Westin Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

In this Key question we looked at 6 quality statements: Safeguarding, Involving people to manage risks, Safe and effective staff, Safe environments, Medicines optimisation and Infection prevention and control. The provider evidenced good practice in most areas to keep people safe. However, during our assessment of this key question, we found concerns around the around the providers audits, including risk assessments and care plans which resulted in a breach in relation to governance. You can find more details of our concerns in the evidence category findings below.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We found staff had completed Safeguarding training had we found staff had a good understanding about safeguarding and the actions they would take if they had any concerns about abuse. The manager said they have an open door policy for staff to raise Safeguarding concerns and they check staff understanding about Safeguarding and where to report their concerns through regular discussions in meetings.

People mostly appeared to be supported safely, however there was one occasion we observed a person was not following their Speech and Language eating and drinking guidelines.

People living in the home said they felt safe. Relatives we spoke with did not have any concerns about the safety of their relative. One relative said, “We have discussions with staff about safeguarding and they are very open and willing to discuss any issue.”

We saw there was a safeguarding policy in place and staff were trained in safeguarding. Safeguarding incidents were reported appropriately, and action taken to make people safe. For example, referrals were made to other health professionals and the Dementia Well-being service. We saw a monthly analysis of falls records was completed to identify trends and other actions to take. However, we found shortfalls in people's risk assessments and care planning information to ensure people's care needs were safeguarded. We saw inconsistent information was recorded in people's risk assessment and care plans. For example, One person had been assessed as being at risk of pressure damage. They had an air mattress in use, but this was not referred to in the person's care plan. We found risk assessments and care plans had been reviewed regularly, however, we found some risk assessments and some care planning information did not provide clear instructions about how to reduce the risk of harm to people.

We found risk assessments had been completed for areas such as falls, skin damage, malnutrition and choking. Risk assessments had been regularly reviewed. However, care plans did not consistently provide clear instructions for staff on how to reduce the risk of harm to people. Additionally, some plans provided conflicting guidance. For example, we a looked at the care plan for one person who had a urinary catheter in situ. The plan informed staff the person could manage their catheter independently in one section, and in another section, it was documented that they needed staff to manage this aspect of their care.

Relatives we spoke with were involved in discussions around risks. One relative said we have regular meetings to discuss her care. Another relative said, “They are on the ball, they put things in place to minimise risk.”

Staff we spoke with told us how they help people to understand the risks to them and what is in place to make things safe. One staff we spoke with gave bed rails as an example: “I explain they are there to keep safe… we discuss with family. Families know their relatives well and can help the relative understand the risks.”

We observed people were supported most of the time. For example, we observed staff check on a person while they were drinking. The staff member explained they are aware of people at risk of choking and the actions they need to take. However, we saw one person was drinking a drink not in line with their speech and language therapist (SALT) eating and drinking guidelines. When we asked staff about this, they said a lidded beaker was being used because of the risk of spillage. We did not see this deviation from the SALT guidance had been included in the person's care plan.

Staff knew the action to take to maintain a safe environment. Staff said ‘If I saw something was broken, I would make sure no one used it and report it.’ Staff confirmed they have been involved in fire evacuation practice and have been shown how to use the fire extinguishers and fire evacuation mats. The Registered manager said: ‘We have a full-time maintenance staff who completes daily checks, monthly checks and monitor routine health and safety checks, including L.O.L.E.R (Checks required by law for moving and handling lifting equipment), Gas electrical and legionella's.’ The Registered Manager said they ensure the facilities and equipment, and technology are well maintained through routine assistive tech contract with service provider and electrical tests. The Registered Manager confirmed staff are trained in risk assessment in health and safety which includes safety checks in electronic equipment.

Relatives said the environment was safe. Relatives told us 'They are safe, there are no slips, trips or falls.' and, 'they have fire notices and fire detectors in the rooms and corridor and door guards; I am fairly confident its safe.'

We found the home to be visibly clean and free of hazards and odours. One set of bed rail covers that we saw were torn and were visibly soiled. We showed this to the clinical lead who said they would replace them.

We saw staff had health and safety training and fire training. Risk assessments were completed in relation to the environment. Routine health and safety checks were seen to take place. We found the fire risk assessment had not been updated since the refurbishment had been completed in 2020 to reflect the new checks. The Registered Manager sent us evidence from the contractor confirming all fire checks were completed and satisfactory following the works in 2020. However, this information had not been included in the Fire Risk Assessment we looked at. We saw the fire risk assessment had been reviewed, but there was no evidence this was reviewed by a competent person.

People told us there were enough staff to support them safely. People living in the home said they felt safe. Relatives told us there were enough staff in the home and felt staff knew how to support their relative well. Relatives told us: “I must admit the staff on now, are absolutely brilliant and really lovely”. And, “Yes, there always seem to have staff supervising at lunch time and at breaks as well – for mum there are enough staff.”

We observed there was enough staff to support people throughout the day, safely and without rushing.

We saw staff were trained in all the areas necessary to be effective in their job roles. New staff have an induction into the home to help them understand the organisation’s policies and procedures. However, we found shortfalls in recruitment checks and may put people at risk from unsafe staff being employed in the home. We found staff employment history was not fully completed, only showing the year of employment, and not including the month of employment. This could mean gaps in employment were not explored during the interview. Documents confirming the person’s identity were held on file, but there was no verification to demonstrate the original documents had been seen by the staff responsible for recruiting. References were completed, but the authenticity of the references were not confirmed by an accompanying email from the referee, letter head or stamp. We saw the provider had identified shortfalls in their recruitment process, but had failed to rectify the shortfalls within their own timescales.

We found staff receive support to deliver safe care. Staff felt there were enough staff to support people safely. We saw staff were trained in all the areas necessary to be effective in their job roles. Staff said they felt confident and competent to undertake care tasks relevant to their role. The Registered Manager said they use a dependency tool to make sure the home has sufficient staffing levels. We found staff receive support to deliver safe care. Staff told us they received supervisions and could request additional training if needed. We saw staff were given opportunities to talk about their performance and training requirements.

The Registered Manager told us all staff are trained on infection control through practical shadowing session and through e-Learning. The RM said they check staff understanding about infection control in relation to their job roles. RM said the home completes infection control audits. Staff could explain how they keep the home clean and minimise the risk of infection.

Relatives said the home was clean. Relatives we spoke with said; “It’s very clean and it smells clean as you walk in the door”. And, "The home is very clean, the bedding is always fresh and clean and we have always been happy with cleanliness in there”.

We found the home was visibly clean and free from odour on the visit. One set of bed rail covers that we saw were torn and were visibly soiled. We showed this to the clinical lead who said they would replace them

We found the home completed 'home Infection Control' audits, however some action plans did not always identify actions needed to ensure the audits were effective. For example, bedroom audits identified issues with towels and flannels being visibly stained, a gap in floor by door and curtain rail broken, however is not clear from some of the audits about the action taken to resolve these findings because the audits did not include the actions taken and completed information.

We found there were processes in place to ensure people received their medicines safely however, these were not always effective. Where people were prescribed medicines that required additional safety monitoring, these had not been risk assessed in all cases. For example, we saw three residents prescribed an anticoagulant medicine without a risk assessment to support staff to identify the associated risks such as bleeding and bruising. Where risk assessments had been completed, these did not always contain adequate person-centred information. Medicines audits were completed regularly, however, these had not identified issues with medicines that we observed during our inspection. For example, the audit had failed to identify that protocols to support the administration of “when required” medicines were not in place for all residents that needed them. This meant staff did not have the required documentation to support the administration of these medicines. The provider had body maps in place to document the application of topical medicines. However, there was no system in place to check that topical patches remained in place between applications.

Relatives said they were informed about their relatives medication and any changes most of the time. Relative's said 'my relative is on a lot of medication and they seem to manage it.' And ' my relative is kept comfortable and the staff monitor their pain.'

We found staff took a person-centred approach to medicines and were able to tell us how they supported each person in the home to take their medicines. Staff had up-to date knowledge of medicines and followed the provider's medicines policy. Annual medicines e-learning and competency checks were in place for all staff involved in medicines related processes at the home. Staff told us how the home documented medicines incidents and learnt from these.