Archived: Westgate House

Westgate House is a care home that is registered to provide accommodation and personal care for up to 44 older people including people living with dementia. At the time of inspection 31 people were using the service.

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

Safeguarding procedures were not consistently followed. Unexplained injuries were not always investigated, and physical interventions were not always appropriately recorded.

People were put at risk. Records were not consistently completed to evidence people’s needs were met. Not all known risks to people had been assessed or mitigated.

Medicine management required improvement. People did not always receive their medicines as prescribed.

Preventing and controlling infection required further improvement. We found the service appeared cleaner, however best practice and government guidance on preventing the spread of COVID-19 had not always been followed.

Staff did not always receive up to date training to enable them to learn the skills required to support individual people.

Provider oversight of the service was ineffective. Concerns found on inspection had not been identified therefore, no actions had been implemented to reduce the risks.

People were not asked to feedback on the service and staff told us they did not feel involved in the running or improving of the service.

People, staff and relatives knew how to complain. The registered manager understood their responsibilities under the duty of candour.

People were supported by staff who had been safely recruited. We found sufficient numbers of staff on duty during the inspection.

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

The last rating for this service was inadequate (published 18 September 2021) and there were three breaches of regulation. At this inspection we found improvements had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 6 September 2021. During this inspection the provider had not demonstrated that improvements have been made. The service is therefore still rated as inadequate overall and remains in Special Measures.

Why we inspected

We received concerns in relation to records, safeguarding, staff training, risks and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We also undertook this inspection to check whether the Warning Notice we previously served in relation to Regulations 12 (Safe care and treatment), 13 ( Safeguarding service users from abuse and improper treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westgate House on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risks to people, safeguarding, records, staff training and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Westgate House is a care home that is registered to provide accommodation and personal care for up to 44 older people including people living with dementia. At the time of inspection 35 people were using the service.

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

People were not consistently protected from harm. Physical interventions were not recorded appropriately, and unexplained injuries were not always investigated to identify a cause. Not all safeguarding's had been notified to the relevant professionals.

Risk assessments were not always in place or contained enough information. Staff did not always have the information required to support people safely. Some care plans held conflicting information and some care plans had missing information.

People’s care was not reliably recorded. We found gaps in the recording of repositioning charts, oral care, food, fluids, cleaning and incident forms. This meant we were not assured tasks had been completed.

Medicine administration required improvement. People were at risk of not receiving their medicines as prescribed. Staff did not always record they had given people their medicines or explained why they had given ‘as required’ medicines or their effects.

The environment required attention. The home appeared dirty with stains on walls, floors and furniture. We found damaged furniture. Cleaning records had gaps in the recording.

Improvements were needed to promote people’s independence, dignity and respect. We observed limited positive interactions between people and staff. Activities were limited and people stayed in one communal area for the day.

People’s communication needs required further development. We found people who required specific communication aids, did not always have this need met.

Systems and processes to ensure oversight of service required improvement. We found limited governance systems to ensure care was delivered, and records were kept and maintained. Policies and procedures were not always followed.

Lessons learnt and improvement of the service was lacking. Feedback from staff, people and relatives had not been sought to improve and monitor the service. Trends and patterns were not always reviewed and shared.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were recruited safety and completed an induction, training and shadow shift before starting work. However, not all staff had received refresher training.

People were supported to access healthcare. Referrals were made to external professionals such as speech and language therapists, dieticians and GP’s.

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.

The last rating for this service was requires improvement (published 4 May 2020) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about cleanliness, oversight, records and safeguarding. A decision was made for us to inspect and examine those risks.

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 improvement.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risks, recording, safeguarding, oversight, food and hydration and person-centred care at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Westgate House is a care home that is registered to provide accommodation, nursing and personal care for up to 44 older people including people living with dementia. At the time of inspection 37 people were using the service.

We found the following examples of good practice.

¿ Safe arrangements were in place for professional visitors to the service. These included temperature checks, hand sanitisation and wearing a mask. Arrangements were in place to manage family visitors in to the service when it became safe to do so. People were supported to keep in touch with friends and relatives by telephone and video calls.

¿ There was a supply of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the corridors and nearby all of the rooms where people were isolating.

¿ All staff, including temporary staff had been trained in current infection prevention and control (IPC) guidance and in the use of personal protective equipment (PPE). There were designated areas for putting on and taking off PPE and handwashing facilities were easily accessible to people and staff. We observed staff followed current guidance and practice throughout our visit.

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service.

¿ Enhanced cleaning schedules including regular cleaning of frequent touch areas such as handrails and door handles were in place. This reduced the risk of cross infection. We observed the environment was clean and hygienic. Communal spaces were used creatively to ensure people could continue to interact with each other and staff in a safe way.

¿ Regular IPC audits were undertaken to ensure staff complied with current guidance and practice. Any concerns picked up through these checks were acted upon.

¿ The infection prevention and control policy was up to date. People and staff had risk assessments in place to identify their individual risks associated with COVID-19. This meant protective measures could be put in place to keep people and staff safe.

¿ People were admitted to the service safely following government guidance. This kept everyone safe and reduced the risk of infection spread.

Further information is in the detailed findings below.

Westgate House is a care home that is registered to provide accommodation and personal care for up to 44 older people including people living with dementia. At the time of inspection 38 people were using the service.

People’s experience of using this service

Staff had not received training on physical restraint. Recording of physical restraints had not been completed in line with the providers policy or best practice.

People were supported to have maximum choice and control of their lives; however, staff did not always support them in the least restrictive way possible and in their best interests. Mental capacity assessments and best interests meetings had not been completed for every specific decision required.

We have made a recommendation regarding mental capacity assessments and best interest decisions being completed.

Staff did not always receive supervisions and annual appraisals in line with the providers policies. Staff meetings had been held regularly. Staff felt supported by the managers and had opportunities to complete additional training for develop their skills and knowledge.

We have made a recommendation that all staff have regular formal supervisions.

Risk assessments had been implemented and included strategies to reduce any potential risks.

People told us they felt safe and were supported by kind staff. Staff had been recruited safety and the necessary checks had been completed to ensure staff were suitable to be working in care.

Staff knew people well and care records contained person centred information. This supported staff to get to know people and be able to talk with them about things that interested them.

Medicines were managed safely and people received their medicines as prescribed.

The environment was clean and appeared well maintained. Cleaning schedules were in place to ensure all areas were cleaned regularly.

Accidents, incidents and falls were audited, and trends or patterns identified were shared with staff to reduce the chance of reoccurrence.

People’s healthcare needs were met. The staff worked well with other healthcare professional and referrals were made as needed. The service had a regular doctor who visited the service weekly.

The registered manager understood their responsibilities and regulatory requirement. Comprehensive audits were completed regularly to ensure the service was safe.

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 requires improvement (18 September 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to restraint being used at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using this service:

• People living at Westgate house had a range of physical health and emotional wellbeing needs.

• Many people had dementia and had moved to Westgate House following failed placements in other care homes.

• People were not consistently cared for in a kind and caring way. Some interactions with people were at times dismissive and decisions about specific aspects of their lives had not always been made in their best interest.

• The registered manager had completed audits on the home to support quality checks. However, for some areas, these had not identified where improvements needed to be made. For example, cleanliness of the environment, care plans, risk assessments and daily records.

• There were not enough cleaning staff to maintain a safe environment.

• Medicines were managed safely, systems and processes for administration and storage of medicines were followed by staff.

• There were sufficient staff to support people in a timely way.

• The provider was committed to developing the skills and knowledge of the care team. Staff received training appropriate to the needs of the people they were caring for.

• People had good health care support from professionals. When people were unwell, staff promptly sought support from the appropriate health professionals to address their health care needs.

• Staff felt well supported by the management team and any complaints raised were effectively responded to and appropriate action was taken.

More information is in the detailed findings below.

Rating at last inspection:

GOOD (Report published 16 July 2016). At this inspection found the service had deteriorated and has been overall rated as requires improvement.

Why we inspected:

This was a planned inspection based on our previous rating.

Enforcement:

At this inspection we found the service to be in Breach of Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

Following our inspection, we requested an action plan and evidence of improvements to be made in in relation to governance. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. Should further concerns arise we may inspect sooner.

There was manager in post who was in the process of applying to be the 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.

People were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. Senior 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 care 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. Relatives had been involved in planning and reviewing their care when they wanted to.

People were supported to have sufficient 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.

People experienced caring relationships with the staff that 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.

Feedback and complaints had been used to drive improvement in the service. The manager continually strived to find ways to improve the service through monitoring the quality of the service by regular audits.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles.

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that risk assessments identified individual risks to people's health, safety or welfare. The staff received appropriate training to ensure they had the skills and knowledge to meet people's needs.

Is the service effective?

Effective systems were in place to monitor the management of the service.

People's care plans and risk assessments were regularly reviewed and updated as and when people's needs changed.

Is the service caring?

Comments from people using the service were in the main positive, for example, "The staff are very good' and 'I feel safe the staff know me very well'. One relative said 'The carers care'.

Is the service responsive?

We saw that meetings took place with relatives to listen to their views and the provider took action to address people's suggestions for improvements. People's complaints were listened to and appropriately acted upon. We saw that people's physical and mental health was closely monitored and appropriate action was taken in seeking the advice and guidance of health and social care professionals. However one relative told us they observed staff sitting chatting together and not giving much attention to people, other than attending to basic care needs. The provider may wish to note the person said they had brought their observations to the attention of the registered manager but had not seen much improvement in the staff attitude.

Is the service well-led?

The provider and the registered manager operated an 'open door' policy and staff received appropriate support in order for them to do their jobs effectively. We saw that the provider regularly met with people using the service and relatives to discuss how Westgate House was meeting people's needs. The provider produced a regular newsletter to inform people using the service and their relatives about social events, communicate information and share other matters of interest.

We spoke with five relatives of people that used the service. They did not have any concerns about the service. One relative told us "The Home is perfect for my brother in law and he is looked after well, we have no concerns, in fact it is a nice location".

There was an adequate recruitment process in place. We found that people's complaints had been investigated and responded to but we were concerned that the complaints policy was not brought to the attention of people using the service or people acting on their behalf.

We found that people's basic care needs were being met but that there was a lack of stimulation for people throughout the day. We saw that people's basic dietary needs were catered for however, people were not given a choice of meals.

We were concerned about the cleanliness around the service. We found that people's independence was not being promoted and people's dignity was not being maintained. We also had concerns as people were not always offered choices about their care.

We asked the provider to send us a report setting out their actions on how they were to achieve compliance with outcome 9, regulation 13. The provider sent us an action plan on 5 October 2012 telling us what they would do to achieve compliance.

We visited Westgate House again on 8 October 2012 to check the provider had carried out the actions as set out within their action plan. We found that improvements had taken place in the storage, administration and recording of medicines.