West View

West View is a residential care home providing personal care to up to 28 people. The service provides support to older people. At the time of our inspection there were 25 people using the service.

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

Quality assurance and governance systems in place to assess, monitor, and improve the quality and safety of the services provided had failed to identify the issues we found during this inspection.

People were placed at risk of unsafe care as their care needs and associated risks had not been routinely assessed, updated and monitored. Records and checks in place had failed to identify when people had lost weight, had not received sufficient to drink or were not having their diabetes monitored effectively.

Risks associated with the environment were not always managed safely as some routine safety checks of the environment were not always being completed.

Medicines management was not always safe as medicines were not always stored appropriately, guidance for staff was not always in place and some liquids and creams were not dated when they were opened. However, we found people were receiving their medicines as prescribed for them and when they needed them.

People were not supported to have maximum choice and control of their lives and 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. Mental capacity assessments and best interests decisions had not always been completed for some restrictions.

People and their relatives spoke positively about the service and told us they felt safe and were happy with the support they received. People described staff as “lovely”, “Staff are wonderful” and “I’m looked after very well.”

People were cared for by enough staff to meet their needs and staff were recruited safely.

Systems and processes were in place to protect people from the risk of infections and people were supported to receive visitors when they wanted.

Staff were provided with an induction and training relevant to the needs of people living at the service. However, there were gaps in the staffs' training and staff supervision that had been identified and action was being taken to address this.

People told us they enjoyed the meals on offer and choices were available. There was a calm atmosphere during mealtimes with staff respectfully asking people if they needed support before intervening.

People and relatives told us staff responded appropriately to their health needs and staff worked closely with health professionals to ensure people received the support they needed.

People and their relatives were engaged and involved in the service and asked for their feedback.

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 good. (published 31 August 2017)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for West View Inspection report 27 July 2017 on our website at www.cqc.org.uk.

Enforcement and recommendations

We identified breaches of regulation regarding protecting people from risk, application of the Mental Capacity Act 2005 and good governance.

Please 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 will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were clear processes in place to ensure visitors to the service were prevented from catching and spreading infection.

Visitors were asked to consent to a rapid COVID-19 test, have their temperature checked, wear personal protective equipment (PPE) and wash their hands before they were allowed into the service.

Family visits had been restricted during the national lockdown, unless there were exceptional circumstances. For example, if a person was receiving end of life care or their mental health had been impacted.

To facilitate safe visiting once national restrictions had been lifted, the provider had created a visiting area which had its own access and could be screened off with a Perspex screen. Staff also helped people keep in touch with their family with social media and phone calls.

Sufficient stocks of PPE was available and was appropriately stored, used and disposed of. Staff were observed wearing PPE in line with Government guidance.

Staff checked their temperature, changed into their uniform and applied their PPE before starting work to minimise the spread of infection.

Signage within the home reminded staff to maintain good infection control practices. Staff compliance with infection prevention and control procedures was monitored through supervision and observed practice.

The service took part in regular COVID-19 'whole home' testing. Tests were carried out three times weekly as a minimum for staff, and every 28 days for people. Staff knew what action to take if they or people, received a positive test result.

Staff had undertaken additional training in infection prevention and control, hand washing and how to safely put on and take off PPE.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches, and we saw this taking place during our inspection.

COVID-19 policies, procedures and risk assessments had been developed, reviewed and updated where necessary in line with the latest guidance.

At the last inspection in June 2015 the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

The service continued to provide safe care to people. One person commented: “The staff keep us safe.” Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

The service was caring and people had built strong relationships with each other and staff. People engaged in a wide variety of activities and spent time in the local community going to specific places of interest.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received and made continuous improvements in response to their findings.

One relative we spoke with said 'there is no smell of urine here, it is very clean and I can't praise the home enough'. Another relative said 'it is a clean environment'.

People we spoke with told us that they had been able to bring their own possessions with them when they moved to West View. One person said 'I was able to bring my own furniture into my room; that was nice too'.

A member of staff said 'I have supervision every three months, the manager checks how I am feeling and if I am happy with my work. I feel well supported; I am really happy here. It is a good home and we are very lucky".

We were informed of the completion of an audit of person centred practice within the home. The assistant manager told us 'this has been a good process for learning'.

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

People we spoke with who lived at the home said that their care and welfare needs were being well met. Comments included: 'It's like the Ritz here with hugs and kisses'; 'Nothing is ever too much trouble'; 'My needs are met' and 'When I need support the staff are always there to assist me.' Visiting relatives commented, 'It is wonderful here, so homely. The staff are nice and can never do enough to help people.'

Medicines were safely administered. We saw the medication recording records which were appropriately signed by staff when administering a person's medication.

We spent time talking to people who lived at West View and on occasions visiting relatives. Comments included: 'The staff are lovely, so helpful' and 'The staff are fantastic.' We observed that staff were well organised, motivated and competent in their roles.

People were made aware of the complaints system. This was provided in a format that met their needs.