Westerley Residential Care Home for the Elderly - Westcliff-on-Sea

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.
 

This service scored 59 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Following our last inspection, the registered manager had implemented a formal monthly record of lessons learnt. However, this had not been completed recently.
The registered manager told us they are always discussing how to move forward and improve the service. The management shared learning with staff from incidents, accidents, complaints and safeguarding so that the service could continually improve and develop positive outcomes for people.
However, we identified some issues during the inspection, including areas for improvement within the environment and how people were involved in managing risks. This meant, while learning was shared with staff, there were opportunities to strengthen how this learning was consistently embedded into everyday practice.
The registered manager told us, “I have a WhatsApp groups which I use daily to ensure everyone gets the information they need instantly.” A member of staff told us, “The manager keeps us informed of any changes to a person’s care plan or if there is anything else we need to know about.”
 

Theproviderdid not always have a proactive and positive culture of safety based on openness and honesty. Staff told us they read through the care plans to ensure they had all the information they needed to provide support safely. Relatives told us they were happy with the initial assessment process and the way the support package was put into place. A relative told us, “We did an assessment, they asked us everything about [relative] and even their struggles in life, they treat [relative] with the love, respect and the understanding [relative] needs.”

However, we identified that information relating to a person who was no longer receiving care was still stored within care files. This meant that systems were not always promptly reviewed or updated when people moved out of the service, and highlighted the need to strengthen processes to ensure information remained accurate and appropriately managed during transitions.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people. This action included informing other agencies if there were concerns about how the service was responding and what actions were being taken. A staff member told us, “I would report to my manager, and I would escalate to Local authority if I needed to.”

A relative told us, “I have no concerns about [relative’s] safety”. Another relative told us, “[Relative] is safe, they haven’t had any falls, the door are locked, no one comes into their room.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found staff practice reflected the principles of the MCA. People were encouraged to make their own decisions, while still minimising risk. Staff understood their roles and responsibilities in relation to the MCA 2005 framework.

The provider did not always work effectively with people and those involved in their care to understand and manage risks. Not all risks to people’s safety and wellbeing were adequately assessed, recorded, or detailed clearly enough to guide staff on how risks should be managed and mitigated.

For example, records relating to a person’s mobility and support needs were not consistent. The care plan stated the person could no longer walk and required assistance from 2 staff for transfers. However, the mobility and functional assessment recorded that they walked independently, and the dependency assessment continued to rate them as independently mobile. This meant staff did not always have a clear or consistent understanding of the person’s actual mobility needs, increasing the risk of inappropriate support being provided and contributing to the risk of falls and injury.

We also found that some risk assessments remained in place despite no longer being relevant. This included a sensor mat risk assessment for a person who no longer mobilised independently.

For another person, records did not consistently reflect their current needs and level of dependency. The person was receiving end‑of‑life care and was fully dependent on staff. They had specific care needs, including a modified diet and fluids, required the use of moving and handling equipment, and was fully dependent on staff for support with eating and personal care. However, the dependency assessment did not accurately reflect these needs. It did not record difficulty with swallowing or the need for modified food and fluid consistencies. The nutrition assessment stated they now required support with all eating and was unable to feed themselves, including with finger foods, which was not consistently reflected across other records.

This meant staff did not always have clear, consistent information to guide them in safely supporting the person and managing risks in line with their current needs.

Following this inspection, the registered manager told us all care plans and risk assessment were being reviewed and updated.

A relative told us, “I know [relative] has a care plan, but it hasn’t been reviewed recently. I haven’t seen it, but we do get an email to say if there are any concerns.” Another relative told us, “I don’t often get a phone call in a timely manner if anything has happened to [relative]. I think there are often issues with communication.” However, some relatives told us they are kept informed of any changes or incidents.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During the inspection, we identified environmental safety concerns. A fire door did not activate the alarm when opened, which posed a risk to effective fire safety arrangements. A lift control box had been left open, creating a potential risk of injury. In addition, a wardrobe was not securely attached, increasing the risk of it becoming unstable. These issues had not been identified through the provider’s maintenance, safety checks or audits.

Following the inspection, the registered manager told us the maintenance arrangements would be updated, and these items would be added to routine audits to ensure they are checked and addressed promptly going forward.

Risks relating to the service's fire arrangements were monitored and included individual Personal Emergency Evacuation Plans [PEEPs] for people using the service. However, some of the information lacked detailed and was not accurate. Following this inspection the management updated the PEEPs for each person to ensure they were detailed, up to date and accurate.

For example, one person’s PEEP stated they could be supported by 1 member of staff to walk downstairs and exit via the nearest fire exit. However, records showed the person could no longer walk and required assistance from 2 staff members for transfers using a wheelchair and lift. This was inconsistent with the person’s care plan, mobility and functional assessments, and stair‑use risk assessment, which had been updated to reflect reduced mobility.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. The registered manager had processes in place to ensure all staff received an extensive induction and staff we spoke to confirmed this. Appropriate checks were in place before staff started work including providing full work histories, references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. The registered manager had implemented a new staff file audit process which ensured that all employee records were regularly reviewed, up to date and contained all the necessary information. Following our last inspection, the provider had introduced a staff file audit. All staff files had been checked, and gaps in information identified previously had been addressed.

There was enough staff available to provide safe and consistent care to people safely. However, we received mixed feedback from people and relatives. A person told us, “They could probably do with a few more staff here at times.” A relative told us, “Sometimes I have gone and there is no one around, sometimes when I want to get in or out you can wait for ages.” Another relative told us, “It always seems that there isn’t awful lot of staff but the ones there are very caring.”

However, a relative also told us, “I feel there is always plenty of staff there and the managers pull their sleeves up if there isn’t enough there, they are very approachable.”

Theproviderdid not always assess or manage the risk of infection. We found a used bar of soap in a communal bathroom, which increased the risk of cross‑contamination and was not in line with best practice for infection prevention and control. Following the inspection, the registered manager immediately disposed the bar of soap.

A relative told us there had been occasions where a bedroom smelt of urine and a used continence pad was found on the bathroom floor. The person concerned was unable to safely dispose of continence products independently, increasing the risk of poor infection control if checks were not carried out consistently. This meant that risks related to continence management and environmental cleanliness were not always adequately assessed or managed, despite wider cleaning audits being in place.

Staff had personal protection equipment situated throughout the service giving them easy access to wear when needed. The deputy manager carried out regular checks and completed regular audits to monitor the cleanliness of the service. However, the registered manager did not always sign off the audits.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The registered manager told us, "Staff did not support people with medicines until they had completed the required training, and medicine competency assessments were completed." Medicine competency assessments were seen on staff files. People had care plans and risk assessments in place which detailed what medicines they were prescribed and how they liked to be supported. Protocols were in place for as and when required medicines (PRN). The deputy manager carried out regular audits and where discrepancies were noted these were investigated to identify the cause and any actions needed. There was a system in place to identify any shortfalls and to ensure people received their medicines safely.