Westlands Retirement Home

Westlands Retirement Home is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Westlands Retirement Home accommodates up to 51 people some of whom may be living with dementia, across two linked units. On the day of the inspection, 49 people were accommodated.

The service had 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.

People were kept safe from the risk of abuse as staff had undertaken relevant training and understood their responsibilities to protect people. Risks to people both as individuals and from their environment had been identified, assessed and managed safely. There were sufficient staff to provide people’s care. The provider followed safe staff recruitment practices. People’s medicines were safely managed within the service by trained staff who followed good practice guidance. Staff followed infection control guidance to ensure people were kept safe from the risk of acquiring an infection. Learning took place following incidents and processes were in place to identify any trends that needed to be addressed for people.

People’s care needs were assessed prior to their admission. The planning of their care considered good practice guidance, to ensure it was effective. Staff were supported in their role through the provision of an induction, on-going training, supervision and professional development. People were supported to eat and drink sufficient amounts for their needs. Risks to people from dehydration and malnutrition were assessed and managed effectively. Processes were in place to promote effective working both within the team and with other services. People were supported to access healthcare professionals as required and staff had undertaken relevant training to support them in recognising promptly if people’s health was deteriorating. Parts of the service were being refurbished and enhanced for people’s use and enjoyment. 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.

We observed care and support was given to people throughout the day, in a kindly manner. Staff supported people to be involved in making decisions about their care where possible. People were treated with dignity and respect by the staff who provided their care.

People received care that was responsive to their needs. People and their families were involved in their care planning, which reflected their care needs and preferences. Staff had undertaken relevant training to enable them to be responsive to the needs of people whose behaviours could be challenging. People were provided with daily activities to stimulate them and could have visitors when they wished. People’s concerns and complaints had been used to improve the quality of the care provided. Staff had completed training and were undertaking further training to enable them to support people appropriately at the end of their life.

People told us the service was well-led. The new registered manager had fostered a positive culture within the service, with staff feeling pride and commitment to their work. The registered manager had submitted notifications as legally required. People’s views on the service were sought and used to improve the service. Processes were in place to assess and monitor the quality of the service provided. The service had good working relationships with local services.

Westlands Retirement Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Westlands Retirement Home accommodates up to 51 people some of whom may be living with dementia across two linked units. On the day of the inspection, 42 people were accommodated.

We carried out an unannounced comprehensive inspection of this service on 12, 13 and 14 July 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westlands Retirement Home on our website at www.cqc.org.uk.

At the last inspection on 12,13 and 14 July 2017, we asked the provider to take action to make improvements in relation to safe care and treatment, medicines, premises and equipment and governance, and these actions had been completed.

This is the second time the service has been rated Requires Improvement. Although the requirements of the breaches had been met, we were unable to change the ratings for the key questions of safe and well-led to good as further work had to be completed and changes embedded within staffs practice. The manager had already undertaken a number of actions in areas such as medicines, but was aware that it would take further time for all of the required improvements to be completed.

The provider had appointed a new manager, who had applied to the Care Quality Commission to become the registered manager for the 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.

Processes were in place to ensure staff could recognise when to alert healthcare services about potential risks to people. People’s fluid requirements were identified, their intake monitored and appropriate action taken to prevent dehydration. Equipment safety checks had been completed.

Staff’s competency to administer medicines had been assessed and relevant guidance was in place. The dating of topical creams and drinks thickeners by staff upon opening required improvement. People were receiving their medicines safely, but further time was required for the improvements the manager was making in this area to become consistent staff practice.

Processes were in place to monitor and improve the service and feedback from professionals had been acted upon. However, some audits required further improvement in order to make them fully effective such as the infection control and staff file audits. More time was needed for the manager to be able to demonstrate that audits had driven consistent improvements in the service over time.

People were safeguarded from the risk of abuse. The manager understood their responsibilities and took the correct action to safeguard people.

Sufficient staff were deployed to provide people’s care. Pre-employment checks had been completed, but this area required improvement to ensure all information was available and verified.

Aspects of the cleanliness of the service required attention. The manager took action following the inspection to address this and they were recruiting additional cleaning and maintenance staff. More time was needed for the provider to be able to demonstrate that the required standards of cleanliness were being maintained.

Lessons were learnt when incidents and accidents occurred. Learning was shared with the team and relevant agencies and safeguards and plans were put in place to avoid where possible the reoccurrence of these happening in the future.

There were clear aims and objectives to improve the service. Staff felt the manager listened to and supported them. Staff did not always carry out their tasks to the best of their ability; the manager was aware of this and was addressing this to improve the service for people. The new manager had addressed the ‘priority’ areas that needed to be actioned for peoples’ safety and appreciated that it was going to take further time to address all of the issues facing the service.

People and staff were involved in the development of the service through both meetings and feedback. People were encouraged to take part in decisions about their care and support, and their views were listened to.

The service had made improvements with regards to strengthening their inter-agency working. A GP held a regular clinic in the service and there was communication and joint working with the provider's pharmacy and Social Services.

The service had a registered manager. 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 told us they received their care safely. Although most risks to people were well managed staff did not consistently recognise or proactively respond to some potential risks to people. We found staff had not acted to sufficiently reduce potential risks for two people. Staff were not always provided with sufficiently detailed guidance with regards to people’s individual care needs to enable them to manage potential risks safely.

Not all required safety checks on the environment had been completed to ensure peoples’ safety. People told us the service was clean and the communal areas, bathrooms and people’s bedrooms were seen to be clean. A new kitchen was due to be fitted however; the current kitchen had not been cleaned or maintained to the required standard to ensure safe food preparation. During the course of the inspection the provider took immediate action to ensure the kitchen was cleaned to the required standard.

The providers told us that following a medicines safe incident actions had been taken to improve medicines safety and people confirmed they had seen improvements. However, we still found some aspects of medicines management were not being managed safely for people.

Audits were not consistently completed in accordance with the provider’s audit schedule nor were they fully effective; they had not identified or fully addressed all of the issues we found. The providers did not always take prompt action in relation to issues identified either internally through their own audits or through external feedback or audits. People’s records were not always kept fully up to date as required. Robust processes were in place to document and analyse incidents.

During the course of the inspection the providers started to take action on the issues we identified. Following the inspection they submitted an initial action plan based on the written feedback provided at the end of the inspection. This set out the actions they had started to take or planned to undertake, this has served to lower the level of the above risks identified.

Staff had undertaken relevant safeguarding training and understood their role and responsibilities. However, further improvements are required to ensure that actions taken in response to safeguarding alerts are fully effective in preventing the risk of reoccurrence for people.

Although not all people felt there were enough staff we found there were sufficient staff deployed to meet people’s needs. Staffing requirements for the service were kept under regular review and adjusted accordingly. Relevant checks had been made in relation to staff’s suitability for their role.

At our previous inspection of the service we found the providers had failed to follow the requirements of the Mental Capacity Act prior to making an application to deprive people of their liberty or when determining if the use of bed rails was in their best interests. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found this legal requirement had been met. 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. Further time is required for all staff to undertake the planned Mental Capacity Act training to ensure they can apply this in their day to day work with people.

People told us they were very happy with the care staff provided. Staff training was being transferred from e-learning to face to face training and arrangements were underway to ensure all staff completed their required training, which will take further time. Staff were supported in their professional development. The frequency of staff supervisions was variable and could be improved but staff reported feeling supported in their role. People’s care was provided by adequately supported staff.

People told us they were satisfied with the meals and choices provided. They were provided with a choice of food and drinks that reflected their preferences. If people did not like the meals on offer then alternatives were available. People living with dementia cannot always recall what they have chosen and would benefit from choosing at the point of service.

Records showed people had seen various health care professionals. A concern had been expressed by a professional regarding staff skills and training in when to making appropriate referrals to emergency healthcare services and further training had been arranged. After the inspection the registered manager told us a recognised tool for making referrals to external services would be implemented to support staff consistency when making decisions. This still needs to be embedded in practice, which will take time and the provider will need to be able to demonstrate how effective this development has been for people.

People told us of staff “They are all very caring –They have excellent staff in general.” Staff were observed to speak in a friendly manner to people whilst they provided their care. They were kindly and caring in their approach to people.

People told us they felt listened to and that their views about their care were respected. Staff were observed throughout the inspection to consult people about their care and to respect their wishes. Couples were accommodated in their own bedroom to ensure they remained together and new friendships between people were respected.

People told us staff respected their privacy and dignity in the delivery of their care. They said that the staff were hard-working people who were always polite when dealing with them.

People told us they had been involved in both planning and reviewing their care, they felt consulted and listened to. Records demonstrated people’s care needs had been assessed and regularly reviewed. People and their relatives were also involved in regular reviews of their care. There was a record of people’s preferences about their care.

Action had been taken to ensure people were provided with sufficient levels of social stimulation. There were now three activities co-ordinators including a new full-time co-ordinator who had just commenced their role. They ran the programme of activities and one to one activity sessions for people.

Processes were in place to seek people’s views of the service and issues raised were noted and acted upon to improve the service for people. There were processes in place for people to make complaints and these were actioned for people.

People told us the service was well managed and that it was improving. Although the general manager had provided stability and leadership to the service fulfilling the vacant registered manager’s role, the service needed a permanent manager. Despite there being a clear leadership structure in place and processes to aid communication, staff did not always complete delegated tasks as required for people’s health and welfare. Senior staff did not feel they had sufficient time to complete all of the required checks or to be fully effective in their role. This was due to the demands of arranging people’s medicines and healthcare appointments, which the providers are taking action to address.

The objectives of the service were to provide a ‘Standard of excellence which embraces fundamental principles of good care practice.’ Although the providers strived to meet this objective further work was required. There was a culture of openness with staff regards the current issues and they were included in discussions regarding the development of the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the providers to take at the back of the full version of the report.

The service had a registered manager. 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.

At our last inspection of this service on 13 and 14 July 2015 we found two breaches of legal requirements in relation to safe care and treatment and governance and record keeping. Following the inspection the providers wrote and told us they planned to meet the requirements of these regulations by the end of November 2015. At this inspection we found the requirements of these regulations had been met.

Risks to people had been assessed; staff had written guidance about how to manage identified risks to people. Risks to people from falling had been assessed and relevant action taken to manage these risks safely for people. People who had diabetes had a care plan to provide staff with written guidance about how to support them to manage their condition.

Various aspects of the service had been audited and action had been taken to improve the service for people. People’s records were found to be accurate, reflected the care they had received and were stored securely.

The providers did not always follow procedures to ensure people’s rights were upheld in line with the Mental Capacity Act (MCA) 2005. There was a lack of written evidence to demonstrate that either people had consented to the use of bed rails or that they had been assessed as lacking the capacity to consent to their use and a best interest decision had been made in consultation with relevant parties. Deprivation of Liberty Safeguard (DoLS) applications had been made on people’s behalf. However, there was a lack of written evidence to demonstrate legal requirements had been met in relation to the requirements of the MCA prior to the applications being submitted. The providers had not carried out mental capacity assessments and best interest decisions where people’s freedom of movement was restricted.

People were safe as staff understood their roles and responsibilities in relation to safeguarding. Safeguarding alerts had been made to the relevant authorities as required to ensure people were safeguarded against the risk of abuse.

People, their relatives, staff and professionals provided mixed feedback about staffing levels. Staffing levels had been increased in response to staff feedback even though people’s assessed needs had actually decreased. Records demonstrated that the registered manager regularly assessed and kept under review people’s staffing requirements. Staff had been required to undertake appropriate pre-employment checks to ensure their suitability to work with people.

Staff who administered people’s medicines had undergone appropriate training and had their competency assessed. Improvements were required to ensure staff administering medicines were not distracted for people’s safety. The providers took measures during the inspection to ensure people’s medicines were stored at a safe temperature. Processes were being introduced to improve record keeping in relation to people’s topical creams. However, it will take time for these changes to become embedded within staff practice.

Staff received an induction to their role and were supported to undertake professional development. Not all staff felt fully supported in their role. The providers were taking action to address this for staff but it will take time to achieve the required improvement. The process for monitoring and supervising staff practice had not identified that not all care staff had maintained their competence in moving and handling people in accordance with best practice. Not all staff had received relevant training to meet people’s care needs in relation to catheter or stoma care or had the opportunity to update their training. The providers were arranging this training for staff; however, these arrangements should have been made prior to people with these needs being accommodated.

Improvements had been made to people’s lunchtime experience. Risks to people from malnutrition were assessed and managed effectively. Risks to people in relation to fluid intake had been identified and managed. We observed people had a pleasant lunchtime experience.

Staff arranged for people to be seen by a variety of health care professionals as required to maintain their health.

People and their relatives told us the staff were kind and caring. Staff were observed to interact in a kind and caring manner towards people. Staff were seen to be patient with people. Staff had documented people’s preferences and acted to ensure these were met.

People’s care plans and care needs summary provided guidance for staff about how to support them to make choices about their care. They also included guidance about how to promote effective communication with the person. Staff were observed to involve people in making choices about their care. Staff upheld people’s dignity and privacy.

People’s care needs were assessed prior to them being accommodated and relevant information was sought about them from other agencies. People and their relatives were consulted about the content of their care plans and they were involved in reviews of their care.

An activities co-ordinator had left the service. The providers had taken reasonable measures to recruit a replacement and a new activities co-ordinator was due to commence their post imminently. In the interim the providers had taken appropriate measures to ensure people’s needs for social stimulation were met.

The providers’ complaints policy and procedures were displayed in the communal areas for people and their relatives to access if required. The complaints file showed no complaints had been received by the providers since December 2015. Residents’ and relatives meetings had been held to seek their feedback on the service.

Staff learnt about the providers values during their induction and applied them in their work. Overall staff feedback was that the service was a good place to work. There were opportunities for staff to raise any issues and their feedback had been acted upon to improve the service for people.

People and their relatives felt the service was well managed. The majority of staff felt the service was well managed. Since the last inspection the management structure of the service had been reviewed and strengthened for people by the providers.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the providers to take at the back of the full version of the report.

Following the inspection, the provider sent us an action plan, telling us what actions they were taking to address the areas of non-compliance. On the 04 March 2014 we carried out a further inspection to assess whether the home was now compliant.

At the time of our inspection in March 2014, Westland's Retirement Home was providing care to 32 people. We spoke with the registered manager, six care workers, the activities co-ordinator and the chef. We looked at four peoples care records.

We spoke with five people who used the service who told us about their experiences of the care they received. One person said, 'I am very happy here'I like to be independent and I can do what I want'. Another person told us, 'The staff are all kind and caring'. A relative told us that they had looked at a number of homes but, 'This one was the best'.

We found that the provider had made improvements to the way in which people's needs were assessed and care planned and delivered. The service had put in place arrangements to ensure that people received adequate food and nutrition and we saw that people were supported to eat and drink in a relaxed and supportive manner.

The service had made improvements to their systems for assessing and monitoring the quality of care plans to ensure that care records were accurate and up to date. However, these improvements will need to be embedded in practice and sustained over time.

We observed staff supporting people in a manner that was respectful, sensitive and considerate. However we had some concerns staff did not have sufficient guidance to provide appropriate support. We found that specific assessments of people's care and support needs had not always been made.

We observed the midday meal, which was uncoordinated and resulted in a disjointed mealtime experience. Some people were not adequately supported to eat their meal. Staff stood at tables to assist people, they did not sit with them or wait until people had finished their meal before moving away.

The care records at the home were not clear or contained inconsistencies. These issues had not been identified through the audit process. This meant that the auditing of care records was not effective in identifying the shortfalls of the care records.

Two of the staff we spoke with told us that they felt the care plans were a good source of information but felt they could be more person centred. One member of staff said that they were sometimes unsure of the support people needed as the information in care plans was not consistent.