West Hill Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

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.

The provider had a shared vision, strategy and culture. Since our last inspection a new manager had started at the service. They told us, “Our vision is for the home to be outstanding. We need to do everything well inside first before we go outside. The tools are there and the owner is very understanding.” The provider said, “Looking after people is not difficult. It’s how you would look after your mum. Provide good care and chat to them. I remind staff to take time to just sit and have a chat.”

Relatives were complimentary about the service. They said, “I have not found anything I haven’t thought was good” and, “People are generally nice, we feel welcome, they do work hard.”

Staff enjoyed working at the service. One told us, “I have always wanted to be a nurse. I don’t see this as work. I look forward to coming back to work (each day)” and “She (the new manager) is doing a lot of changes. Trying to enforce things better now.”

The provider had a shared vision, strategy and culture. Since our last inspection a new manager had started at the service. They told us, “Our vision is for the home to be outstanding. We need to do everything well inside first before we go outside. The tools are there and the owner is very understanding.” The provider said, “Looking after people is not difficult. It’s how you would look after your mum. Provide good care and chat to them. I remind staff to take time to just sit and have a chat.”

Relatives were complimentary about the service. They said, “I have not found anything I haven’t thought was good” and, “People are generally nice, we feel welcome, they do work hard.”

Staff enjoyed working at the service. One told us, “I have always wanted to be a nurse. I don’t see this as work. I look forward to coming back to work (each day)” and “She (the new manager) is doing a lot of changes. Trying to enforce things better now.”

The provider had leaders at all levels who understood the context in which they delivered care, treatment and support. The new manager had the skills, knowledge and experience to lead, as well as improve the service, effectively. The manager had identified shortfalls within the service and had started work to address these to help ensure people were receiving safe and effective care. A staff member said, “She's very clued up on health and safety. The checking of the wounds and bed rails. We are always open to the relatives, we welcome them. We are not 100 totally perfect but we are moving there.”

Staff said they were looked after by management and they felt supported by their line manager and the service manager. One staff member told us, “I have a supervisor who supports me.”

Staff felt there had been improvements to the service since the manager had started. They told us, “There have been a lot of changes since [manager’s name] started. A lot in a short time. She is shaking things up” and, “Extreme improvements. It’s like a fresh wind blowing around. Nurses used to just sit at the desk. It needs to be teamwork and I love it.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. All staff we spoke with said they would not hesitate to speak up and the new management team had supported them to feel this way. Staff said they would not hesitate to whistleblow should they observe poor practice by other staff. The manager told us her door was always open to staff and she invited them to come and chat to her should they have any concerns.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture. Staff undertook equality, diversity and inclusion training as part of their induction into the service. This helped to bring a wider range of perspectives and skills to the staff team. Regular staff meetings were held in which staff could discuss all aspects of the service, however upon review of the minutes of meetings, it was not clear whether staff had the opportunity to give their input or ideas. There was good attendance at meetings.

There were clear responsibilities and governance processes in place. Through these processes, the new manager was starting to make positive changes to help ensure people consistently received good quality care. They told us, “I have introduced standards for the home. For example, like making sure chairs are facing out, so people can look at the view. Making the home more homely. I am rolling out a new dining experience. I rolled out a daily walkaround. I drafted a home development plan based on what I was identifying.” However, we found further work was needed to ensure any changes were fully embedded into daily practice. We observed staff working with people and noticed some staff lacked the understanding of people living with dementia. In addition, we observed little engagement and interaction between staff and people at times throughout the day. Some people’s care plans were inaccurate, contradictory or missing information. This included one person who was cared for in bed, but their care plan stated they liked to eat lunch in the dining room, a second person who had bed rails in place, but no risk assessment for this. This same person was recorded as being able to stand with the assistance of 2 carers, but later it stated they was non-weight bearing. A further person had distressed behaviours, but guidance for staff in response was simply, ‘provide reassurance’. One person was described as ‘a disruptive person’ in their care plan and a second had, 'consider using two staff during personal care'. This meant it was unclear whether this person needed 2 staff or not. The manager was aware that people’s care plans needed to be reviewed and they had already included this on their service development plan. But the current lack of accurate or detailed information in people’s plans meant the provider could not be assured that people were always receiving the most appropriate care.Other people’s care plans were contemporaneous and contained good and detailed information for staff. Staff worked with an electronic care planning system, which helped to ensure that care was being provided in line with people’s needs. In addition, management carried out daily checks on staff practices to help ensure that people received safe care.

The provider worked with external partners, agencies and the local community. The local church, nursery and cub and scout groups visited the service to run services or carry out cross-generation activities. A local choir came to sing for people and volunteers and work experience students were also involved in the home. Each week the GP visited people and staff made referrals to other health care professionals when necessary.

The provider focused on improvement across the service. The manager had developed an improvement plan for West Hill Care Home in which they recorded identified shortfalls, with an action plan and timescales for completion. This included some of the areas we had identified, such as care plans needing to be more person-centred and the missing capacity assessments and best interests evidence.

The manager told us, “When I first arrived and realised how many staff were supernumerary it should have been a good home with no problems at all. But the accident and incident records were not being filled in properly and there were a lot of skin tears and a lot of falls, both witnessed and unwitnessed. Staff were having a handover, but it was not a room-to-room handover. There were a lot of sensor mats not in the right place and I have had a learning discussion with staff about that. Random buzzer checks showed bells were not being answered quickly enough. I have prioritised safety as that is the most important and the one area that needed to improve. Staff feel it’s overwhelming, but told them I have an open door and they can come and speak about anything at any time.”