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.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since our last inspection of the service the provider had made improvements in their culture around safety, and we saw evidence that safety at the service was now based on openness and honesty. Staff listened to concerns about safety and the registered manager investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager had encouraged staff to be open and honest when incidents occurred, and processes had been developed to improve shared learning. Records showed safety events were effectively reported and reflected upon to drive improvements. This included submitting notifications to CQC, where required. Team meetings were held regularly, and minutes were shared with staff. One staff member told us, “We have team meetings where we discuss updates, concerns and learning from incidents.” Another staff member told us, “Management will discuss incidents with us about what happened and what we can do better next time.”

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.

Families were involved in planning and felt they were kept informed of any updates. One relative told us, “We were involved in their (person using the service) care plan at the beginning and in small changes as we moved forward.” Visiting professionals confirmed the provider worked with them effectively when making referrals and escalating concerns. One professional said, “If the hospital hasn’t referred to us on discharge, Westmorland Court are proactive about putting a referral in.”

We found one person’s health condition which had been identified in their pre-admission assessment, had not been included in the person’s care plan. However, when we informed the registered manager about this, the care plan was updated straight away.

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.

People told us they felt safe. One person said, “I have never felt unsafe in the home. The staff are always here.” Another told us, “The staff are the people who keep me safe. I would be lost without them.”

Staff had a clear understanding of their responsibilities to keep people safe. Staff had received safeguarding training and understood how to identify and report abuse. When we asked about reporting safety concerns, one staff member told us, “I can tell the clinical lead and if I see that no action is being taken, I escalate to the [registered] manager, I can call [the local authority] safeguarding [team] and CQC.”

Where people needed to be deprived of their liberty to keep them safe, the manager had applied for a Deprivation of Liberty Safeguards (DoLS) through the local authority. One person’s DoLS application had not been updated with their more recent restrictions, however the registered manager took immediate steps to rectify this during the inspection.

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.

Systems in place to ensure people’s risks were managed were not always effective. For example, risk assessments in relation to people’s constipation, diabetes and asthma did not include enough information to guide staff in how to manage those health risks.

For one person assessed as needing support with diabetes, their risk assessment did not detail their blood glucose levels or the symptoms associated with hypo or hyperglycaemia. As a result, staff did not have clear guidance to provide consistent, safe support. This placed this person at risk of harm.

People’s continence needs were not always managed effectively. For one person, their assessed risk of constipation was not reflected in their records, bowel movements were not always monitored, and their care plan did not include known behaviours that indicated constipation. There were also inconsistencies in how staff recorded bowel movements for other people, which meant we could not be assured their continence needs were being monitored and supported effectively.

Oral health care plans and assessments were not always effective. Some of these records did not set out how people’s oral health should be managed, how people accessed routine checkups or who staff should refer to if dental concerns arose.

One person’s behaviour care plan described behaviour that communicates a need, persistent wandering and heightened frustration. However, there was no associated risk assessment in place, which meant staff did not have clear guidance on how to manage these risks.

The epilepsy care plans we reviewed were detailed and provided staff with clear guidance on how to manage risks associated with people’s epilepsy.

We observed staff moving and handling people safely.

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.

Procedures in place to ensure the environment was safe were not always effective. For example, we found unlocked doors leading to rooms containing hazardous chemicals and sharp objects. We also found environmental safety issues such as trip hazards.

Some areas of the décor were worn, including ripped wallpaper. The registered manager took immediate action to mitigate environmental safety risks during the inspection and began arranging improvements to the décor with the provider.

Improvements had been made to fire safety procedures since the last inspection.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff had received the required training for their role. Staff told us they felt they had received enough training to care for people safely. There was now a dependency tool in place which enabled the provider to assess effectively how many staff were needed and how they should be deployed. Staff were receiving regular supervision and told us they felt supported by the management team. However, where staff fed back concerns, it was not always clear what action had been taken as a result.

Most people said there were enough staff available and that staff responded promptly when help was needed. However, one person told us they sometimes waited a little longer at night for support, although they said this did not affect how safe they felt.

Staff had been recruited safely and staff that had been recruited from overseas had the correct documentation in place.

We observed staff interacting with people with kindness and compassion and staff were responsive to people’s needs.

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.

Before our inspection, the provider had identified a recent infection outbreak and had taken appropriate measures to control its spread. The premises and equipment were clean, and staff had clear roles and responsibilities around infection control.

Staff had access to personal protective equipment (PPE) and understood how to prevent the spread of infection. The environment was clean and smelt pleasant. One person told us, “My room is clean and looked after by the staff.”

On the day of inspection we found the provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

We saw one person was prescribed a medicine to be given at a specific time, the records showed the medicine was not always administered at the correct time. This meant they were at risk of experiencing symptoms the medicine was prescribed to treat.

Care plans to support staff to safely care for people with on-going health conditions did not always contain person centred information and lacked detail. This meant there was a risk staff would not be able to safely care for people and identify when their health was declining.

When people were prescribed a medicine to be given ‘when required’ there was not always information available to support staff to know when to give the medicine. In addition, when people were prescribed a medicine with a variable dose, for example an option to give 1 or 2 tablets, there was not always information to support staff to know which dose to give. Therefore, people might not get their medicines when they needed them or at the most appropriate dose.

When people had their fluid thickened, due to the risk of choking, the records did not show the fluids had been thickened to the correct consistency. This placed the person at increased risk of choking.

When people were prescribed topical preparations, such as medicated patches, they were not always applied in line with the manufacturer’s instructions, this meant the person was at risk of experiencing side effects. The storage of topical preparations, such as creams, had not been assessed to ensure this was safe, and the fire risk associated with paraffin-based creams had not been assessed for each person. This was discussed with the registered manager, who took action to address these concerns.

The service was completing medicine related audits; however, they had not been effective in identifying all of the issues found during this inspection.