Archived: Westcroft Nursing Home and Domiciliary Care

Following the inspection the service was placed into special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. 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 at its next comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can read the report for previous inspections, by selecting the 'All reports' link for ' Westcroft Nursing Home and Domiciliary Care' on our website at www.cqc.org.uk

Following the inspection in December 2015 the provider wrote to us to say what they would do to meet the legal requirements. We undertook another comprehensive inspection on 6 October 2016 to check the provider was meeting the legal requirements for the regulations which they had breached. At this inspection the provider had made sufficient improvements to be removed from special measures.

Westcroft Nursing Home and Domiciliary Care is registered to provide nursing and personal care for up to 21 people and also to provide personal care to people who live in their own homes. At the time of our most recent inspection the nursing home had been closed since March 2016 and the provider had applied to de-register the home. The provider continued to run the domiciliary care service and at the time of our October 2016 inspection the service was providing personal care to 14 people in the local community.

There was a registered manager in post for the domiciliary care service. 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 quality and safety monitoring systems were not fully effective in identifying and directing the service in ensuring the quality of records and service provision. Three of the regulatory breaches identified at the last inspection in December 2015 been not been remedied.

The provider’s staff recruitment process was not robust. The poor operation of the system meant that records relating to recruitment were incomplete and risk assessments had not been undertaken and recorded when the provider was unable to obtain satisfactory references.

People’s needs were regularly assessed however care plans were not personalised and did not contain individual information and references to people’s daily lives.

Staff told us they had received training to support people to be safe and respond to their care needs. We found however that records demonstrated that some staff had not completed suitable training before undertaking their role.

Medicines were managed safely and staff were aware of the service’s safeguarding and whistle-blowing policy and procedures.

There were enough staff to meet people’s needs. Staff demonstrated a detailed knowledge of people’s needs.

Training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been provided to staff. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Staff had variable knowledge about the protection of people’s rights.

There were positive and caring relationships between staff and people at the service. People praised the staff that provided their care. We also received positive feedback from people's relatives. Staff respected people's privacy and people said that staff worked with them in a kind and compassionate way when responding to their needs.

People had access to healthcare professionals when required, and records demonstrated the service had made referrals when there were concerns.

The provider had a complaints procedure, and people told us they could approach staff if they had concerns.

The provider had made appropriate notifications to the Commission; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

We found three breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider was in the process of submitting applications for the authorisation of deprivations following recent changes in the interpretation of this legislation. The service had suitable policies and procedures in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. We saw from observations and from speaking with staff that they had a good understanding of people's care and support needs. Comments included, 'The staff are very nice, they provide all the care that I need', and, 'The carers are very kind and helpful.'

The records of care that staff provided to people were not always accurate. There were gaps in records relating to people's nutrition and the support they received to reposition to prevent pressure damage. This increased the risk that people would receive inappropriate or unsafe care and treatment.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining accurate records.

Is the service caring?

People were supported by kind and respectful staff. We saw that staff showed patience and compassion when supporting people. People told us that they could do the things they enjoyed. Our observations confirmed this. One person told us that the staff 'provide excellent care'. Staff told us they were able to provide the care that people needed.

People using the service, their relatives and staff completed a satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

We saw information in people's records which indicated they had been consulted over the care they received. This meant that information about people's preferences were gathered and used to plan care to meet their specific needs. People were supported to maintain relationships with people that were important to them.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

Is the service well led?

The provider did not have a registered manager for the service they provide at the nursing home. It is a condition of their registration that they must have a registered manager for all of the regulated activities they provide.

The service had a quality assurance system and records we saw showed that the provider monitored people's care needs and the care provided. As a result the quality of the service was improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and the quality assurance processes in place. This helped to ensure that people received a good quality service.

We saw the home had taken action to address most of the issues identified at the last inspection. We observed staff supporting people in making choices and in ensuring their privacy and dignity. We saw people who remained in bed most of the time looked comfortable and had fresh bed linen.

The new manager had begun a process of fully revising people's assessments and care plans. For example a person told us about the moving and handling support they needed. They had a clear care plan which staff knew about and reflected what they told us. The care plan took appropriate good practice guidelines into account.

The new manager had developed improved systems to review the quality of service provision so as to identify, assess and manage risks to people. This had included taking appropriate action to reduce risks to people relating to falls.

Where people had more complex care and treatment needs the new manager had introduced appropriate monitoring records. We saw variability in completion of such records, so these monitoring systems were not yet fully embedded among all members of staff.

We saw the home had taken action to address issues identified at the last inspection. All areas we inspected were clean. The home had revised its verbal complaints procedure.

We observed the atmosphere was homely. We found staff were not consistently supporting people in their dignity and independence.

The home continue not to ensure all people had their individual needs assessed, planned for and met, or followed national guidelines. This related in particular to ensuring the risks of pressure ulceration were reduced for people and their nutritional needs met. Additionally, it was unclear how some people had risks and needs assessed relating to equipment and mental health needs met. Some records relating to care provision and medication were not fully maintained. Other records were inaccurate or not in place.

The provider had systems to review the quality of care provided in certain areas but this was not consistent. Some known risks to people were identified during this inspection but managers had not identified them as part of their audits, or taken subsequent action. Systems for general home maintenance were not effective in ensuring matters needing attention were identified and acted on.

People gave us a range of comments about the care provided. One person told us 'I'm well looked after' and a relative described the home as 'lovely'. Another person was less happy with the service provided, describing the home as 'only as good as can be expected.'

We saw frail people were given some of the care they needed. This included following good practice guidelines on prevention of pressure ulceration. We found the home were not fully assessing some risks for people. Some care plans were not drawn up when needed. Some care plans were not followed.

We found the home had systems to ensure hygiene and infection control practice. These were, however, not consistently followed. For example we saw a lack of cleanliness in communal bathrooms and several commode inserts were not clean.

The home had a complaints procedure. However, not all issues raised by people had been documented. This meant the provider could not demonstrate all matters had been investigated and appropriately addressed.