Background to this inspection
Updated
18 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was completed by two inspectors.
Service and service type
Westmead is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced on the first day and announced on the second inspection visit.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection-
We spoke with eight people living at the service and nine staff, including the registered manager, deputy, cook, and care staff.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff training and supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We reviewed two further care plans and risk assessments. We spoke with two professionals who regularly visit the service. We also spoke with two relatives and received written feedback from four.
Updated
18 January 2022
About the service
Westmead is a residential care home providing personal care and support to 16 people aged 18 and over at the time of the inspection. The service can support up to 19 people in one adapted building.
People’s experience of using this service and what we found
Most people said they felt safe, well cared for and enjoyed living at Westmead. Two people were less positive about their life at Westmead, but for both individuals the service was working with commissioners to find more appropriate placements.
Not all medicines were safely managed. We did not find people had come to any harm and the management team have already addressed issues of concern to ensure medicines were administered and recorded more safely and accurately.
Staff were knowledgeable about people’s needs and wishes and had strong relationships with them. The culture was caring and supportive but not always forward thinking in terms of ensuring people had enriched lives outside of the service. We are mindful that the pandemic had stopped some activities but there were options to enable people to go out and about which had not been fully explored until we gave this feedback. The registered manager believed there had been a reluctance for staff to think about assisting people to access the local community for fear of their vulnerable status. They said with some support they were now thinking of ways they could offer trips and outings that were low risk.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible within the service and in their best interests; the policies and systems in the service supported this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture (RSRCRC).
Right support:
• Model of care and setting maximises people’s choice, control and independence. The building was large, and staff were seen to use only some sections of communal areas meaning lots of people were in one area. They did not make use of other spaces to ensure people had quiet times, a change of scenery or just space away from noise and lots of people.
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights. Staff did work in a person-centred way to ensure individuals had personalised care and support. Due to the large number of people living in one building this was not always done in an individualised way. For example, most people ate at the same time in one dining area.
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. This model of care had not been considered or included within the service’ statement of purpose or service user guide. There were no current plans to consider how Westmead might be adapted in line with RSRCRC principles and staff were not aware of this guidance.
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 the service under the previous provider was good, published on 24 July 2018.
Why we inspected
This was a planned five key question inspection as the service has been registered under a new provider for 12 months.
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.
We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report. Following feedback, the registered manager and provider has taken action to mitigate the risks we identified so people were not at risk of any harm.
Enforcement We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified breaches in relation to safe management of medicines and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.