Westwood Residential Care Home

Westwood Residential Care Home provides accommodation for persons who require personal care. The service can provide support for up to 20 people, including older people and younger adults. At the time of our inspection, there were 19 people using the service.

The property is set over 3 floors with lift access to the upper floors. There were several communal areas and a small rear garden. Aids and adaptations were in place to meet people’s individual needs.

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

Though people said they felt safe; some systems and processes to monitor and manage fire safety, health and safety and infection prevention and control (IPC) were not robust. Concerns regarding medication storage and recording systems were identified, which we have asked the provider to review. We received positive feedback about staffing levels, and recruitment processes were safe. People were safeguarded from the risk of abuse, and the provider learnt lessons from incidents, accidents and safeguarding concerns.

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.

Staff received an induction and a good level of support from the management team. However, we raised concerns in relation to the frequency of training; and lack of training around people’s individual needs, including mandatory learning disability training. Care records were detailed, though we found some inconsistent information around people’s dietary needs. Improvements to the home’s environment were being made when resources allowed, but signage could be improved to help support independence and well-being for people living with dementia. People commented positively about their experience of care delivered. One person said, “I am very well supported. I regard this as my real home now.”

Though audits and checks were in place, these were not fully embedded and had failed to identify concerns raised during inspection. The registered manager acknowledged areas of development within monitoring systems and spoke about improvement plans. We observed a happy atmosphere and positive interactions, and feedback about the culture and the registered manager was good. A relative told us, “The home is well run. Staff are friendly and work together. Some have been here years which is a sign they enjoy working at the home. The manager is very helpful and friendly.” People, their relatives and staff had regular opportunities to give feedback and timely action was taken in response to concerns raised.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 December 2019). The service remains requires improvement. This service has been rated requires improvement for 2 consecutive inspections.

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

Previous breaches and recommendations

At our last inspection we found that security at the premises was unsafe and placed people at risk of harm. At this inspection we found those specific concern had been rectified.

At the last inspection, we also made a recommendation about staff training. Adequate improvements had not been made. Please see ‘safe’ section of this report for more details.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about care and treatment; and seeking medical attention in a timely manner. This inspection examined those risks.

The provider has taken appropriate action to mitigate these risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We identified breaches in relation to safe care and treatment, and good governance. We made a recommendation in relation to storage and recording of medication.

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 to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

Visitors were required to book an appointment, to ensure the number of people visiting the home at any one time was limited. Visitors were monitored for Covid 19 symptoms on arrival and were required to wash their hands on entry to the home. They were required to wear appropriate PPE and maintain social distancing during their visit.

Staff who would normally be reliant on public transport to get to and from the home, were supported by the provider to travel by taxi, to reduce the risk of contracting the virus and bringing it into the home.

People were supported to maintain contact with their friends and relatives through video calls, garden and door visits and increased phone calls. This helped to reduce feelings of social isolation.

Westwood Residential Care Home is a residential home which provides accommodation and personal care for up to 20 older people. Accommodation is provided over three floors, with a lift providing access to all floors. At the time of the inspection, 19 people were living at the home.

People’s experience of using this service:

Improvements were needed to the security of the premises, to keep people safe and ensure unauthorised people could not gain entry to the home. People received their medicines as and when they should. People felt safe at the home and most people were happy with staffing levels. The provider recruited staff safely and staff understood how to protect people from the risk of abuse. Staff followed appropriate infection control procedures and we found the home was clean throughout.

Staff supported people to achieve good outcomes. People and relatives felt staff were skilled and competent. Some staff training updates were overdue and we have made a recommendation about this. 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. Staff supported people with their dietary and healthcare needs and contacted community professionals when they needed extra support. The environment had been adapted but further improvements were needed to ensure it met people’s needs. We have made a recommendation about this.

People and relatives liked the staff at the home. They told us staff were kind, caring and respectful. Staff respected people’s right to privacy and dignity and considered their diversity when providing support. They encouraged people to be as independent as they could be and involved them in decisions about their care. Information about local advocacy services was available, to ensure people could access support to express their views if they needed to.

Staff provided people with care that reflected their needs and preferences and people told us staff provided support when they needed it. Staff knew people well and offered them choices. Staff reviewed people’s care needs regularly and updated documentation when people’s needs changed. Concerns and complaints were managed appropriately. People were happy with the activities and entertainment provided at the home.

The local authority had visited the home and identified a number of improvements that were needed. An action plan was in place. The registered manager regularly completed a variety of audits to check safety and quality at the home and told us the security of the home environment would be monitored closely in future to ensure people were kept safe. The provider had oversight of the service. Staff worked in partnership with a variety of community agencies to ensure people received the support they needed. People and relatives were happy with the management of the service. Staff found the registered manager approachable and were able to raise any concerns.

Rating at last inspection:

At the last inspection the service was rated good (published 1 October 2018).

Why we inspected:

This inspection was prompted in part due to concerns identified by our Registration team, as part of their visit to the home to assess the manager’s application to register with the Care Quality Commission (CQC).

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up:

We will request an action plan from the provider to understand what they will do to ensure the home environment remains safe. We will monitor the progress of improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

At the time of the inspection 19 people lived at the home.

The inspection visit took place on 13 September 2018 and was unannounced.

At our last inspection we rated the service Good in all domains. On this inspection, we found the service had remained good in each domain.

We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There had been a change of registered manager since the last inspection. The new manager had become the registered manager for the home shortly before the inspection. 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 who lived at Westwood residential care home, their relatives and staff were positive about the management support in the home.

People told us they felt safe and looked after by staff. We observed interactions between staff and people. These were positive friendly and supportive. There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments had been developed to minimise the potential risk of harm to people. These had been kept under review and were personalised to meet people’s needs.

Medicines were managed safely. People received their medicines when needed and appropriate records had been completed.

There were sufficient staffing levels in place to provide the support people required and staff responded promptly when people needed assistance. Staff had been recruited safely and received training to develop their skills and knowledge.

We saw people had access to healthcare professionals. People told us staff cared for them in the way they wanted and met their care needs promptly. They referred them to healthcare professionals in a timely way. We saw and people told us staff provided care in a way that respected peoples’ dignity, privacy and independence.

We saw staff were attentive to people’s needs and wellbeing and responded promptly to requests for assistance. They provided care in a personalised way, taking people’s preferences into account. They were aware the importance of upholding people’s rights and diverse needs and treated people with respect and care. People told us they enjoyed a variety of social and leisure activities and staff were welcoming to their families and friends. People said this assisted their well-being.

People had been 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.

People told us they enjoyed the food provided and had choice and variety. We observed the lunchtime meal. People received sufficient food and drink and the assistance they needed. The kitchen was clean, organised and stocked with a variety of provisions and staff were trained in food safety.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. The design of the building and facilities in the home were appropriate for the care and support provided. We found equipment had been serviced and maintained as required. There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when providing personal care to people so they did not risk causing cross infection.

The management team sought people's views in a variety of ways. They assessed and monitored the quality of the service through audits, resident, relative and staff meetings and surveys. People told us the management team were approachable and willing to listen. They knew who to complain to if they were not satisfied with their care and felt appropriate action would be taken. People also had information about support from an external advocate should this be required.

Further information is in the detailed findings below.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We undertook a tour of the premises during our inspection and viewed a number of people's private rooms, toilets and all communal areas of the home. The environment was very clean and hygienic and there were no unpleasant odours.

We found evidence that monthly infection prevention and control checks were carried out that looked at details of any outbreaks (none were identified), audits undertaken, staff training and monitoring activity and reviews of relevant policies. We saw that individual members of staff had been observed whilst carrying out their duties to ensure that they followed correct procedures. Eight observations had been carried out during 2014 at the time of our inspection. No issues had been identified.

Is the service effective?

We looked at care plans for three people living at the home. People's needs were assessed and care and support was delivered in line with their individual needs. We saw that care assessments had been carried out and daily monitoring records were in place. Care plans were easy to follow and it was evident that regular reviews of people's needs were carried out. Risk assessments were in place covering areas such as moving and handling, falls and nutrition. Evidence was in place showing that monthly reviews of all risk assessments were carried out. At the time of our inspection the home were in the process of transferring some of the care plans to an electronic system. Staff training was taking place to ensure that all staff were familiar with the system and felt confident using the system.

Is the service caring?

We spoke with four people who lived at the home, one visiting relative and another visitor to the home. All the people

we spoke with were happy with the care they or their relatives were receiving at Westwood Residential Care Home. One person who lived at the home told us, "I'm happy here, staff treat me well". Another person who lived at the home said, "I can't grumble, I'm comfortable, the staff are good, I'm alright". A visitor to the home who also went into other local care homes said, "It's a lovely atmosphere here. The staff are great and always very helpful. Their attitude is second to none".

Is the service responsive?

All the people we spoke with who lived at the home felt comfortable raising any issues with staff and said they knew how to make a compliant if they needed to. One person told us, "I think I would know how to make a complaint, I'd just ask a member of staff". Another person said, "If we have any issues we talk to staff, they couldn't be more helpful".

We spoke with two members of staff who were able to talk us through what would happen if a person living at the home wanted to make a complaint or raise any issues. We also saw that the subject of complaints was discussed at the latest residents meeting held on 30 May 2014.

Is the service well-led?

There was evidence that the home carried out a number of audits including medication, care planning and infection control.

The home had a comprehensive quality assurance policy in place that covered a range of issues including internal reviews, staff and management meetings, residents meetings, annual satisfaction surveys, care plan reviews and risk management.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop.

The premises were clean and tidy and the design, layout and security of the premises were fit for purpose to meet the needs of the residents.

People living in the home that we spoke with said they were pleased with the home and felt supported. One said, 'When we were looking for somewhere this one kept coming up and I am delighted.'

People we spoke with who lived in the home, all said they were kept safe. One person said, 'If ever I want to go downstairs I always find someone to help me with the lift.'

People we spoke with who lived in the home said that staff were able to provide the support required to meet their individual needs. One person said, 'Staff go above and beyond to make sure everything is ok.'

Confidential information policies were available and security of this information was acknowledged. Staff files were kept secure and archive records were locked away.