who require nursing or personal care' from Westlands Care Home. At the time of our visit the manager confirmed that the regulated activity personal care was not currently being provided so it did not form part of the inspection.

We spoke with a visiting health professional and three relatives of people living in the home. They all spoke highly of the care people receive. One relative explained that the staff communicate well and that the manager deals with any issues raised very promptly.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that people using the service and their relatives had been able to give feedback about the service through quarterly satisfaction surveys. We looked at a selection of these and saw the feedback from people living in the home and their relatives was positive.