Westbourne Care Home

Westbourne Care Home is a residential care home providing personal to up to 27 people. The service provides support to older people, some of whom are living with dementia, in one adapted building. At the time of our inspection there were 23 people using the service.

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

People were supported safely and told us they felt safe. More robust documenting of risk management was needed to ensure staff had clear information to follow. For example, ensuring timings of repositioning was in the skin integrity plan and updates following an incident were completed swiftly. Medicines were managed safely. We found that records and quantities tallied and recording systems were used consistently. Protocols for medicines to be administered as needed were not always in place.

Infection control practices were in place and staff knew what they needed to do. However, we identified occasions when staff were not wearing their masks correctly. The carpets in the lounges needed to be cleaned or replaced.

People had their care needs met. In most cases this was done in a person-centred way. However, we raised awareness of some areas needing a review to ensure care was always delivered in a way that promoted people’s choices and dignity. For example, respecting people’s gender preferences of staff.

People were supported to eat and drink well and had access to health and social care professionals as needed. People had access to food, drink and call bells throughout our inspection. We saw that staff were friendly in their approach with people and knew people well. People and relatives were positive about the staff team’s approach and abilities.

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. People told us they could choose how care was delivered and how to spend their day.

People and staff said there was generally enough staff to meet people’s needs. Agency staff were supporting the home, many having worked at the home often. Staff told us they had enough training and felt well supported.

People had a range of activities and events to get involved with and told us they enjoyed. There was a quarterly newsletter shared with people and relatives to recap on what they had been joining in with. People had end of life care plans in place and staff had been trained. Feedback about the care people received at the end of their lives was positive.

People had their communication needs assessed on moving into the home and reviewed monthly. Information could be given in a different format and assistive technology available when needed. Staff spoke with people in their preferred way.

The manager was new in post after previously working in the home as a deputy manager. There were management systems in place and the manager was further developing these to drive improvements in the home. People, relatives and staff were positive about the management and leadership in the home.

Lessons learned were recorded and actions implemented. We found that they had made improvements in the areas raised at previous inspections.

Following our feedback, action was taken to address all points raised. These actions, and supporting records provided, gave us reassurance that any risks were mitigated.

We found the manager to be open and responsive to feedback. Visiting healthcare professionals told us that the management team and staff worked well with them.

People told us that their needs were met, and staff were nice. They told us they felt safe. Relatives were confident about the standard of care and told us staff were friendly. Relatives felt the management team and staff were approachable and knew people well. People and relatives were confident to raise any concerns and the manager responded to them appropriately. They looked for themes and trends.

Rating at last inspection

At the last inspection the service was not rated (published 12 January 2022.). The last rating for this service was requires improvement (published 22 April 2021).

Why we inspected

We undertook a focused inspection of safe and well led based on our internal monitoring of the service and to follow up on information which we had received about the service about management, infection control and staffing.

We inspected and found there were improvements across the service, so we widened the scope of the inspection to become a comprehensive inspection which included all key questions.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

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

Westbourne Care Home is a care home providing accommodation for up to 27 older people, including people living with dementia. At the time of the inspection there were 23 people living at the home.

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

People felt they were safe and well supported by the service. There was a new manager in post who people and staff were positive about and the changes they were making. Individual risks were assessed, and staff were aware of these risks and the action needed to reduce the risks.

Work was ongoing to update care plans to ensure they were accurate and ensure they reflected people’s needs accurately. Areas in the laundry room were a potential infection control and fire safety risk. This was addressed by the manager at the time of our visit.

People told us staff were kind and helpful, but at times they were busy. Staffing levels at night had been reduced. This was in response to a recent dependency assessment and a change to night staff duties. There was no negative impact found in relation to this at the time of our inspection.

A fire drill was planned as this had not been completed since June 2021, even though there was a change to staff and staffing levels at night. The provider told us they test staff knowledge about fire safety.

Reviews of events and accidents were carried out and any actions needed were completed. There was an analysis to look for themes or trends. Medicines were managed safely.

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

Rating at last inspection

The last rating for this service was Requires Improvement. (Published 22 April 2021)

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about people’s safety in relation to falls, pressure care, staff Covid-19 vaccination status, care needs not being met and staffing.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not give a rating or change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Westbourne Care Home is a care home providing accommodation for up to 27 people older people, some of whom are living with dementia. At the time of the inspection there were 26 people living at the home.

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

At the last inspection, the service was failing to ensure people’s safety was promoted, did not have effective governance systems and did not comply with duty of candour. As a result, there were found to be multiple breaches of regulations.

At this inspection we found that the required improvements had been made and systems implemented to address the shortfalls had been more effective.

More effective governance systems had been introduced and there were ongoing developments in this area. New assurance tools were being implemented to help drive improvement in the home. There was an action plan in place relating to the whole service. Audits checked all areas of the home.

People felt safe and told us the staff looked after them. We noted that in most cases staff worked safely and in accordance with people’s care plans and risk assessments. However, we noted one instance where this did not happen. This was dealt with immediately following our inspection. Relatives told us that most of the staff team were good but had been concerned about changes in management of the home. Some were aware of the new manager who had recently started. People’s safety and welfare was monitored. There was an overview of accidents and events and these were reviewed to help ensure there was not a reoccurrence.

People were given choices and staff knew people well. Care plans were detailed giving staff the appropriate information to meet people’s needs. People were encouraged to eat and drink well to help promote their wellbeing.

Staffing was monitored and additions were being made to the staffing numbers to help improve people’s experience and staff availability. This was as a result of listening to people, staff and quality monitoring.

Staff felt they had enough training and support to do their role. Training relating to infection control and COVID-19 had been delivered. There was additional training booked as a result of the quality assurance process and lessons learned. Staff knew how to reduce the risk of transmission of COVID-19. Staff worked safely in relation to COVID-19 in most cases. However, we did identify two staff not wearing their masks and one staff member not wearing their mask correctly. This was addressed following our visit.

Medicines were managed safely, and these were checked through an audit system. We noted a recording error and one discrepancy in quantities as part of our inspection. This was followed up the manager and a lessons learned record, with actions was completed.

Rating at last inspection

The last rating for this service was Requires Improvement (published 27 March 2020) and there were multiple breaches of regulation. The provider sent us an action plan stating how they would make the required improvements.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 January 2020 and 13 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance, safe care and treatment, duty of candour, consent and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The rating in well led has improved however the overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Please see the safe section of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westbourne Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

‘Westbourne Care Home’ is a residential care home providing personal care to older people and people living with dementia. At the time of the inspection, 26 people were living at the service. Accommodation is spread over two floors in a large detached property. The service can support up to 27 people.

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

Risks to people's health and wellbeing had not always been assessed, which put them at risk of harm. People were not supported by sufficient numbers of staff, which increased the likelihood of harm occurring. People did not receive their medicines as the prescriber intended. When incidents occurred in the service, lessons learned were not embedded in practise to reduce the likelihood of recurrence.

Prior to people moving in to the service their needs were assessed. These assessments were used to develop the person’s care plans. However, care plans were not reviewed when needs changed and in some instances were not completed at all.

People were not supported by staff who had received all the required specific training to meet people’s needs. Staff were not able to undertake further training to enable them to develop in their role. The environment did not follow best practise guidance for some of the people who lived in the home.

People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were systems in place to monitor the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to management of risk, training, care planning, staffing, lessons learned or duty of candour. A service improvement plan to develop the service was implemented during the inspection. There was no system in place to monitor developments or areas for improvement formally.

When errors occurred and people either experienced harm or were at significant risk, the provider and registered manager did not demonstrate an open and transparent approach.

People told us they felt safe living at Westbourne Care Home. People said staff were kind and supported them to develop meaningful relationships with others to avoid isolation. People felt they were valued, listened to and respected.

People had access to a range of different activities throughout the week. People were able to raise concerns and complaints which were responded to. People who required end of life support received this appropriately from a staff team that had been trained to provide this important area of care.

Rating at last inspection and update

The last rating for this service was Good (published 02 August 2017).

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing levels, safe care and treatment, obtaining consent, governance and being open and honest with people and relatives when things went wrong.

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 will meet with the provider to further discuss our concerns. We will seek assurances from them about how they plan to make the necessary improvements. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information before that time we may inspect sooner.

Westbourne Care Home provides accommodation for up to 27 older people, including people living with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 25 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People felt safe and staff knew how to report any concerns. People’s individual risks were assessed. However, unexplained injuries required consistent monitoring. People’s medicines were managed safely.

People were supported by sufficient staff. However, recruitment processes needed further development to ensure they were robust. We found that staff felt trained and supported.

People’s ability to make decisions was assessed and the principles of the Mental Capacity Act 2005 were adhered to. Their consent was sought before care was given and they were treated with dignity and respect. People were supported to eat and drink sufficient amounts and there was appropriate access to health and social care professionals.

People or their relatives were involved in their care planning and their confidentiality was promoted. People’s care needs were met and their care plans were clear and up to date. People enjoyed the activities available and were able to enjoy going out into the community.

People and staff were positive about the management of the home. There were quality assurance systems in place. We found that complaints were responded to and feedback was sought.

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 20 August 2014. This included speaking with members of staff and looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

At our previous inspection carried out on 03 June 2014, we found that people had not been adequately protected against the risks of health care associated infection. This was because appropriate standards of cleanliness and hygiene had not been maintained in all areas of the home.

During our inspection carried out on 20 August 2014, we found that necessary improvements had been made and that the regulations in relation to cleanliness and infection control had been met.

Is the service effective?

We saw that the provider had systems in place to assess and reduce the risks of health care associated infection. These included policies and procedures that had been based on current Department of Health guidelines. This meant that people had been protected against the risks associated with health care associated infection.

Is the service caring?

We saw that people had been cared for and supported in a clean, hygienic and well maintained environment that promoted their dignity.

Is the service responsive?

New cleaning schedules had been drawn up and put in place which gave staff clear guidance about roles, responsibilities and the standard of cleanliness required. We spoke with members of staff who demonstrated a good understanding of infection control policies and procedures together with how to achieve and maintain appropriate standards of cleanliness.

Is the service well led?

We saw that the manager had taken steps to ensure that the improvements necessary had been made. We saw that posters reminding staff about their responsibilities had been displayed around the home and that infection control issues had been discussed at staff meetings.

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 03 June 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

During our inspection we saw that people who lived at the home were treated with consideration and respect. Staff provided care and support in a way that promoted people's dignity, privacy and independence.

We looked at the care records relating to four people who lived at the home. These showed that people's individual needs had been assessed, documented and reviewed. They provided staff clear guidance about the care and support that people needed in a way that ensured their health and safety.

During our inspection we walked around the home and found that most areas, including people's bedrooms, corridors, communal lounges and the dining area, were clean and smelt fresh. One person who lived at the home told us, 'They [staff] keep my room beautifully clean.' Another person commented, 'My room and toilet are kept spotlessly clean.'

However, we found that two of the shared bathroom and toilet facilities we checked had not been maintained to the required standards of cleanliness and hygiene. For example, we saw that the toilet bowl in the first floor bathroom was dirty and stained with what appeared to be dried on faecal matter. There were a number of shed body hairs in the bath together with a rubber anti-slip mat that was dirty and badly perished in places.

We saw that people's health and welfare needs had been met by sufficient numbers of appropriate staff. One person who lived at the home told us, 'There are always plenty of staff around and they come very quickly when you call for them.'

Is the service effective?

We looked at care records which showed that people's choices and preferences had been taken into account in the planning and delivery of the care they received.

We saw that risk assessments had been completed and regularly reviewed in relation to a wide range of issues relevant to people's care needs and personal circumstances. These included assessments relating to the management of people's medicines, skin integrity and risks associated with pressure care, nutrition and hydration, mobility and the risk of falls.

Is the service caring?

We observed the lunchtime meal and saw that staff provided appropriate levels of support where necessary to help people to eat and drink in a calm, patient and dignified manner.

Everybody we spoke with told us they were happy at the home and with the levels of support and care they received. One person said, 'I am very happy here and have absolutely nothing to complain about. All of the staff are lovely and look after us very well.'

Is the service responsive?

We saw that people's views, experiences and choices taken into account in the way that care, support and treatment was delivered.

People told us they liked the activity opportunities provided at the home. These had included themed meals and events to celebrate Burn's night, Shrove Tuesday [Pancake Day], St. Patrick's, Valentine's and Mother's Day, Easter and people's birthdays. We saw that staff had arranged cooking and reminiscence activities, crossword quizzes, church services, charity fund raising events, gardening sessions and visits by children from a local primary school.

Is the service well led?

A relative of a person who lived at the home commented, '[Family member] decides what help and support they need. We sit down regularly [with staff] to review the care plans and agree any changes that need to be made.'

During our inspection we saw that people had access to relevant health care professionals where necessary and appropriate. These included community nurses, opticians, chiropodists, GPs and occupational therapists.

Systems had been put in place to assess and monitor the quality of services provided. These included processes to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home. This meant that people had been protected against the risks of inappropriate or unsafe care.

We saw that suitable arrangements had been put in place where necessary to assess people's ability to make decisions in line with published guidance relating to the Mental Capacity Act (MCA) 2005.

We observed that staff treated people with respect and kindness while delivering appropriate levels of care and support. We also saw that care was delivered in a way that met people's individual needs and welfare requirements. A relative said, 'We think it's excellent here and really cannot fault it. The staff are very kind and caring.'

We saw evidence that people were provided with a good choice of food and drink in a way that both encouraged and promoted a healthy balanced diet. One person told us, 'There is a very good choice of food. They [staff] ask us what we want and like. There is plenty of drink available at all times.'

The premises were safe, suitable and fit for purpose. Adequate emergency procedures were in place and the safety equipment we saw had been regularly checked and well maintained.

Records showed that the provider had put recruitment procedures in place to ensure that staff were fit, able and properly trained to meet the needs of people who used the service. This included carrying out appropriate checks before staff began work.

A complaints policy and procedure had been put in place and we saw evidence that people's comments, feedback and suggestions had been regularly sought.