Background to this inspection
Updated
4 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by three inspectors.
Service and service type
Westgate House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three people who used the service and two relatives about their experience of the care provided. We spoke with eight members of staff including the provider, registered manager, nurses and care workers. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included 21 people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
4 March 2022
About the service
Westgate House is a care home that is registered to provide accommodation and personal care for up to 44 older people including people living with dementia. At the time of inspection 31 people were using the service.
People’s experience of using this service and what we found
Safeguarding procedures were not consistently followed. Unexplained injuries were not always investigated, and physical interventions were not always appropriately recorded.
People were put at risk. Records were not consistently completed to evidence people’s needs were met. Not all known risks to people had been assessed or mitigated.
Medicine management required improvement. People did not always receive their medicines as prescribed.
Preventing and controlling infection required further improvement. We found the service appeared cleaner, however best practice and government guidance on preventing the spread of COVID-19 had not always been followed.
Staff did not always receive up to date training to enable them to learn the skills required to support individual people.
Provider oversight of the service was ineffective. Concerns found on inspection had not been identified therefore, no actions had been implemented to reduce the risks.
People were not asked to feedback on the service and staff told us they did not feel involved in the running or improving of the service.
People, staff and relatives knew how to complain. The registered manager understood their responsibilities under the duty of candour.
People were supported by staff who had been safely recruited. We found sufficient numbers of staff on duty during the inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 18 September 2021) and there were three breaches of regulation. At this inspection we found improvements had not been made and the provider was still in breach of regulations.
This service has been in Special Measures since 6 September 2021. During this inspection the provider had not demonstrated that improvements have been made. The service is therefore still rated as inadequate overall and remains in Special Measures.
Why we inspected
We received concerns in relation to records, safeguarding, staff training, risks and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We also undertook this inspection to check whether the Warning Notice we previously served in relation to Regulations 12 (Safe care and treatment), 13 ( Safeguarding service users from abuse and improper treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westgate House on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to risks to people, safeguarding, records, staff training and oversight at this inspection.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.