Archived: Westward Care Home

Staff were not always wearing Protective Personal Equipment (PPE) in line with government guidance. We have made a recommendation to the provider about this and shared what we found with the local authority.

We found the following examples of good practice.

The service ensured that only essential visitors came inside the premises. All visitors entered through the rear entrance where everyone was temperature tested and completed hand disinfection prior to entering the home.

The provider participated in regular Covid-19 testing of people living in the service and staff. This ensured action could be taken swiftly to reduce the potential spread of infection if a positive test was returned.

The environment was very clean. Additional cleaning was taking place including frequently touched surfaces. Infection control audits were carried out.

People were supported to see their family through window visits and staff also helped people maintain contact using social media platforms and regular phone calls.

People had been supported to access the community safely with the use of face coverings and hand sanitisers provided.

Further information is in the detailed findings below.

Westward Care Home provides care for people with a learning disability and associated conditions such as autism. On the day of our inspection there were 5 people living at the service.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service does not require a registered manager.

We checked the service was working in line with ‘Registering the Right Support’, which makes sure services for people with a learning disability and/or autism receive services that are developed in line with national policy - including the national plan, building the right support - and best practice. For example, how the service ensured care was personalised, how people’s discharge if needed, was managed and people’s independence and links with their community promoted.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection on the 17 August 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing 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.

At this inspection we found the service remained Good.

Why the service is rated Good:

We met and spoke to all five people during our visit. However, people who lived at Westward Care Home had some communication difficulties due to their learning disability and associated conditions, such as autism. Therefore, they were not able to tell us verbally about all their experience of living there. We spent short periods of time with people seeing how they spent their day and observing the interactions between people and the staff supporting them.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received medicine training and understood the importance of safe administration and management of medicines.

People who required it had extra staffing when they went out. Staff confirmed there were sufficient numbers of staff to meet people’s needs and to help keep them safe. Staff were recruited safely and checks carried out with the Disclosure and Barring Service (DBS) ensured they were suitable to work with vulnerable adults.

Staff had completed safeguarding training. Staff had a good knowledge of what constituted abuse and how to report any concerns. Staff understood what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated. Staff confirmed they’d have no hesitation reporting any issues to the provider.

All significant events and incidents were documented and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from people living in the home, relatives, professionals and staff.

Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff completed an induction programme and completed the Care Certificate (A nationally recognised training course for staff new to care) if they did not have any formal care qualifications. Staff meetings, one to one supervision of staff practice, and appraisals of performance were undertaken.

People’s risks were documented, monitored and managed well to ensure they remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given a choice of meals, snacks and drinks they enjoyed whilst maintaining a healthy diet. People had input as much as they were able to in preparing meals and drinks.

People were engaged in different activities during our visit and enjoyed the company of the staff. People were busy; however, there was a happy, calm and relaxed atmosphere within the service.

People were supported to maintain good health through regular access to health and social care professionals, such as occupational therapists. The provider worked with external health and social care professionals to help ensure a co-ordinated approach to people’s care.

The service was responsive to people's individual needs and provided personalised care and support. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs. The provider had taken account of the Accessible Information Standard (AIS). The AIS is a requirement to help ensure people with a disability or sensory loss are given information they can understand, and the communication support they need. Staff adapted their communication methods dependent upon people’s needs, for example using simple questions. Information for people with cognitive difficulties and information about the service was available in an easy read version for those people who needed it.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not all able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; considering people’s preferences and wishes. Overall, people’s individual equality and diversity preferences were known and respected. Information recorded included people’s previous medical and social history, and people’s cultural, religious and spiritual needs. People were treated with kindness and compassion by the staff who valued them. Staff had built strong relationships with people who lived there. Staff respected people’s privacy. People, or their representatives, were involved in decisions about the care and support people received.

People were 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 could make choices about their day to day lives. The provider had a complaints policy in place and it was available in an easy read version. Staff knew people well and used this to gauge how people were feeling about the service.

The provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the provider was approachable and made themselves available to people and staff. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

The service provides accommodation and support for up to 6 people of all ages who have autism, learning disability and mental health needs. At the time of the inspection there were six people living at the home. The complexity of people’s care needs meant we were only able to engage in short conversations with people. We therefore used our observations of care and our conversations with staff and people’s relatives to help us understand their experiences.

The registered provider of the service was in day to day charge at the home. Registered providers are 'registered persons' who have registered with the Care Quality Commission. 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.

The atmosphere in the home was warm and welcoming and we saw laughter, warmth and trust between people and staff. We observed staff treated people in the home with kindness, dignity and respect.

Records showed each person had comprehensive assessments of any potential risks to their health and welfare. Where risks were identified there were measures in place to reduce these. We saw that staff were skilled at managing risks in relation to people’s complex needs, including challenging behaviour.

People received care and support in line with their individual care plans. They appeared happy and comfortable with the staff who were supporting them. We observed people responded positively when staff approached them with smiles and happy expressions. This indicated they felt safe and secure. One person said “Good staff. They so friendly. I feel very safe”. Relatives told us they were very happy with the care provided. One person’s relative said “[name] is as safe as she can be living there”

Staff received training in safeguarding adults and knew how to raise concerns if they were worried about anybody being harmed or neglected.

We observed staff always checked with people before providing care or support and then acted on people’s choices. Where people lacked the mental capacity to make certain decisions about their care and welfare the service knew how to protect people’s rights. Staff ensured people's privacy and dignity was respected at all times. They worked closely with people to ensure they understood their needs and preferences. People were involved in planning and reviewing their care as fully as possible.

There were robust recruitment processes in place to ensure that suitable staff were employed. Staff were well supported by the provider/manager and deputy manager through supervision and appraisal. High standards of care were encouraged through staff training and development. Staff participated in a wide range of training courses in topics relevant to people’s care needs. This included specialist areas such as autism and how to use least restrictive support methods when people’s behaviour challenged their own safety or that of others.

People were able to follow their interests and hobbies and could go out every day if they wanted. Staff had time to spend individually chatting with people and reassuring them if they became anxious. There was a holiday organised by the service each year, where a group of people went away for a few days, supported by staff. These were greatly enjoyed. People were encouraged to maintain their independence and to be part of the local community.

People were supported to eat and drink enough to ensure they maintained good health. We spoke with people about their meals and observed the lunchtime meal and saw everyone enjoyed the meals provided and staff supported people appropriately.

People’s relatives said they were always made welcome and could visit the home whenever they wished. They said the service was very good at keeping them informed and involving them in decisions about their relatives care.

We observed medicines being administered and this was done safely and unhurriedly. Staff received regular training in medicines management and medicines audits were completed to ensure consistent safe practice. People were supported to maintain good health by a range of external health and social care professionals.

People's needs were met by the adaptation, design and decoration of the service. There was an ongoing programme of maintenance at the home. It was decorated and furnished in a comfortable, homely way.

The culture of the home was person-centred, open and friendly. There was clear leadership from the manager and deputy manager. The service’s quality monitoring systems enabled the service to maintain high standards of care and to promote continuing service improvements.

One inspector visited the home and looked to answer the question was the service safe?

We spoke with the owners of the home, the deputy manager and two care staff at the home. We also spoke over the telephone with the two staff who worked at the home whose first language was not English.

Below is a summary of what we found. The summary is based on our observations during the inspection and speaking with the staff team.

If you want to see the evidence supporting our summary please read the full report.

Was the service safe?

We found that recruitment practice was safe and thorough.

We found no evidence to support the concern that staff who worked at the home could not speak English.

People were encouraged to express their views. We saw that people had full and active lives. People we spoke with told us that they were happy with their support. One person told us 'all the staff are very nice and kind".

We saw that care plans accurately described each person's needs and preferences, and were reviewed regularly to remain up to date.

Staff were knowledgeable about people's support needs and treated people respectfully. Staff were patient, calm and reassured people where necessary. Staff we met told us that they received appropriate training for their roles.

The service had a system whereby complaints and concerns were listened to, and acted upon immediately in order to improve quality.

We followed up on the improvements required at this inspection. We found that people who used the service were protected from the risk of abuse. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

All staff had attended training on the safeguarding of vulnerable adults, the Mental Capacity Act (2005) and the deprivation of liberty safeguards provided by the local authority. The provider had produced a new safeguarding policy based on guidance from the local authority.

The provider was able to give examples of how they had proactively contacted the local authority safeguarding team for advice on how to prevent abuse. They were also able to demonstrate that they understood safeguarding reporting processes.

We spoke with two people and four staff. We also spent time observing care and looked at four care plans. On the day of our inspection six people were living at the home and receiving care from the service.

One person said 'I like it here. I like everyone. There's a nice atmosphere.' One member of staff described the standard of care at the home as 'top quality' and commented that the home was 'like a family setting'. All the staff we spoke with were positive about the support they received.

We asked two people if staff were kind and both said yes. In the annual quality assurance survey carried out in February 2012 all the people living at the home were asked if staff were kind and all replied positively. Both people we spoke with said they felt safe at the home. However staff were not up to date with training on the safeguarding of vulnerable adults. Procedure information held by the home about the safeguarding of vulnerable adults was out of date. The manager did not have a clear understanding of the safeguarding referral process or the need to inform CQC of abuse or an allegation of abuse. This meant there was a risk that abuse would not be managed effectively.