Westholme Care Home Limited

Westholme Care Home Limited is a residential care home providing personal care to up to 26 people. The home consists of 3 large houses converted to 1 large home over 3 floors. The kitchen and laundry facilities are on the ground floor. There are several communal rooms including lounges, conservatory, dining room and landscaped gardens. At the time of our inspection there were 19 people living in the home.

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

We have made a recommendation about staff deployment and person centred language. Medicines were stored and administered safely. People were supported safely, and the provider had plans in case of emergencies. Staff were employed following a safe and robust recruitment process Staff had received training to keep people safe and knew what action to take in response to any allegations of abuse. There were no restrictions on family and friends visiting.

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.

Community health and social care professionals had been involved in the care and support of those who lived at the home and people's dietary needs were met.

People told us they received good care. Their preferences and wishes were respected by the staff team. People were treated with dignity and respect and were involved in the decision-making process. We observed some lovely interactions by staff members towards people who lived at the home and staff we spoke with were clearly committed to the people who lived at Westholme Care Home Limited.

People’s needs were assessed, and care plans were developed to promote their lifestyle choices and positive risk taking. The provider had a complaints policy and procedure. People and staff told us they could raise concerns with managers and feel safe and supported. The provider knew how to access support to support people when they required end of life care.

The service was led by a management team who were described as approachable, supportive and caring. The culture at the home was open and inclusive. Staff understood their roles and responsibilities. The provider monitored the quality of the service using a range of systems. The care manager and provider acted upon suggestions or ideas that were made by people, staff and professionals, to ensure the service continued to improve.

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 23 March 2023). 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 been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider manage the risks around building maintenance and gathering people’s end of life preferences. At this inspection we found the provider had made improvements in these areas.

This service has been in Special Measures since 23 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

Recommendations

We have made recommendations around the deployment of staff and the use of person centred language. Please see the safe and well-led sections of this report.

Follow up

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

Westholme Care Home is a residential care home providing personal care to up to 26 people. The home consists of two large houses converted to one large home over three floors. The kitchen and laundry facilities are on the ground floor. There are a number of communal rooms including lounges, conservatory, dining room and landscaped gardens. At the time of our inspection there were 23 people living in the home.

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

The provider had recently purchased the home and was in the middle of large-scale renovations. This impacted on the accessibility of some services to assure good infection prevention and control including the use of a dedicated sluice room. Risks to people were not always well assessed and managed and people’s medicines were not always administered as prescribed. We found staff were not always safely recruited or allocated to best meet the needs of people 24 hours a day, but we were assured there were enough staff and when required additional staff were used.

People were not supported to have maximum choice and control of their lives and staff did not 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. Where people lacked capacity, assessment for best interest decisions and Deprivation of Liberty Safeguards were not routinely completed to ensure those with authority consented to care and treatment where people themselves were unable too.

Staff supervisions and team meetings were generic and did not include the depth of information sharing required to support staff effectively. As a consequence, some poor practice around respecting people’s dignity was undertaken. Discussions around end of life care had not been held and we were told people did not like to discuss this, action was required to evidence this was the case and information to ensure people had opportunity to be involved in the circumstances around their death needed to be captured.

The management team were aware of concerns and shared with us plans they had to make improvements. However, these were not captured in the completed audits and there was not an audit trail to evidence the work already completed. Records held to show the care and support delivered were not always contemporaneous accounts of support provided. This could lead to confusion when new staff or staff unfamiliar with people, supported the permanent staff team when delivering care.

Staff spoke positively of the new management team and shared with us how things had improved and continued to improve.

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 11 June 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the environment. A decision was made for us to inspect and examine those risks. Due to the this being the first inspection of the new provider at this address a full comprehensive inspection was carried out.

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.

You can see what action we have asked the provider to take at the end of this full report.

We identified 5 breaches of regulations. We found no evidence during this inspection that people were at risk of harm from these concerns and when shared with the management team they began to take action to remedy issues. Please see all key question sections of this full report.

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to safety including medicines management, infection control and risk management. Staff were not always safely recruited and when in post support provided was not always effective to ensure staff were competent. Support provided to people was not always provided considering people’s dignity and consent was not routinely acquired when delivering care in people’s best interest. Governance systems were in their infancy and did not identify concerns as detailed to us by the management team and records were not always complete. We also made 2 recommendations around gathering end of life preferences and the use and maintenance of the building.

Please see the action we have told the provider to take at the end of this report. 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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 of their 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.