Archived: Westmead - Care Home Physical Disabilities

At the previous comprehensive inspection completed in March 2017 we rated the service as overall requires improvement and issued a warning notice in relation to staff recruitment and a requirement in relation to staffing. Following this the service sent us an action plan showing how they intended to be fully compliant.

We completed a focussed inspection in October 2017 and found the service had met the warning notice and had taken steps to ensure their recruitment processes and policies across the organisation were updated and robust. They also met the requirement in relation to staffing and ensuring there were sufficient staff to meet people’s needs in a timely way.

At this inspection, we found that the improvements to staffing and recruitment had been sustained.

Westmead is a ‘care home’. 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 care home) accommodates up to19 people in one adapted building. People living in the home have complex physical needs and some have learning disabilities.

The care service has not been developed and designed in line with the values that underpin the Registering the Right Support because it is registered for more than six people. However, it does follow best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

Since the last inspection the service had a new registered manager, who had been in post for a few months when we completed this inspection. 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 said they felt safe and well cared for. Two people mentioned the use of agency staff but felt that the continuity of having the same agency staff had helped. Two people mentioned the home had been in a “turmoil” as there had been some tensions between some individuals living there. This had caused “disruption and a tense and difficult atmosphere.” This had been resolved because one person had left the service.

There were sufficient staff with the right skills and understanding of people’s needs and wishes. This meant outcomes for people had improved. People said staff were kind and helpful. Our observations showed staff respected people’s dignity and privacy and worked in a way which showed kindness and compassion.

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's consent to care and treatment was sought. Staff used the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and understood how these applied to their practice.

Care and support was person centred and well planned. Staff had good training and support to do their job safely and effectively. Activities were beginning to be tailored to meet individual’s needs. The use of volunteers had helped to ensure people had regular opportunities to get out and about.

Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People received their medicines safely and on time most of the time. There was a high number of medicine errors. An action place had been developed to ensure staff had further training and to reduce the number of errors. Accidents and incidents were carefully monitored, analysed and reported upon.

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

People enjoyed a wide and varied choice of meals. Mealtimes were relaxed and enjoyable for people.

Quality assurance processes and audits helped to ensure that the quality of care and support as well as the environment was closely monitored. This included seeking the views of people and their relatives.

We completed this focussed inspection on 18 October 2017 to check the service was meeting the warning notice and requirements in relation to recruitment and staffing levels being appropriate and safe for people. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westmead on our website at www.cqc.org.uk.

Westmead is a care home without nursing which is registered to accommodate up to 19 people with physical and learning disabilities. At the time of the inspection there were 16 people living at the service.

There was a manager at Westmead, who had worked for the provider for a number of years and been a registered manager for one of their other services. She was awaiting an interview with CQC to become the registered manager for this service. 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. The provider had informed us that another manager had been recruited who will eventually take over from the current manager. The plan was for there to be an extended handover between the two managers. This would help to ensure the service did not go for a further long period without a registered manager in situ.

People said they felt safe and well cared for. Two people said there were new staff and there had been lots of changes in staffing, but believed their needs were being met in a timely way. One person said they had been trying out more activities including Thai-chi, music sessions and going out more. One person spoke about how much they had enjoyed a recent local event hosted by Westmead called 'Westfest', which was held locally. This was a full day of music, crafts and food and drink open to the public as well as people living at the service.

Staffing rotas showed staffing levels were being maintained at the providers preferred levels. They had introduced a tool to review people’s dependency levels and look at staff hours needed to ensure the assessed needs of people, were being met.

Recruitment practices had been changed to show that potential new staff members were asked to declare if they had any convictions or cautions prior to being offered employment. Recruitment files showed safe recruitment practices were taking place.

Since the last inspection there had been three safeguarding alerts raised. These were discussed with the manager. We saw these had been handled appropriately and people were kept safe by measures put in place. These included adjustments to risk assessments for one person and staff being asked to complete further training in understanding safeguarding processes and when to report issues of concern.

Westmead is registered to provider accommodation and support for up to 19 people with physical disabilities. At the time of the inspection there were 15 people living at the service.

Since the last inspection the registered manager has left this post to take up another post within the same organisation. A new manager had been appointed who was in the process of registering with CQC. He was new to this type of service but had a mentoring and support network set up by the provider.

We found that in recent months there were not always sufficient staff available to meet the needs of people in a timely way, or to ensure their social needs were being fully met. This was because of staff sickness and annual leave. Some people who lived at the service said they were unhappy with the staffing levels and had made their concerns known to the manager. We were assured these issues were being addressed and any gaps in staffing rotas would now be filled with agency staff where possible. We also heard there had been a recruitment drive to ensure there were sufficient staff to cover sickness and leave in the future.

People said they felt safe and were confident staff knew their needs. Relatives were also confident people’s needs were being met and that staff were kind caring and compassionate towards people. Dignity and privacy were respected, although we made one recommendation about ensuring people’s dignity was maintained at all times.

Staff had the right skills training and support to do their job effectively. They understood how to protect people’s human rights, offer choices and ensure people’s preferred routines were honoured. Risks had been fully considered and reviewed on a regular basis to ensure care and support was delivered safely.

Staff understood what may constitute abuse and how and to whom they should report any concerns to. Complaints were investigated and resolved, with actions taken clearly recorded.

Medicines were well managed and kept secure. People received their medicines in a timely way and where errors were noted, staff acted quickly to ensure people were not at risk. People were offered pain relief and received their medicines on time.

People were offered a variety of meals and snacks to ensure good health. Where people were at risk of losing weight due to their health condition, staff monitored what they ate closely. Mealtimes were seen as important social events and staff offered support in a relaxed and unhurried way.

People, visitors and staff were all able to voice any concerns or suggestions to help improve the quality of the service provided at Westmead. Systems were in place to monitor and review the quality of the service, as well as to ensure the environment and equipment was well maintained and safe.

There were two breaches of regulation. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection we spoke with eight people who live at the service, four staff and looked at some key records. These included care plans, daily records, risk assessments, staff training records and minutes of meeting with staff and people living at the home. This helped us better understand how well the home was being run.

People we spoke with told us that in the last 12 months they have felt that there has been more activities and that their views were being listened to. Comments included, ''I feel really positive about living at Westmead. I feel there have been a lot of good things happening such as the Christmas ball, new staff and we are going to have the place redecorated.'' ''I would say things are fantastic. We have more staff, lots of new ones and we are doing more.''

We saw that people were supported in a kind and respectful way. Staff were supported to gain the skills and knowledge required to do their job safely and effectively.

Systems were in place to review the quality of care and this included seeks the views of people living at the home and the staff group who supported them.