Archived: Westdene Residential Home

The service had a registered manager in post as required by a condition of their registration. 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.

We undertook this unannounced inspection on the 26 April 2016. At the time of the inspection there were a total of 40 people living in Westdene Residential Home. At the last inspection on 14 May 2014, the registered provider was compliant with all areas assessed.

We found people’s health and nutritional needs were met. Staff contacted community health care professionals when required and supported people to visit hospital appointments. The meals provided to people were varied and choices were available. There were special diets for some people as required. Dieticians were contacted for advice and treatment when people lost weight or there were concerns about their food and fluid intake.

We found people who used the service received their medicines as prescribed. Staff managed medicines well and ensured they were obtained, stored, administered to people and disposed of appropriately.

We found staff supported people to make their own decisions. When people lacked capacity for this, staff acted within the principles of the Mental Capacity Act 2005 and ensured important decisions were made within best interest meetings with relevant people present.

People had assessments of their needs completed and care plans were developed to guide staff in how to support people in the way they preferred. We saw person-centred care was provided to people. There were meaningful activities for people to participate in which helped them to be occupied.

Staff were recruited safely and employment checks were carried out prior to them starting work at the service. The checks helped to ensure only appropriate staff were employed to work with people who potentially could be vulnerable.

We found there was sufficient staff on duty to support people with their assessed needs and to sit and chat with them. People told us staff were kind and caring and we observed this during the inspection. Staff provided people with information and spoke with them in a patient way. People’s privacy and dignity was respected and their confidential information was held securely.

Staff had access to training which helped them to feel skilled and confident when supporting people who used the service. The training was monitored and refresher courses made available. Their competence was checked to make sure the training was effective. Staff received supervision, appraisal and support.

Staff knew how to protect people from the risk of harm and abuse. They completed safeguarding training and there were policies and procedures to guide them should they have any concerns. People who used the service had risk assessments for specific areas of daily life. These helped to guide staff in how to minimise risk. We found the environment was clean and safe for people. Equipment used in the service was monitored and well-maintained.

The service had a quality monitoring system in place which ensured that checks were made and people were able to express their views. The registered provider and registered manager were approachable and people who used the service and their relatives were listened to and their views taken seriously so practice could be improved. There was a complaints procedure on display and people felt able to complain.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff who supported them, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had procedures in place in relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded as required.

Safeguarding policies and procedures were in place and staff had received training in how to manage safeguarding concerns in order to protect vulnerable people from the risk of abuse or harm. The manager was aware of local protocols in place to guide practice when incidents occurred between people who used the service. The Care Quality Commission and local safeguarding adults team were informed of any safeguarding incidents. This enabled us to monitor the actions taken to manage risks.

Risk assessments were completed and steps had been taken to minimise risk. Staff had been made aware of risk assessments. This helped to guide staff when supporting people who had behaviours that could be challenging to themselves, and other people.

We observed people were treated with dignity and respect. People told us they felt safe.

The service was clean and tidy and there were infection prevention and control systems in place, which included staff training, cleaning schedules and personal, protective equipment.

The manager sets the staff rotas and they took into consideration people's care needs when deciding on the numbers of staff on duty and the skills they required to meet people's needs. There were additional staff at peak times to ensure people's needs were always met.

Is the service effective?

People's health and care needs were assessed and we saw that care plans contained preferences for how care was to be provided to people. This showed us people had input into their assessments and care plans. The district nursing service told us there had been an increase in people receiving minor skin tears and they were to discuss this with the manager to try to address the cause.

People told us that staff asked for their consent to carry out day to day tasks such as assisting them to wash, dress and bathe. When people had been assessed as lacking capacity to make their own decisions, staff had followed procedures and best interest meetings had been held to discuss the decision required.

Staff had completed life story boards with people with dementia, which were on display in their bedrooms. These were bright and colourful and helped people with dementia to recognise important people, places and times in their life. However, we did find that helpful signage such as symbols for the toilets and bathrooms were not on all the doors required. The manager was to address this.

Visitors told us they were able to see their relative in private and visiting times were flexible. They also said they were kept informed of incidents that affected their relative.

Is the service caring?

People were supported by kind and attentive staff. We observed staff speak to people in a friendly and professional way. We saw that staff gave people time to respond to questions and encouraged them to make decisions for themselves.

People who used the service and their relatives were asked for their views in surveys. We saw the returned surveys had positive comments about the care received by people who used the service.

Is the service responsive?

People had access to a range of health and social care professionals for support and treatment. Records indicated people received treatment in a timely way. This was confirmed in discussions with people and their relatives.

The service had policies and procedures in place for the management of complaints. People knew how to make a complaint if they had concerns or were unhappy about something.

The service had changed things as a result of feedback from surveys and audits. These included menu changes, fortified smoothies for people at nutritional risk, an additional domestic worker for the afternoon and another member of staff to work as 'hospitality' to assist people with meals and drinks.

Is the service well-led?

The service had a quality assurance system which included checks to make sure the service was safe and meeting people's needs. It also included surveys and meetings to ensure people were able to express their views. When shortfalls were identified, these were addressed so that the service continually improved.

Staff were clear about their roles and responsibilities and had a good understanding of the ethos of the service.

We saw that staff had policies and procedures to guide their practice and received training, supervision and daily management support. The manager and provider made themselves available during the day and there was an on call system for evenings and weekends. This ensured staff felt supported and they knew who to contact for advice.

Notifications of incidents that occurred in the service were sent to the Care Quality Commission and other agencies as required. This ensured we were able to monitor how these were managed.

What people who used the service and those that matter to them said about the care and support they received.

'They ask me if I want to get up and when I want to go to bed; they know I like to choose this myself', 'They always ask us if we want a bit more to eat' and 'They come and ask if you want a bath or a shower.'

'I'm quite healthy but they get the doctor when needed', 'They are quick in getting the doctor if anything is the matter with you' and 'I feel well looked after. These (the staff) have helped me get through because I wasn't eating at home; they couldn't do anything better.'

Visitors spoken with told us they were happy with the care their relative received. They said, 'I am happy with the care' and 'He always looks smart and tidy and he has a lot of independence here. He has told me he likes it here.'

A district nurse said, 'They have provided us with a lovely room to treat patients in private' and 'On the whole it is very good. The staff are lovely and we have a good rapport with the manager and provider.'

People told us the service was always clean and tidy. They said domestic staff cleaned their bedrooms well and they were happy with the laundry.

People said staff answered call bells in a timely way. Comments included, 'I like the way the lasses do things' and 'There are quite enough girls; I don't use my buzzer much but they would come quickly.'

Relatives told us, 'The staff support him and he always looks nice. Sometimes he has three changes a day', 'The staff are friendly and helpful' and 'I like the staff; they are friendly and take time out to talk to people.'

People told us they would feel able to complain if needed. They said, 'I have none but they would sort it out if I did' and 'I would tell the owner or one of the seniors.' Relatives said, 'I have no complaints but I feel confident it would be sorted out very amenably.'

During our lunchtime observation we heard comments such as, 'The meatloaf was really nice wasn't it?' and 'I really liked it, it was really tasty.' We saw that the food was well presented and was plentiful.

Medicines were held securely, were recorded appropriately and arrangements were in place to dispose of them safely.

We spoke with three members of staff who told us they had been on a range of training courses and their personal development was supported. They also told us management was really effective about supporting their career progression.

We saw evidence of staff meetings; cooks meetings and domestic meetings, and the manager told us they were held on a monthly basis. Staff have the opportunity to discuss any issues as they arise and can make suggestions to improvements to practise and the service overall.