Westminster House Residential Care Limited

Updated 15 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by 1 inspector.

Service and service type

Westminster House Residential Care Limited is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. Westminster House Residential Care Limited is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. The registered manager was also the provider.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the Local Authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 4 people who used the service and 5 people’s relatives about their experience of Westminster House Residential Care Limited. Primarily, we spoke with the provider’s representative of the service [Admin Manager] and 4 members of staff. We spoke with the provider on the third day of inspection.

We reviewed a range of records. This included 4 people’s care records and 6 people’s medicines administration records. We looked at 7 staff files in relation to recruitment, staff training and supervision. A variety of records relating to the management of the service, quality assurance information and policies and procedures were viewed.

Updated 15 July 2023

About the service

Westminster House Residential Care Limited is a residential care home providing the regulated activity of accommodation and personal care to up to 12 people. The service provides support to adults who are living with dementia and/or have a mental health diagnosis. At the time of our inspection there were 12 people using the service.

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

The delivery of care for people was not always safe. Not all risks to people’s safety and wellbeing provided enough detail as to how identified risks should be mitigated. Suitable arrangements were not in place to ensure the proper and safe use of medicines. The deployment of staff was not always suitable or safe to meet people's care and support needs and improvements were required to the provider’s recruitment practices. People were not always protected by the prevention and control of infection. We have made recommendations about staffing levels, recruitment practices and infection, prevention, and control. Lessons were not learned, and improvements made when things went wrong.

Staffs' training was not embedded in their everyday practice and staff did not receive a robust induction. Although staff received supervision, information had not been examined to ensure where issues were highlighted these were escalated and addressed. We could not be assured if people’s hydration needs were being met as people’s fluid targets were not always met or monitored. The premises did not meet people's needs, particularly for people living with dementia and those people who had mental healthcare needs. We have made a recommendation about the premises.

The leadership, management and governance arrangements did not provide assurance the service was well-led. There was a lack of understanding of the risks and issues and the potential impact on people using the service. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when needed. People were happy with the quality of meals provided. Relatives were happy with the care and support provided for their family member. Staff felt supported and valued.

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 23 July 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The inspection was prompted in part due to concerns received about safeguarding people from harm and abuse. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to risk, medicines management, safeguarding, staffing, governance, and quality assurance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the Local Authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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 when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.