Archived: Westholme

Westholme is registered to accommodate 26 older people who may live with dementia. At the time of our inspection there were 20 people living at the home. Westholme is located near to the centre of St Annes, close to local services and amenities. The property is large, with accommodation spread over three floors. A lift provides access to the upper floors.

People’s experience of using this service:

The registered manager provided staff training and regularly checked their competency to ensure people’s medicines were managed safely. One person said, “Having the staff doing my medication keeps me safe.”

The registered manager had implemented the local authority’s safeguarding policy, which included contact details to report abuse. Staff demonstrated a good level of awareness about their related responsibilities. A staff member explained, “Our function is to keep the residents safe.”

The management team had implemented a new electronic system to enhance risk assessment and better evaluate treatment outcomes. The provider was extensively refurbishing and redecorating all areas of the home. People told us they felt valued, safe and comfortable.

The registered manager deployed good staffing levels and skill mixes to meet people’s needs. The provider had a wide-ranging training programme to enhance staff knowledge. A relative stated, “The staff are skilled and have a really good understanding of [my relative] and her background.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. A relative told us, “Whenever I visit I see people coming and going as they please, there are no restrictions.”

Staff checked each person’s diet to reduce the risk of malnutrition. People said they were offered variety and liked their meals. One person stated, “The food is lovely, I really enjoy my meals.”

Staff were respectful when they engaged with people and understood the value of touch and humour. One person said, “The staff are great. Considering they are much younger than me, they get me and talk to me on my level.”

The new electronic care planning system focused on monitoring people’s health to ensure support was responsive to their needs. A relative commented, “The staff attitude is one of real insight, respect, kindness and compassion. They are lovely and yet highly professional and experienced.”

People and their relatives confirmed there was strong leadership at Westholme. A relative said, “[The registered manager] has this lovely, calm aura about him. He is definitely a great leader.” The registered manager regularly audited the service to retain oversight of quality assurance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated good (published 31 January 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any issues or concerns are identified we may inspect sooner.

Westholme provides care and support for a maximum of 26 older people. At the time of our inspection there were 21 people living at the home. Westholme is located near to the centre of St Annes, close to local services and amenities. The property is large, with accommodation spread over three floors. A lift provides access to the upper floors.

A registered manager was in place. 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.

At the last inspection on 15 December 2016, we rated the service as Good.

During this inspection, we received positive comments about opportunities to enhance people’s social interactions. The registered manager had changed working practices to provide more frequent activities and time for staff to spend with those who lived at Westholme. One person who lived at the home commented, “There are plenty of staff around for me. They do try and get the residents going.”

The registered manager obtained information from individuals and their families before admission and used this to develop care plans. Staff underpinned this with discussion with the person and their family to gain a greater appreciation of how best to support them.

Staff completed a detailed life history to better understand individuals who lived at the home. This included details about their preferences and wishes in relation to their support. The registered manager further strengthened staff skills with training in managing behaviour that challenged the service. A staff member told us, “The most important thing is always thinking about the residents’ moods. I just act silly and make fun of myself and it keeps them going.”

Monitoring charts were used to check on people’s progress, including fluid and food, behavioural and checks on their whereabouts. However, we found staff did not always consistently maintain and complete these records. We discussed this with the registered manager, who showed us a new system they had introduced and additional staff training to improve the service.

We found the registered manager was working with the local authority to improve service delivery at Westholme. All staff we spoke with said the registered manager led the home well and supported them in their roles.

We found the registered manager regularly completed a variety of audits to check everyone’s safety and welfare. We saw feedback from last year’s survey was complementary about the standard of care and Westholme’s environment. The registered manager told us they would act quickly if concerns were identified.

Westholme provides care and support for a maximum of 26 older people. At the time of our inspection there were 24 people living at the home. Westholme is situated in a residential area of Lytham St Annes close to local amenities. Accommodation is spread over three floors, with lift access for people’s ease of use. Communal areas consist of lounges, a dining area and a conservatory with access to a comfortable decking area.

A registered manager was in place. 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.

At the last inspection on 23 September 2015, we rated the service as Requires Improvement under well led. This was because breaches of legal requirements were found. The provider failed to ensure quality assurance systems effectively monitored people’s safety. This was because the management team did not have required care documentation or an up-to-date fire risk assessment in place. This meant staff had no guidance about the safest and most appropriate method for protecting people in the event of a fire.

During this inspection, we found the provider had introduced fire evacuation plans personalised to each person’s requirements in the event of a fire. Additionally, they had implemented a new, updated fire risk assessment. This showed improvements had been made to maintain everyone’s safety.

People and their relatives told us they felt safe and secure at Westholme. One staff member said, “I am passionate about my job and I try my hardest to make sure everyone’s safe and comfortable.” Staff received safeguarding training to underpin their knowledge about protecting people from abuse or poor practice.

Records we looked at evidenced the provider had safe procedures to ensure they recruited suitable staff to support vulnerable people. We found staffing levels were sufficient to meet people’s requirements in a timely manner. Staff had training and regular supervision to support them in their work.

Staff concentrated on one person at a time when administering their medication. The management team provided relevant training to underpin their knowledge and competency. This demonstrated the provider protected people from the unsafe management of their medicines.

Staff received training and demonstrated a good understanding of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. Throughout our inspection, we observed they asked people for their consent before undertaking any assistance. One relative told us, “Even though [my relative] doesn’t always understand, they still ask her first. They explain things in simple, brief terms without patronising her.”

We observed meals were presented well, of ample portion and contained fresh produce. People spoke highly of the chef and we noted staff updated care plans in line with the effective management of the individual’s nutritional support.

Staff were friendly, caring and kind when they interacted with people and their relatives. One family member told us, “The carers are wonderful.” Care records included details about each person’s preference in relation to the maintenance of their dignity and privacy. We found people and their representatives were fully involved in their care planning.

Staff had a good level of information about each individual’s abilities, recognised needs and agreed support methods. The registered manager had guided staff to assist individuals to maintain their personality as part of living a meaningful life.

People and their relatives were encouraged to complete surveys to check their satisfaction levels with the service. The registered manager and staff worked closely together on a daily basis so that any issues could be addressed immediately. We reviewed recent audits the registered manager completed and found they had taken action to address identified issues to maintain people’s welfare.

There was a registered manager at the service at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The inspection was undertaken by the lead adult social care inspector for the service.

We gathered evidence to answer five key questions; is the service safe, effective, caring, responsive and well-led? We found that improvements had been made in the way care and support was provided. If you want to see the evidence that supports our summary please read the full report.

During the visit we reviewed 3 service user care files, audit records and training records. We spoke to the registered manager and 3 staff members. We also consulted the Local Authority contracts team: they had were aware of the previous issues with the service, and did not have any other concerns.

Is the service safe?

At this visit we found improvements to the record keeping had taken place and the service was now compliant with the regulations relating to care and welfare of people living at the home. We reviewed the individual assessments, care plans and risk assessments of 4 people living at the home. We found that the information contained within them was up to date and accurate. They showed that the service had considered what might cause harm to each individual based on their assessed needs, and how and, the person might be affected. They were found to take into account people's needs, and the support they would need to keep them safe. Safeguarding training had been provided to the staff team, and the registered manager had reinforced to the staff the need to ensure the local safeguarding procedures were correctly followed when allegations of abuse were made.

Is the service responsive?

We reviewed the individual assessments, care plans and risk assessments of 4 people living at the home. Care plans focussed on a person's needs and contained detailed information so that staff could meet people's needs consistently and appropriately. We found that the information contained within them was up to date and accurate. The risk assessments showed that the service had considered what might cause harm to each individual based on their assessed needs, and how and, the person might be affected.

Is the service caring?

People were supported to express their views and had been actively involved in making decisions (where possible) about their care, treatment and support. Care plans reflected people's wishes, choices and preferences.

Is the service effective?

People's needs were assessed and care was planned and delivered in line with current legislation.

Is the service well-led?

We found improvements to the record keeping had taken place and the service was now compliant with the regulations relating to assessing the quality of the service provided. Information held within the records at the home demonstrated that the registered manager had taken on board the reports prepared by the Commission relating to the service's repeated non-compliance, as there were now much improved systems in place to manage the risks associated with the regulated activity. We found improvements to the record keeping had taken place and the service was now compliant with the regulations relating to record keeping. Records were now securely kept, with duplicate copies of records being made to ensure that there was always a record available if records were either misplaced or lost.

Is the service safe? We found the registered person had not taken proper steps to ensure residents were protected against the risks associated with receiving unsafe care and support by not ensuring their welfare and safety was properly promoted and protected. The registered person did not protect residents against the risks of inappropriate care and support. The systems in place to monitor the quality of the service were inadequate, so too were the the system in place to identify and manage risk. Relevant professional advice relating to misconduct and safeguarding investigations were not sought in a timely manner.

Is the service effective? Relevant professional advice relating to misconduct and safeguarding investigations were not sought in a timely manner. Record keeping was inaccurate and not robust. The service did not have an appropriate system in place to ensure that records were fit for purpose and held securely. Records that should have been available in relation to the safe operation of the service, and for inspection purposes, were not available and the registered manager was unable to locate or explain the whereabouts of the records.

Is the service caring? The service is not tailored to the needs of the people living at the home. The systems designed to ensure people were kept safe were not robust. The registered person had not taken proper steps to ensure residents were protected against the risks associated with receiving unsafe care and support by not ensuring their welfare and safety was properly promoted and protected.

Is the service responsive? Suitable arrangements were not in place to ensure residents were safeguarded by appropriately responding to an allegation of abuse.

Is the service well-led? The systems in place to monitor the quality of the service were inadequate, so too were the system in place to identify and manage risk. The registered person did not have an appropriate system in place to ensure that records were fit for purpose and held securely. Records that should have been available in relation to the safe operation of the service, and for inspection purposes, were not. Record keeping was inaccurate and not robust.

Is the service safe?

Care plans had been now been audited, and changes made, and other audit and monitoring systems relating to other aspects of service provision had been set up, and were being followed. Risk assessments were in place in relation to different aspects of service provision, and behaviour management risk assessments and care plans were now in place. People were provided with a range of choices in relation to the menus and gaps in staff training had been identified through the home's quality assurance systems. Detailed analysis of incidents such as falls and adverse events had been undertaken. Positive moves by the service provider and registered manager to ensure people's needs were appropriately monitored and assessed against the Deprivation of Liberty Safeguards had now taken place.

Is the service effective?

Care plans and risk assessments were in place for people living at the home, and they were individualised and centred on specific needs such as behavioural difficulties and mental health issues.

Is the service caring?

People were supported by kind and attentive staff. Staff were aware of people's preferences, interests, aspirations and diverse needs, and the records held at the home reflected people's needs and how the staff should work with people to meet and manage those needs.

Is the service responsive?

Our observations showed that people had opportunities to participate in a range of activities both in the home and in the local community. Information held within the records supported this.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service's system to monitor and audit the quality of the services provided was found to have vastly improved. The way the service was run was now regularly reviewed. Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again. People's personal care records, and other records kept in the home, were found to be accurate and completed.

Is the service safe?

People living at the home told us that they felt safe and secure. The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place. We looked to see how the registered manager and service provider continually reviewed the service and how they took into account risks assessments, adverse events and incidents and the quality of experiences of people who use the service. Some care plans had been audited, and changes made, but other audit and monitoring systems relating to other aspects of service provision had not been fully implemented. Risk assessments were in place in relation to different aspects of service provision, however, the risks associated with providing a service without behaviour management care plans in place; restricted choice in menus and gaps in staff training had not fully been identified through the home's quality assurance systems. Due to the behavioural difficulties posed by some people living at the home, some staff expressed concerns for their safety. Although this issue was being dealt with via behaviour monitoring and recording, detailed analysis of incidents such as falls and adverse events had also not taken place. As a result, some issues relating to the care and support of some people living at the home had not correctly been identified and reported to the Commission. The provider and registered manager did not have a working knowledge of the regulations relating to when the Commission must be notified. Positive moves by the service provider to ensure people's needs were appropriately monitored and assessed against the Deprivation of Liberty Safeguards had not taken place.

Is the service effective?

Although the service had care plans and risk assessments in place for people living at the home, they were not individualised and centred on specific needs such as behavioural difficulties and mental health issues.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff were aware of people's preferences, interests, aspirations and diverse needs, however, the records held at the home did not fully reflect people's needs and how the staff should work with people to meet and manage those needs.

Is the service responsive?

Our observations showed that people had few opportunities to participate in a range of activities both in the home and in the local community. Information held within the records supported this as very few references to individualised activities had been made.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. However, the service's system to monitor and audit the quality of the services provided was found to be ineffective. The way the service was run had not been regularly reviewed. Information from the analysis of accidents and incidents had not been used to identify changes and improvements to minimise the risk of them happening again. People's personal care records, and other records kept in the home, were not always accurate and completed.

During this visit we observed the care and support people received, and spent time with people in the communal lounges of the home and over lunch. We looked at care plan records, maintenance and nutrition records.

Although we noted there had been improvements made with the care planning system and food and nutritional support was more thorough. However during the inspection we read of several incident reports where the registered manager had not taken action to report concerns to the local authority as safeguarding matters or notify the Care Quality Commission. This is because the registered manager should take action to identify and prevent abuse from happening in the home, and should protect others from the negative effect of any behaviour by people who live at Westholme.

We could not see any evidence that the malnutrition universal screening tool (MUST) had been used. This tool is used to help identify if a person is at risk of an inadequate nutrition and hydration intake. We also did not see any evidence of detailed care plans in respect of hydration and nutrition. Since the last inspection the registered manager had implemented two sittings at mealtimes. Staff breaks had been changed. This meant that all members of the staff team were available to support people during mealtimes.

We saw that the dining room floor had been completely replaced with a new floor covering. The radiators in the dining room now had covers over them. The gas meter was now securely fastened.

We saw that monthly reviews had been completed but information was very limited. Information regarding accidents and incidents had not been included in the reviews. This showed us that the overall standards of care being experienced by the people living at Westholme were not being closely monitored. Records did not contain accurate information in order to support people with their individual needs.

We spoke with a number of visitors at different times of the day. One visitor told us, "As soon as mum walked in the door she settled'. A second visitor said,' I don't worry for one minute about him as I know he is well cared for'. However we found that the provider failed to notify the Care Quality Commission essential information about important events and incidents that had occurred within the home.

The building was undergoing substantial building works to meet with the fire regulations. Although some rooms had been redecorated, we observed other rooms were poorly maintained and required improvements.

Some of the staff team had attended training in Mental Capacity Act, End of Life care and Safeguarding. Staff told us they felt supported and liked working at Westholme. However staff had not received training to undertake nutritional screening and assessments. They are an important aspect of care provision as people with dementia related conditions can be at a higher risk of malnutrition and dehydration.