Westwood Care Home

Westwood Care Home is a residential care home providing personal care to up to 29 people. The service provides support to adults with a range of needs including care and physical needs. The service comprises of two converted houses, with a lounge/dining area and a garden to the rear of the property. At the time of our inspection there were 16 people using the service.

People’s experience of using this service and what we found

Environmental and building risks were not well managed. Hazards and cleaning standards were not promptly responded to.

We found no evidence of people coming to harm, but medicine management was not sufficiently audited, and staff competence was not regularly checked. There was a lack of information and analysis about incidents, accidents, and quality of care.

Staff did not receive the support and training required to keep them up to date and confident delivering support to people. Staff performance and development was not audited.

Building standards and décor had not been maintained, resulting in some areas of the building being run down and requiring attention.

Governance and audit processes were not robust and did not identify or drive forward areas of improvement. A new manager had recently started in post and was beginning to review the quality of care and draw up action plans for improvement.

People enjoyed their meals and had choices and good access to food and drink. People’s dietary needs and preferences were understood and respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the systems in the service generally supported this practice.

People felt well cared for by kind and respectful staff and managers. People felt their preferences were well understood and generally felt listened to but did not have a lot of choices about how they spent their time.

There had been changes to the provider which they were in the process of registering with us.

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

Rating at last inspection

The last rating for this service was good (published 14 April 2021).

Why we inspected

The inspection was prompted in part due to concerns received that care was not provided to people in a safe or person-centred way. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westwood Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care, the premises, staff training and support, and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Westwood Care Home is a residential care home registered to provide care for up to 29 people. The service comprises of two converted houses, with a lounge/dining area and a garden to the rear of the property. At the time of inspection there were 19 people living at the service, some of whom were living with dementia.

People’s experience of using this service and what we found

The service was well led, relatives spoke highly of the management and staff at Westwood Care Home. They particularly appreciated the provider’s person-centred values which were shared by management and staff. Relatives were confident in the management of the service. Staff understood the importance of being person-centred and felt this was embedded in how the home was run.

The homely atmosphere was particularly good and had helped people to settle in, to feel comfortable and happy. People were encouraged and supported to personalise their rooms and to feel 'at home'. People's individuality was respected and supported by managers and staff. Relatives appreciated the homely environment.

Staff moral was good and teamwork was strong. There were regular handover meetings between shifts to ensure continuity of care and sharing of information and ideas. Staff told us they felt valued in their roles and enjoyed their work, they had access to training and development opportunities.

Audits and reviews of quality were leading to improvements. The provider and management team were keen to learn and were open to feedback.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 20 December 2017).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about how the provider was ensuring that records were being kept up to date and how they were working in partnership with other agencies. A decision was made for us to inspect and examine those risks.

We received concerns in relation to management oversight of the service, infection prevention and control (IPC) following a recent COVID-19 outbreak and how improvements were managed. As a result, we undertook a focused inspection to review IPC management and the key question of well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the well led section of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously carried out a comprehensive inspection at Westwood Care Home on 18 October 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to inconsistencies in staffs’ understanding and implementation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Additionally, the registered manager/provider did not notify the Commission of incidents as required as part of their registration. We also found areas of practice that required improvement. This was because risks to people’s safety had not always been identified and assessed, people’s privacy and dignity were not respected at all times, and formal systems for people and staff to provide feedback, such as meetings and surveys were not in place. The service received an overall rating of ‘requires improvement’. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Westwood Care Home has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

A registered manager was 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 and associated Regulations about how the service is run.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and bowel care training. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included singing, films, arts and crafts and themed events, such as reminiscence sessions and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

As part of this inspection we checked what action had been taken to address the breaches of legal requirements we had identified at our last inspection on 24 March 2015. After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. At this inspection we found improvements had been made and sustained and all the breaches previously identified were addressed.

During this inspection we found risks to people’s safety had not always been assessed. Identified risks were not always followed by appropriate risk assessment and management plans. As a result, the provider was unable to ensure people received care that kept them safe.

Staff had knowledge of the MCA and were observed to be working in a way that enabled people to make their own choices and were delivering support to people in their preferred way. However, we found that the provider was not using the Mental Capacity Act (MCA) to care for people who may lack the capacity to make their own decisions. The provider had not submitted Deprivation of Liberty Safeguards (DoLS) applications to the supervisory body, the local authority, that could lead to people being deprived of their liberty unlawfully.

People's respect and dignity was not always considered. They did not always receive care from staff that indicated respect for the person or acknowledged their needs. We observed a person’s bedroom where there was no curtain or blind cover to two small side windows of a dormer type top floor window.

The provider failed to notify us of deaths within the home. It is a legal requirement for these notifications to be received from the registered person.

Although staff we spoke to told us they felt supported, records showed that, outside of the daily staff handover, regular staff meetings were not held. This meant opportunities that could be used to help share learning and best practice and ensure staff understood what was expected of them at all levels was not in place.

People and their relatives were not given opportunities to participate in a survey or similar process to provide feedback on the quality of service. As a result, opportunities to influence and improve the quality and safety of the service were missed.

People were protected from harm and abuse. They said they felt safe and there were sufficient staff to support them. One person told us, “If I want any help I ring my buzzer and they come at once. At night they put the bell near me so I feel safe”. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. Staff had received essential training. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to eat and drink well. There was a choice in what people ate and drank. One person told us, “The food is good and we have a choice”. People’s weight was monitored, with their permission, to look for patterns of weight loss or gain.

People’s health needs were assessed and met by staff who made referrals to external healthcare professionals when required. A health care professional told us, “People have access to all professionals. When a person moves into the home, [the provider] will contact us if the need arises to ask advice if they want to know what additional support they need.”

There were quality assurance processes in place to enable the registered person to have oversight of the home and to ensure that people were receiving the quality of service they had a right to expect. People, relatives and staff were complimentary about the leadership and management of the home. One member of staff told us, “I’d recommend this home, it’s small so everyone gets attention. Any problems are easily dealt with, we work as a team and the boss [the provider] is here every day.”

Below is a summary of what we found. The summary describes what people using the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected issues identified in the assessment. A care worker said, 'The care plans are there for us to refer to and make sure that what we do is best for the resident and above all, safe.'

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We spoke to staff about their understanding of safeguarding procedures. They had an awareness of the different types of abuse and what to do if they witnessed abuse.

Is the service effective?

People who used the service and their relatives told us that they were happy with the care provided and felt their needs had been met. Staff told us they understood people's care needs and that they knew them well. One person who used the service told us, 'I'm quite comfortable. I have a nice good room and I'm treated well.'

Records were maintained of appointments people had with doctors, nursing and hospital outpatient services. We saw that the service assessed and recorded details of people's medical needs when being admitted to the home. People we spoke with and their representatives were satisfied they could see their doctor when they needed to.

The staff we spoke with said they felt well supported in their roles. They all said they could approach the deputy manager or provider at any time and that issues were resolved. One said, "I definitely get enough support. [The Provider] is always there when I need them." However, the registered person did not have suitable arrangements in place for staff to receive appropriate professional development, supervision and appraisal. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

We saw that staff communicated with people at a suitable relaxed and considerate pace. We observed that people were offered choice such as whether to stay in their room or use the communal areas and were spoken to in a respectful way. The provider told us that people who used the service and their relatives were not given a guide that contained details about the service, important contact details or the complaints policy which contained guidance on how to raise any concerns.

All of the people we spoke with told us they were happy at Westwood Care Home. A relative told us, 'As soon as we walked in we found a homely atmosphere which was supportive of [my relatives] needs, now they thrive here.'

Is the service responsive?

The manager told us that they strive to work in cooperation with community services such as specialist nurses and social services, who all visit the home regularly.

Care staff told us about each person's care needs and support required. One member of staff told us, 'People are well cared for here, we know their needs.'

Is the service well-led?

We were told by people we spoke to that the provider was based in the home on most days and was accessible. One person said, 'I'm treated very well, I'd soon tell them off if they treated me any other way. The staff are nice and friendly and the boss man comes in most days.' We were unable to identify any visitor, staff or resident comment or suggestion system that was being used. This meant it was difficult to independently establish people's views of the service and the quality of care provided. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

The improvements required to comply with the regulations in relation to staffing have been made.

We looked at a range of information held by Westwood Care Home. We found that additional care workers have been employed to ensure that people who use the services are safe and their health and welfare needs are met by sufficient numbers of appropriate staff. One person who used the service said, 'I notice there's more staff on.' A member of the care staff told us 'It has got better. We have two awake night staff on now.'

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One care worker told us 'We have some residents who have struggled to make choices. We still ask them and as far as possible give them choices to do as they please.'

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Staff told us that they knew people well and were aware of their needs. One care worker we spoke with told us 'most of the residents can communicate their needs and I feel confident they do.' People were registered with a GP and had access to a range of healthcare professionals.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained.

There were not enough qualified, skilled and experienced staff to meet people's needs. Some staff voiced concern at the levels of staffing at Westwood Care Home.We found that the provider had ensured that staff were properly trained, supervised and appraised.

Staff records and other records relevant to the management of the service contained relevant information and were fit for purpose.

People experienced care, treatment and support that met their needs and protected their rights. People were registered with a GP and detailed records had been maintained of visits to and from health care professionals. Medicines had been administered by care workers who had been trained to do so.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Care workers had received up to date relevant training and were aware of the local protocol for safeguarding adults at risk.

Care workers had not had the training they needed to meet the needs of people with dementia type illnesses. A care worker who had prepared meals had not received the training they needed to prepare food safely. Care workers had not routinely received supervision or had an appraisal.

Not all records were up to date and accurate. Some people's needs had not been assessed and not all risks had been assessed and mitigated. People's care plans had not always been updated to reflect changes.

Staff recruitment and personnel records did not contain all the required information.