West Hill Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulations in relation to safeguarding and assessing risks for people.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Incidents and accidents were recorded and reviewed by the manager to help reduce reoccurrence for people. The manager checked staff had responded appropriately to any accidents or incidents and lessons were learnt which helped identify and embed good practice as well as reduce the number of incidents happening. The manager told us, “When I started, there were a lot of skin tears and these must have been happening for a reason. I think it was lack of understanding of staff and moving and handling.I reviewed incidents and spoke to staff to help them understand how injuries may have been caused to people. I have had a lot of supervisions with staff which has helped them understand where they needed to change their practices.” Changes made in response to incidents included new bedrails for one person, a crash mat and low bed for another and an updated risk assessment for a further person.

People’s care needs were recorded prior to them moving between their home or hospital into the service, to help ensure a smooth transition. Important information was recorded to guide staff in the care and support the person needed. This information was used to develop the person’s care plan. For example, we read one person had used a walking stick at home, but used a Zimmer frame when in hospital to support them with walking. They also had bed rails in place and a sensor mat in hospital, so staff would be alerted to them attempting to get out of bed. The up-to-date information was made available to staff at West Hill when the person moved in.

The provider did not always share safeguarding concerns appropriately despite having a robust recording system in place for accidents and incidents. We reviewed accidents and incidents records from 14 December 2024 to date and found 13 potential safeguarding concerns. These included unexplained bruising, allegations of staff treating people badly and altercations between people. None of these incidents had been raised as a safeguarding concern with the appropriate authority or notified to CQC in line with registration requirements. Without reporting, investigating or reviewing safeguarding information, the provider could not assure themselves that people were not being intentionally harmed.

Relatives however felt their family member was safe. A relative told us, “She’s safe here. They check her every hour because of her not sleeping.” Staff had undertaken safeguarding training and told us, “We did the online training. I would make sure I whistle blow to the manager and health and safety. I have never had concerns.”

The provider did not always work well with people to understand or manage risks. Some people on pressure relieving mattresses did not have their mattress set correctly which presented a risk of their skin being damaged. One person’s was set 10kg lower than it should be and another over 70kg too high. We alerted the manager to this who immediately had the mattresses reset. Other people suffered from constipation or were at risk of choking, but there was no information on what measures staff should take in response to either of these. A further person had their bed low to the floor due to their risk of falls. Although this helped reduce this risk, we noted a lot of loose wires under their bed which could have posed an additional risk for them. We also found one person who had a bed rail in place, but no risk assessment relating to this in their care documents. This same person had lost 4kg in a month, but there was no record of any action staff had taken in response to this. Following our inspection, the provider sent evidence of the immediate action they had taken to address some of these concerns. Other people however, had good detail in their care plans and risk assessments to help guide staff. This included information about the equipment people required, whether they needed their bed set at a low level when in it and any risks relating to their eating. We observed staff following good practices in order to keep people safe. For example, a staff member walked behind one person as they walked with their mobility aid down the corridor and people who required a modified diet were provided with this. Staff told us , “We all have devices so every update on people’s risks are done on there. We get updates on any changes.” Staff were able to describe to us what they would do should someone choke and told us they had received e-learning on this.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular health and safety checks were carried out and fire drills held. This helped ensure people lived in a safe environment and staff knew what to do in the event of a fire.

The provider made sure there were enough qualified, skilled and experienced staff on duty each day and people’s feedback supported this. Relative’s told us, “They remember everyone’s names. I couldn’t. Staff are all friendly and chat”, “The carers are pretty good” and, “The staff are incredibly kind and helpful, they tell us to press the bell if we need anything.” The manager had reorganised the staffing structure when they arrived to give senior staff more responsibility and oversight. This had helped reduce incidents and accidents and in addition gave more stability in general across the service. They told us they were continuing to advertise and recruit to the staff team. We observed staff meeting people’s needs without delay. For example, one person got up from their chair to walk away and a staff member immediately went to them and handed the person their Zimmer frame.

Staff felt there were enough of them on duty. One staff member told us, “We have a senior and 3 carers (on this floor).” Others said, “We were 3.5 carers, but they increased it. There is always 1 member of staff in the dining room” and, “We have enough carers and the seniors and the nurses are always supporting us.”

Staff were recruited through good processes. This included providing a full employment history, information about their performance in previous roles and their fitness to undertake the role. Each prospective staff member underwent a Disclosure & Barring Service check to make sure they were suitable working at this type of setting.

Staff were provided with training, although they said most of it was on-line and we were told, “I would like more face to face (training)” and, “There is a lot. I would recommend more on the job training and face to face. E-learning is good for refreshing but on the job training and shadowing needs to be increased.” We spoke with the manager about this who told us they were in the process of booking more face-to-face training sessions for staff.

The provider assessed and managed the risk of infection. Regular infection control audits were completed and we observed housekeeping staff working consistently throughout the day. People’s rooms were clean and tidy and there were no malodours in the service. Staff were seen wearing appropriate personal protective equipment (PPE) when carrying out particular tasks. People told us, “It’s (the service) comfortable. They (staff) keep it clean and tidy. They change the sheets nearly every day even if they don’t need it.”

We found the laundry room was well organised with plenty of space and work surfaces for staff to separate out the washing. The kitchen was clean and well maintained and kitchen staff were seen wearing appropriate PPE equipment. A staff member told us, “In care homes it’s easy to spread infections. We have to make sure we have good personal hygiene - handwashing, PPE, disposal of clinical waste properly, wash hands thoroughly.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People received the medicines they were prescribed. One person said, “They give us medication with meals, they’re very good and remember.”

We reviewed the electronic medicine records for a range of people and found no discrepancies or gaps in the records. Where people had ‘as required’ medicines these were supported by protocols and good records were kept in relation to the application of people’s topical creams (medicines in a cream format).

Only trained staff dispensed medicines to people and we saw that staff’s medicine competency was checked annually to help ensure they continued to follow good practices.