Westmorland Court Nursing and Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Requires improvement. At this assessment the rating has remained Requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment and the ways people’s medicines were managed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Although the provider had systems in place to record and monitor people’s behaviours, where required, behaviour charts were not always completed effectively by staff. For example, when a person presented with distressed behaviours and was given as and when medication to support them, staff did not record what de-escalation strategies were used before administering this medication. This meant staff could not learn from the incident in order to better support the person in future.

When the inspection team informed the provider about this, they told their staff about the importance of accurately documenting all incidents and de-escalation strategies before giving as and when medicines. The provider had already identified a need for staff to attend appropriate training which had been scheduled prior to the assessment.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. For example, where one person required specialist support with managing their continence care, the provider liaised with the relevant health partners to ensure the person accessed the care they needed.

People felt safe. One relative told us, “‘My [person] was falling a lot at home, and this appears to have stopped. There have been some falls, but the staff do their best to keep them safe.” Another relative told us, “I believe that outside agencies would be brought in to help my [person] if needed.”

One professional told us, “Staff are very good at contacting me via email or by telephone if they have any concerns.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider investigated safeguarding incidents and shared concerns quickly and appropriately with the relevant authorities. Staff had received safeguarding training and knew how to identify and report abuse. One staff member told us, “If there is a safeguarding concern, I report it to a manager and record what has happened. I am confident the manager will deal with it.”

Where people needed to be deprived of their liberty to keep them safe, the provider ensured a deprivation of liberty safeguard (DoLS) was applied for through the relevant local authority.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Where a person required support with managing a health risk, staff had not considered whether they required their as and when medication as part of managing this, or whether to escalate to healthcare partners for support. The person’s care plan did not guide staff how to escalate concerns when needed. This meant the person was at risk of harm.

Where 1 person required support with their falls risks, their risk assessment included inconsistent information about how the person could request support from staff. This meant the person was at risk of not having their care needs met safely.

When the inspection team informed the provider about this, they reviewed the person’s care and ensured their care plans included consistent information and guidance for staff about how to escalate concerns.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider’s risk assessment had identified actions to be completed to reduce risk in the event of a fire, but these had not been done in line with requirements.

We observed exposed copper piping under a communal bathroom sink which was hot to touch. This meant people were at risk from scalds and burns.

When the inspection team informed the provider about these concerns, they put a plan in place straight away to ensure they were remedied as soon as practicable.

When the inspection team informed the provider about issues with a fire door and 2 unsecured rooms containing environmental hazards, they ensured they were remedied straight away.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

Although staff felt they had received the training required to undertake their roles safely, they gave mixed feedback about how they were able to meet people’s needs. One staff member told us, “They [the management team] give us additional training if needed to help us to do our jobs. I have a supervision frequently and we discuss any issues in the care home, how we can improve and achievements.” Another staff member told us, “If I am honest, I do not feel there is enough staff. The residents we have need a lot of care, and we need enough time to encourage and reassure people.” Another staff member told us, “We always need more staff because of the structure of the building.”

The registered manager did not use a dependency tool to calculate the number of staff they needed. This meant they could not reliably evidence how they made decisions about staff levels.During our assessment, we observed how staff deployment affected the support of 2 people who required additional support with their nutritional intake. They did not receive their breakfast until late morning as staff were supporting other people. When the inspection team informed the provider about these concerns, they reviewed their staff allocation for the mornings to ensure people with nutritional needs received their required support in a timely manner. The provider also put a plan in place to begin using a staff dependency tool.

However, staff were safely recruited and received ongoing support. New staff were subject to pre-employmentchecks such as reviewing their education and employment history, references from previous employers and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. Team meetings, one-to-one meetings and daily handovers were in place, to support staff to provide safe care to people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

During our assessment, the provider identified an infection outbreak and took appropriate infection control measures and informed the relevant external health partners.

Staff were provided with personal protective equipment (PPE) and were observed wearing and removing this appropriately. One staff member told us, “We are never short of PPE. I know how to don and doff and dispose of correctly.”

There were handwashing facilities throughout the building and staff also had access to hand gel. There were clear instructions above every sink on how to wash hands properly.

Legionella assessments were carried out in line with requirements and remedial action was taken where required.

However, during our assessment we observed damage to the décor throughout the building which could make thorough cleaning difficult and pose an infection control risk. When the inspection team informed the provider about these concerns, they put a plan in place to fit protective plates to lower door frames and improve the décor.

Medicines were not always given in line with the manufacturer’s directions, for example before or after food. This meant the medicine might not work properly and placed the service user at risk of experiencing side effects.

When people had their medicines covertly, hidden in food or drink, there was not always information to support staff to give the medicines safely.

When people were prescribed a topical preparation for a set period of time, it was not stopped or reviewed to determine if it was still needed. This placed people’s skin integrity at risk.

When people were prescribed medicated patches, the site of application was not always recorded to support staff to rotate the patch in line with the manufacturer’s directions. This meant people might experience skin irritation. We also found some people’s patches could not be located when they were due to be removed, this meant they might have experienced unnecessary pain. Following the assessment, the service provided information to show they were checking the patch is in place each day.

When people were prescribed ‘when required’ medicines, there was not always person-centred information to support staff to know when to administer medicines. In addition, when people were prescribed a variable dose for example 1 or 2 tablets, there was not always information to support staff to know which dose to give. This meant there was a risk people might not get their medicines when they needed them, or at the most appropriate dose.

The medicines audits completed by the service were not always effective in identifying medicines related issues, so there was a risk improvements would not be made.