Archived: Westcotes Rest Home

Updated 5 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was carried out, in part to identify what improvements had been made following the Care Quality Commission (CQC) previous inspection of July 2018.

This inspection was also carried out to respond to information from a number of departments within the local authority (Leicester City) who had shared with us their concerns, following their auditing and inspection visits of Westcotes Rest Home.

The inspection was carried out by two inspectors and an Expert by Experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The inspection site visit took place on 15 and 16 October and 1 November 2018.

We looked at the information held about the provider and the service including statutory notifications and enquiries relating to the service. Statutory notifications include information about important events which the provider is required to send us. We used this information to help us plan this inspection.

We spoke with six people and spent time with others who used the service. We spoke with the manager and a senior carer.

We looked at the care plans and records of five people. We looked at a selection of medicine records. We looked at the minutes of meetings for staff. We looked at records which sought people’s views about the service. We viewed records in relation to the maintenance of the environment and equipment along with quality monitoring audits.

Updated 5 January 2019

Westcotes Rest Home is a care home. People in care homes receive accommodation and nursing or person 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.

Westcotes rest home can accommodate up to 20 people in one adapted building. At the time of the inspection 14 people, some people of whom were living with dementia were in residence. The accommodation is provided over three floors with a passenger lift for access.

This inspection took place on 15 October 2018 and was unannounced. We returned announced on 16 October 2018 and unannounced on 1 November 2018.

There is no requirement for a registered manager to be in post at this service as the owner is a sole provider. The provider has the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous inspection of 17 and 18 July 2018, we issued the provider with a warning notice. The warning notice detailed the failings of the provider with regards to Regulation 17. Good governance, of the Health and Social Care Act Regulated Activities Regulation 2014. We set a compliance date for 17 September 2018.

In addition, the previous inspection of 17 and 18 July 2018, identified 2 further breaches. Regulation 15 Premises and equipment and Regulation 12. Safe care and treatment. We asked the provider to complete an action plan to show what they would do and by when to improve the key question. Is the service safe to at least good. The provider did not submit an action plan.

We found minimal improvements had been made.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months.

The expectations is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social service 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 no longer rated as inadequate for any of the five key questions it will no longer be in specialist measures.

The provider did not have systems and processes in place to assure themselves of people’s safety with regards to their health, care and welfare. Potential risks to people were not effectively assessed and accidents and incidents were not considered when reviewing people’s safety. This placed people at continued risk. People were at risk as medicine administration processes were not robust. The monitoring of people’s health, safety and welfare following a medicine incident were not consistently carried out.

People’s safety was compromised as personal emergency evacuation plans were not reviewed and in some cases contained conflicting information. The fire risk assessment for the service had not been reviewed since it was initially completed. A lack of systems in place to respond to a fire placed people at risk of harm.

People resided in a service which was not well-maintained both internally and externally. We found external repairs were required and significant improvements were needed to provide people with an outdoor space, which was both safe and pleasant for them to spend their time. Internally we found bathing and shower facilities did not meet the needs of people with mobility difficulties as the current facilities were not accessible.

People were supported by sufficient staff to meet their personal care needs; however, staff were task focused, which included cooking and cleaning.

Information as to the training staff had received had not until recently been collated. There was no system by which the provider could identify what training staff had attended and when or where the training had elapsed to ensure staff had up to date training reflective of good practice. Staff were not supervised through one to one supervision meetings or group supervisions, for example team meetings.

We found people were supported to make decisions and to have control over their lives, however people’s capacity to make informed decisions had not been assessed. We found people, or their relatives had not been provided with an opportunity to be involved in the development of care plans in order that their views and expectations about their care be taken into consideration.

Potential risks of people not eating or drinking sufficiently were not robustly assessed. Systems to assess risk were flawed and not understood by staff undertaking the assessment. Where potential risks had been noted, we found people’s care plans and daily notes did not provide clear guidance as to the role of staff in meeting people’s nutritional needs. People we spoke with were complimentary about the meals provided.

People’s views had been sought about activities they wished to take part in. However, none of the ideas suggested by people had been acted upon. A visiting theatre had performed a show at the service, other activities were dependent upon staff’s availability or the ability of people to occupy themselves.

The leadership or the service was not effective. This directly impacted on the quality of support and care people received and meant they did not experience the best possible health and quality of life outcomes.

The provider did not have systems and processes to assure themselves as to the quality of the service being provided. This lack of oversight as to the quality of the service and the services governance meant shortfalls and areas for development and improvement had not been identified and this placed people at risk of harm.

Policies and procedures did not reflect current good practice guidance or legislation.

Poor record keeping and communication meant people’s safety, health and welfare were compromised as information was not always recorded or communicated amongst the staff team to ensure people’s needs were met. Records were not stored safely to ensure confidentiality. Records were not routinely reviewed or analysed to identify trends or themes to improve the quality of life outcomes for people.

A number of external stakeholders had identified improvements were required in a number of areas, which had resulted in the developing of action plans to bring about improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.