Westerley Residential Care Home for the Elderly - Woodhall Spa

Updated 15 December 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 carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Westerley Residential Care Home for the Elderly – Woodhall Spa is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Westerley Residential Care Home for the Elderly – Woodhall Spa is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 not a registered manager in post. The previous registered manager had left the service in December 2022 and the deputy manager at that time had taken over as the manager of the service in January 2023. The manager who had taken over the running of the service in January 2023 left the service shortly after our inspection.

Notice of inspection

The first day of the inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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 spoke with 7 people who lived at the home to gain their feedback about the care and support they received. Some people were not able to give us verbal feedback, so we observed their body language and interactions with staff to gain feedback on their wellbeing. We spoke with 5 visiting relatives/friends and several staff, including the manager, the deputy manager, care staff, housekeeping staff and an activities coordinator. We observed staff supporting some people in communal areas. We also spoke with the nominated individual, who is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records, including 12 people’s care records and a selection of medicines records. We reviewed 2 staff members’ recruitment files, staff supervision and training records and a variety of records related to the management of the service, including audits. We contacted 5 community healthcare professionals who had regular contact with the service, for their views about the care and support provided.

Updated 15 December 2023

About the service

Westerley Residential Care Home for the Elderly – Woodhall Spa is a residential care home which provides accommodation and personal care for up to 30 older people. Accommodation is provided over 3 floors, with a passenger lift available. At the time of the inspection 28 people were living at the home.

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

Risks to people's health and wellbeing were not being managed effectively and people did not always live in a clean, safe environment. Care documentation did not include up to date information about some people’s needs and risks to guide staff. There were inadequate systems in place to ensure there were sufficient staff available to meet people’s needs and monitor their safety. Medicines were not managed safely, in line with national guidance. Improvements were needed to staff recruitment processes, to ensure appropriate checks were completed before staff started working at the service.

People did not always receive support which reflected their assessed needs. Some people did not receive support when they needed it and people's safety was not always monitored effectively. Some staff had not received an appropriate induction or completed the training necessary to support people effectively. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Some people did not receive appropriate support with their dietary and healthcare needs and risks. The home environment needed to be improved to ensure it met the needs of people living with dementia.

People did not receive personalised, high-quality care which resulted in good outcomes for them. Many audits of quality and safety were not being completed regularly. When audits had been completed and shortfalls identified, the necessary improvements had not always been made. Many of the shortfalls we identified during the inspection had either not been identified by the manager or provider or had not been acted upon. This meant that appropriate standards of quality and safety were not being maintained at the home. There was limited evidence of engagement with people or relatives to gain their views about the care provided. There was a lack of appropriate oversight of the service by the provider; their visits and telephone calls to the service had failed to effectively monitor how the service was being run, the quality of care people were receiving and standards of quality and safety at the home.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 November 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 August and 1 September 2022. Breaches of legal requirements were found. We issued the provider with a warning notice.

We undertook this focused inspection to check the provider had complied with the warning notice and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement and recommendations

At this inspection, we have identified breaches in relation to the management of risks to people’s health and welfare, medicines management, infection prevention and control, the safety of the premises, staffing levels, staff training, safeguarding people from abuse and improper treatment and the provider’s oversight of the service.

We have made recommendations in relation to staff recruitment and providing a dementia friendly environment.

You can 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 met with the provider shortly after our inspection to discuss our findings. We will continue to monitor information we receive about the service, which will help inform when we next inspect and will work with the local authority to monitor progress.

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 of 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.