We carried out a review of the data available to us about OSJCT Westgate House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about OSJCT Westgate House, you can give feedback on this service.
Westgate House is a residential care home registered to provide personal and nursing care to older people. The service can support up to 61 people. There were 59 people living at the home at the time of the inspection.
People’s experience of using this service and what we found
Westgate House’s team always sought to improve their care, treatment and support by identifying and implementing best practice. There were champions within the service who actively supported staff to make sure people experienced good healthcare outcomes that led to an outstanding quality of life. For example, the dementia champion ensured the provision of current research-based dementia care was implemented. They were always looking for new research to be involved in and be a part of the changes to good practice guidance.
Links with health and social care services were excellent and resulted in people receiving support in a timely manner. Staff at Westgate House worked effectively with the GP and Care Home Support Service’s (CHSS) mental health team and as a result reduced the use of anti-psychotic medicines. Staff were highly skilled to work with people that might displayed behaviour that challenged. There was no one at the service using antipsychotic medicines.
The registered manager had embraced the new oral health initiative in line with the National Institute for Health and Care Excellence (NICE) guidelines. They had gone above and beyond and ensured people had good access to dental services and had their oral hygiene needs met.
The service had been designed around people’s needs and creative ways had been used to help people be as independent as possible. A great deal of time and effort had been spent by the management team and staff in designing and decorating the home. As a result, it provided a stimulating environment, which not only met people’s specific needs but also promoted socialising.
The provider had successfully adopted the 'Dignity plus project’. This aimed at adapting the environment by improving lighting and reducing noise levels. There were different areas for people to use for their preferred activities, and private spaces to spend time with their families or visitors. Themed destinations, such as a beach had been created which gave people living with dementia an opportunity to experience different experience.
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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the home
People living at Westgate House told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.
Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines safely and as prescribed.
People told us staff were caring. This ethos consistency enabled people to receive good care from staff who knew them well. Staff did all they could to promote independency and we saw examples of such practices.
The home was well-led by a registered manager who was committed to improving people’s quality of life and empowering staff. Significant changes had been implemented to support effective team working and improve people’s outcomes. The service had a clear management and staffing structure in place and staff worked well as a team. The provider had effective quality assurance systems in place to monitor the quality and safety of the service. Staff worked well with external social and health care professionals.
Rating at last inspection and update
The last rating for this service was Good (published 13 April 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Westgate House nursing home is registered to provide accommodation for up to 61 older people some living with dementia who require personal or nursing care. The home is divided into three units namely Kingfisher, Skylark and Nightingale. At the time of the inspection there were 59 people living at the service.
There was a registered manager 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 about how the service is run. The registered manager worked closely with the deputy manager as well as the area operations manager.
We were welcomed by the registered manager and head of care who were clearly happy to see us.
People who lived at Westgate House felt safe. Some people living with dementia were not able to tell us their experiences. We saw those people sought reassurance from staff and were relaxed with them. This showed they felt comfortable and safe with staff. Relatives told us they felt their family members were safe living at the home. Staff had a clear understanding of how to safeguard people and protect their health and well-being. People’s medicines were stored and administered safely.
The provider followed safe recruitment procedures and people were involved in the recruitment of staff. There were enough suitably qualified and experienced staff to meet people's needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.
People were supported to express their views and were involved in making decisions about their care and were offered day to day choices. Staff sought people's consent for care and treatment and ensured they were supported to make as many decisions as possible. The registered manager and staff had a good understanding of the Mental Capacity Act 2005. Where people were thought to lack capacity, assessments in relation to their capacity had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions
People received effective care from well trained staff. Staff demonstrated high levels of knowledge and understanding required to be able to positively impact on people’s wellbeing. People received care from staff that understood the needs of people living with dementia. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.
People's mealtimes were positive and sociable experiences. Staff were innovative in the ways they supported people who were living with dementia to eat and drink and this improved their health and wellbeing. People were given choices and received their meals in timely manner. People were supported with meals in line with their care plans.
There was a calm, warm and friendly atmosphere in the home. Staff we spoke with were motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these influenced the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.
People had access to meaningful activities and stimulation at the home. Activities were structured to people's interests. Staff knew how to best support people and what activities and further improvements to the home would suit the needs of people.
Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.
Leadership within the service was open and transparent at all levels. The provider had effective quality assurance systems in place. The provider had systems to enable people to provide feedback on the support they received.
The registered manager informed us of all notifiable incidents. The registered manager had a clear plan to develop and further improve the home. Staff spoke positively about the management and direction they had from the registered manager. The provider and the registered manager continuously looked for innovative ways to improve the quality of care.
We visited Westgate house on 25 February 2015. It was an unannounced inspection. We previously inspected the service on 26 August 2014. The service was meeting the requirements of the regulations at that time.
The service provides accommodation for up to 61 people and is divided into three units called Kingfisher, Skylark and Nightingale. Each unit is designed to meet the needs of people living with dementia, people who require nursing care and people who have personal care requirements.
Prior to this inspection we had received some concerns about how people’s medicine was administered, the staffing levels on Kingfisher unit and the cleanliness of the home.
Medicines on Kingfisher unit were sometimes left with people without staff making sure they had been taken. This did not follow the homes policy on the safe administration of medicines.
Although people’s needs were met on the Kingfisher unit, staff were busy and had their breaks interrupted to answer call bells. They were not always available in communal areas to support people. The manager had identified more staff were needed on this unit and had made a business case to the provider to increase staffing levels.
The home was clean and tidy and staff followed best practice in infection control but had not all attended update training in infection control.
There were plans to keep people safe in the event of an emergency. However, some staff had not attended fire extinguisher or fire evacuation refresher training in line with the providers training schedule.
People liked living at the home. They told us they felt safe and staff were kind and caring.
People were cared for in a respectful way. People were supported to maintain their health and were referred for specialist advice as required. People were involved in their care planning. They were provided with person-centred care which encouraged choice and independence. Staff knew people well, understood their individual preferences.
People were supported to have their nutritional needs met. People liked the food, regular snacks and drinks were offered and mealtimes were relaxed and sociable. People who had lost weight had a plan in place to manage their weight loss and were referred for specialist advice.
People felt supported by competent staff. Staff felt motivated and supported to improve the quality of care provided to people and benefitted from regular supervision, team meetings and training in areas such as dementia awareness.
People told us they enjoyed the many and varied activities. People who were living with dementia benefitted from an interesting and stimulating environment.
The home had a registered manager in place. 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 about how the service is run. People, relatives and staff were complimentary about the registered manager and the management team. The registered manager sought feedback from people and their relatives and was continually striving to improve the quality of the service. There was an open culture where people and staff were confident they could raise any concerns and these would be dealt with promptly.
Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see the action we took and what action we told the provider to take at the back of the full version of the report.
We found that there was a variety of activities available. The provider provided personalised care, treatment and support. Peoples needs were assessed with appropriate plans drawn up and implemented. We found that people were supported in a manner that was consistent with these plans.
There was guidance in the home on safeguarding people from abuse. Staff members knew how to report concerns regarding abuse. The provider had responded appropriately to allegations of abuse. People told us they felt they would be listened to if they had any concerns regarding the way they were treated.
Through looking at staffing levels, training records and speaking with the provider we found that there was sufficient qualified, skilled and experienced staff to provide care and support for people. We were told by one staff member that "the teamwork is good".
We found the provider sought the views of people and their family representatives and made changes as a result. The provider told us they tried to be open and transparent so that they could learn and improve. We found the provider had a comprehensive system in place for assessing the quality of the service provided to people and had a system for continually trying to improve.
People told us "l feel very fortunate to be in this home, staff are very helpful and give me plenty of time","brilliant staff, if I have to be in a home then this is where I want to live","the food is very good","always plenty to do, we have an excellent activities person" and "never needed to complain as this is like living in a five star hotel".
The home had a copy of the Oxfordshire Safeguarding Adults procedure, available for staff to refer to. Staff we spoke with were clear about the procedure to take if they suspected that abuse had taken place. People and their relatives told us that if they had concerns or complaints they would speak to their key worker or senior member of staff.
Medication administration was given by a RN on the nursing unit. On the other two units, medication was administered by care leaders, who had received appropriate management of medication training and had successfully demonstrated their competence.
We were told that staff turnover was low, as most staff felt the home was a good place to work.
We saw evidence that regular audits were carried out each month by a senior manager of the Trust. We examined a sample of audits completed. The audits and action plans were detailed and well documented.