We carried out a review of the data available to us about Westbury Grange on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Westbury Grange, you can give feedback on this service.
Westbury Grange is a residential care home that can provide personal care for up to 45 people some of whom have dementia care and nursing needs. At the time of the inspection, 44 people were living at the service.
People’s experience of using this service
People continued to receive safe care, and staff we spoke with understood safeguarding procedures and how to raise concerns.
Detailed risk assessments were in place to manage risks within people’s lives, and staff we spoke with felt safe supporting people with a wide range of needs.
Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.
Medicines were stored and administered safely, and people we spoke with were happy with the support they received in this area.
Staffing support matched the level of assessed needs within the service during our inspection, and staff were trained to support people effectively. All staff felt well supervised and confident in their roles.
People told us they enjoyed the food prepared for them, and food and fluid intake were monitored as required. Support was given to people to eat in communal areas or within their own rooms.
Healthcare needs were met, and people had access to health professionals as required. Care plans outlined any support people required to manage their healthcare needs.
People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives. Staff treated people with kindness, dignity and respect and spent time getting to know them. People were supported in the least restrictive way possible.
Care plans reflected peoples’ likes, dislikes and preferences. An activities programme was in place, and people were engaged with by staff.
People and their family were involved in their own care planning as much as possible, and a complaints system was in place and used effectively.
The manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required. Audits of the service were detailed and any issues found were addressed promptly. The service had a registered manager in place, and staff felt well supported by them.
Rating at last inspection
Good (report published 13 April 2017)
Why we inspected
This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At the last inspection, the service was rated Good.
At this inspection we found the service remained Good.
People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.
People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.
There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed. Staff received an induction process and ongoing training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions.
Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.
People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.
People were enabled 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 were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. Drinks and snacks were available throughout the day.
People were supported to access a variety of health professional when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.
Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.
People’s privacy and dignity was maintained at all times.
People were supported to follow their interests and join in activities.
People knew how to complain. There was a complaints procedure in place which was accessible to all. Complaints had been responded to appropriately.
Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.
Further information is in the detailed findings below
The inspection took place on 2 March 2015 and was unannounced.
Westbury Grange provides care for up to 45 people who have advanced dementia or other conditions that require nursing care. On the day of our inspection there were 45 people using the service.
There was a registered manager. 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.
People felt safe living at the service. It was evident from talking with staff that they were aware of what they considered to be abuse and how to report this.
Staff knew how to use risk assessments to keep people safe alongside supporting them to be as independent as possible.
There were sufficient staff, with the correct skill mix, on duty to support people with their needs.
Recruitment processes were robust. New staff had undertaken the provider’s induction programme and training to allow them to support people confidently.
Medicines were stored, administered and handled safely.
Staff were knowledgeable about the needs of individual people they supported. People were supported to make choices around their care and daily lives.
Staff had attended a variety of training to ensure they were able to provide care based on current practice when assisting people.
Staff always gained consent before supporting people.
There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff knew how to use them to protect people who were unable to make decisions for themselves.
People were able to make choices about the food and drink they had, and staff gave support when required. Catering staff knew who required a special diet and this was taken into account.
People had access to a variety of health care professionals if required to make sure they received on-going treatment and care.
People were treated with kindness and compassion by the staff, and spent time with them on activities of their choice.
People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon.
Staff treated people with dignity and respect.
There was a complaints procedure in place.
People were complimentary about the registered manager and staff. It was obvious from our observations that staff, people who used the service and the registered manager had good relationships.
We saw that effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvements.
This is a summary of what we found-
Is the service safe?
We found that the home had sufficient numbers of staff, based upon the dependency levels of the people who lived at Westbury Grange. We were told that the home also had access to volunteers who came in and spent time with people, providing additional support to both staff and people.
People who lived at the home told us they felt safe. They said that staff were kind and friendly towards them and delivered the care and support they needed. One person said, 'I am protected here, I know that I am looked after.' We saw people were treated with respect and dignity by staff. A person told us, 'The care is really very good, I am always spoken to in a nice way and the staff really understand what I need.' Another person said, 'I always feel safe with the staff that look after me.'
We found that the service had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). These policies provided staff with information about how to support people who lacked capacity to consent to decisions about their care and treatment. The manager was aware of the need to make a referral if it was felt a decision relating to DOLS needed to be made.
Is the service effective?
People's care needs had been assessed prior to their admission, to determine their needs and make sure the service could meet them effectively. We saw from information detailed within care files that people had been involved in decisions about how their care was delivered.
We saw that arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate. We found that reviews were up to date and included people and their relatives, where appropriate.
We observed that people were able to make choices about food and drinks and received a good selection of both. One person said, 'The food here is lovely, I always have enough to eat. It's great.'
Is the service caring?
We observed that staff were very attentive to people's needs throughout our inspection. Staff engaged positively with people and gave people time to respond. We found staff showed patience and respect when communicating with people who lived at Westbury Grange.
People we spoke with were positive about the care provided and the staff. Records indicated that people had choices as to when they could get up and eat and we saw that when people did not want food or medication, that staff would attempt to provide this later, in a calm and supportive manner.
People told us they enjoyed the range of activities offered within the home and we observed that people were encouraged to join in, either on a group or individual basis. People expressed their enjoyment and we observed that people were laughing and joking with staff.
Is the service responsive?
Records confirmed that people had access to a GP, who regularly visited the home to treat people and respond to health concerns. We found that people were also able to access help and support from other health professionals such as dentists, physiotherapists and dieticians.
One person was in pain during our inspection and we found that this was reported to the nurse in charge and timely action taken to address this.
People were supported to participate in activities both inside and outside of the service. On the notice boards we found evidence of the regular newsletter that was produced. This told both people and relatives of the activities planned and those that had taken place. We saw numerous photographs of people enjoying activities, displayed around the home.
Is the service well led?
During our last inspection we found improvements were needed in medication processes and systems. We found that improvements had been undertaken and that all previous issues had been addressed.
The home had a registered manager in post who was supported by a deputy and a range of other staff, who ensured that a robust structure was in place to manage the home effectively and safely.
We saw evidence of robust quality assurance processes in place, including regular audits. We found that quality monitoring questionnaires were used and this meant that people had been asked for their views about the care and services provided.
We found concerns with the management of medication and the handling of complaints.
We found that equipment was safe and adequately maintained and people were happy living there.
We saw that staff were attentive and responsive to people's individual needs and involved people in conversation and activities. We observed that staff treated people with respect, and spoke to people politely. We saw that staff assisted people to make informed decisions about aspects of their daily lives.
We spoke with two people during our visit, both people told us that they were comfortable and felt safe living at Westbury Grange. They also told us that they thought the staff were very good and that they were well looked after; one person said 'the staff are very dedicated'.
We spoke with two visiting relatives they told us that they were confident that their relative was well looked after by the staff at Westbury Grange. They said 'We can't praise the staff enough, they are kind, patient and they always keep us informed about our relative's well being'.
We were told that the main meal was now in the evening and lunch was a light meal. The feedback we received about this was positive.
People told us their rooms were kept clean and tidy. One person said 'someone comes to my room every day to clean it. They have a good chat with me. '
A visiting relative told us 'it's nice that the home is always hygienic and never smells unpleasant.'
People told us that they liked the staff and felt they were kind and treated them well.
Two visiting relatives told us they had visited the home with their relative, which included staying for lunch, before they made a decision to move in.
People who use the service and visiting relatives told us that they were given opportunities to express their views about the service. This was through regular talks with the manager and by completing surveys sent out by the organisation.
We were told that staff treat people with dignity and their privacy was always respected. One person said they like to go to bed and have a sleep in the afternoon and they were supported to go to their room if they wanted to.
People told us that they were able to make decisions about their day to day life. A visiting relative told us that they had been involved in discussions about the use of bed sides to reduce the risk of falling from the bed. One person whose relative had recently passed away at the home told us that the care received by their relative was excellent. They told us that staff were respectful of the families wishes to remain in the home with their relative and staff were always welcoming and provided support to the family which made the experience easier.
People told us they were happy with the food provided, they were always offered a choice of meal and there was always plenty of food. People were positive about the medical and other care they received and one person confirmed recent treatment with the dentist and that they had recently seen their doctor. People we spoke to said the home was always clean and tidy. One relative told us that the home had a nice open feel and there were never any offensive odours. They told us that their relative liked to spend a lot of time in their room and staff made sure it was always tidy and clean. One person told us that the move into the home had been made easier because they had been able to bring some of their own furniture with them. They said staff had been very kind in making sure their photographs had been put up on the wall of their room.
Two relatives told us that staff were often rushed and there appeared to be a shortage of staff at the busiest hours of the day. One person said that there was often a delay in waiting for staff to attend to their relative's personal care.