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Archived: Westcotes Rest Home Inadequate

Reports


Inspection carried out on 15 October 2018

During a routine inspection

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 in

Inspection carried out on 17 July 2018

During an inspection to make sure that the improvements required had been made

Westcotes Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulated both the premises and the care provided, and both were looked at during this inspection.

Westcotes accommodates 20 older people, some people are living with dementia in one adapted building. At the time of the inspection there were 14 people using the service. The accommodation is provided over three floors with a passenger lift for access.

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.

The inspection was prompted by information of concern received by the Care Quality Commission about the service. This inspection has focused on these areas of concern, which included staff recruitment, medicine management, supplies of food and drink, cleanliness and maintenance of the service.

We found significant shortfalls in the prevention and management of infection control. Systems to identify potential infections risks to people were neither comprehensive or robust. Many soft furnishings within the premises, which included armchairs and carpets, were heavily stained and malodorous. Damage to kitchen cupboards, paintwork, bathing and toileting facilities, which included broken tiles, meant surfaces could not be effectively cleaned.

People’s safety was compromised as information held within their records, which included risk assessments and care plans, contained conflicting information. This meant there was potential for people not to receive consistent and safe care. People’s records had been reviewed, however the review process was not robust as it had failed to identify inconsistencies. Information identifying how people’s safety was to be promoted was not supported by clear guidelines and protocols. This included what action to take in an emergency and the use of medicine that was prescribed to be taken as and when required.

People were supported by staff who had undergone the appropriate checks prior to commencing their employment. There were a number of staff vacancies, which meant existing staff were working additional hours. This had an impact on other services, which included the day to day management of the service and cleaning, as staff employed in these roles were instead providing personal care and support.

The provider did not have systems and processes to assure themselves about the quality of the service being provided. This lack of oversight and ineffective governance meant the premises, fixtures and fittings being in a poor standard of repair.

The provider’s policies, which had been reviewed, contained inaccurate information and were not consistently put into action or followed. This had a direct impact on people using the service, as people lived in a property that was not well maintained, putting them at risk of harm. Opportunities to develop the service were missed as people using the service and family members were not consulted on an annual basis as set out in the provider’s policy. Where people’s views were sought in meetings, there comments had not been acted upon.

People we spoke with and a family member spoke positively about the care and support provided by staff.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Inspection carried out on 22 September 2016

During a routine inspection

This inspection visit took place on 29 September 2016 and was unannounced.

Westcotes Rest Home provides care and accommodation for up to 20 older people. Some of these people are living with dementia. At the time of our inspection there were 13 people using the service. The service is located in Leicester, close to the city centre. The home is located on the main road and accommodation is provided over three floors with a passenger lift for access.

At our last inspection on 10 March 2015 we asked the provider to make improvements to the way they maintained the premises, responded to allegations of abuse, and ensured people’s consent to care and treatment was sought in line with legislation and guidance.

Following that inspection the provider told us about action they were taking to rectify this. At this inspection we found action had been taken to address these breaches.

There is no requirement for a registered manager to be in post at this service as the owner is a sole provider. However the service has a care manager and a deputy manager.

At our last inspection we found the provider had not ensured the premises were being maintained safely and to a good standard of cleanliness. At this inspection visit we found the improvements we asked for had been made, however some areas of the premises were again in need of attention. Some carpets were stained and marked in places, a toilet floor needed replacing, and an easy chair was not fit for purpose. The provider agreed to address these issues.

The atmosphere at the service was friendly and warm. Relationships between staff and the people they supported were good. Staff were patient and understanding and knew how to build relationships of trust with people. They treated people as individuals and took an interest in their lives and families.

People told us they felt safe using the service. They said that when they needed assistance staff provided this. Staff met people’s needs promptly and also had time to talk with them and assist them with activities. Staff knew how to protect people’s well-being and if people were at risk, they knew what to do to minimise this and keep people safe.

Staff ensured people’s consent to care and treatment was always sought in line with legislation and guidance. People and relatives had signed care plans to show they were in agreement with the support provided. People’s lifestyle choices were respected and records made this clear.

Staff had an induction and regular training, supervision and competence checks to enable them to provide effective care. They told us they were satisfied with the training they’d received and used best practice ideas from it to improve the service.

People told us they liked the food served. At lunchtime there was a pleasant sociable atmosphere in the dining room and people seemed to enjoy their food and the company. If people needed assistance to eat their meals staff provided this discreetly. There was a choice of two dishes for each course and people could also have something that wasn’t on the menu if they preferred.

Staff supported people to access healthcare services and receive ongoing healthcare support. They arranged for people to see a GP if they needed to, and provided extra support to help their recovery. They ensured people were referred to healthcare specialists like physiotherapists and dieticians if this was required.

Staff provided people with responsive, personalised care. Care plans were personalised and included the information staff needed of how to meet people’s care and support needs. They also included information on people’s, life histories and their activities, interests, and likes and dislikes which helped staff to engage in conversations with people

During our inspection some people read newspapers and did crosswords. People told us about activities they had taken part in. These included ‘Grow With Me’, an activity where a staff member brought in a Jack Russell puppy each week so

Inspection carried out on 10 March 2015

During a routine inspection

This inspection took place on 10 March 2015 and was unannounced.

Westcotes Rest Home is a residential care home which provides care and support for up to 20 older people who require personal care. Some of these people are living with dementia. At the time of our inspection there were 13 people using the service. One person was at the home for respite care. The service is located in Leicester, close to the city centre. The home is located on the main road and accommodation is provided over three floors.

There was no requirement for a registered manager to be in post at the time of our inspection. There was a manager and deputy manager in post at the service.

People’s consent was not being obtained. We found that current legislation in relation to people’s mental capacity was not being followed. Mental capacity assessments had not always been carried out where needed and no best interest meetings and decisions had been documented. This meant that people’s human rights may not have been protected at the service and that decisions about their care were being made without the legally required processes being in place to ensure the decisions were in their best interests.

We found that improvements were needed in relation to how people’s risks were identified and managed at the service to ensure that people were receiving safe care.

We found infection control issues at the home. Some of the carpets and furniture needed replacing and there were strong, offensive odours in some areas of the home.

People felt safe and staff understood how and when to report any safeguarding concerns. However, some safeguarding incidents had not been reported as required.

Some systems were in place to monitor the quality of the service being delivered. Although audits were being carried out in relation to people’s care plans, these did not always reflect changes to people’s care needs. There were no audits carried out in relation to infection control. However, there were regular checks on the premises and in relation to people’s medication.

There was no programme of activities in place for people using the service and we observed that some people sat for long periods of time with little or nothing to do. One person regularly accessed the local community as they were fairly independent, however, other people told us they would like more opportunities to take part in activities.

We found that nobody under the service was subject to a Deprivation of Liberty Safeguards (DoLS). We discussed this with the deputy manager who said they would review this to consider whether anyone using the service could be considered to require a DoLS.

We found that people’s medication was being managed safely.

Staff told us that they felt supported and we found that staff were trained and supported to delivery care to people using the service. Staff treated people with dignity and respect and understood people’s individual needs.

The service offered a choice of nutritious meals to people and people were adequately supported to eat and drink.

We found that there was a system in place to manage complaints and that there were sufficient numbers of staff to meet people’s needs. Referrals were made to appropriate health care professionals.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 11 October 2013

During an inspection to make sure that the improvements required had been made

We carried out this inspection to check whether the provider had made the required improvements in relation to the premises and the staffing levels at the home. We visited the home and spoke with people who used the service and staff working at the home in order to do this.

We spoke with four members of staff at the home, including the manager. Staff all told us that there were enough of them working at the home. They described being able to meet the needs of people living at the home. The manager in post told us that there were now more hours dedicated to office duties. They said that this meant they were now able to ensure the paperwork was up-to-date.

We observed care being delivered at the home and found that people's needs were being met. One staff member said: "When I'm here there's enough staff." Another care worked told us: "I love it. I absolutely love it. I'd like to have more staff but we all work together. We know exactly what we are doing." None of the staff expressed any concerns about the care being delivered at the home.

We found that people's needs were being met by adequate numbers of staff. We found that the manager now had more hours to dedicate to office duties. We saw that some of the improvements had been made to the premises people were living in. People were no longer at risk from unsafe or unsuitable premises.

Inspection carried out on 5 June 2013

During a routine inspection

At the time of our inspection there were 16 people living at the home. Two of these 16 people were in hospital at the time of our visit. As part of our inspection we spoke with four people who used the service. We also spoke with four members of staff at the service. Following our visit we spoke with two professionals involved with the care being delivered at the home.

People who used the service were all complimentary about the care delivered by staff and they all commented on how much they liked and enjoyed the food at the home. One person told us: "The staff here are wonderful. They are spot on. It's a home from home." Another person said: "The food is excellent." Three of the four people we spoke with told us that staff were very busy and that there was not much to do at the home. Two people told us that they were not able to go out as staff did not have the time to take them.

Staff we spoke with described being very busy on a daily basis. All of the staff we spoke said that, at times, there were not enough staff on duty. We observed this to be the case during out visit.

We found that the building was in need of some repair and that disused furniture and electrical equipment was being stored in both the communal areas of the home and in people's bedrooms. We found that consent to care was being obtained and that people were receiving adequate amounts of food and drink.

Inspection carried out on 5 March 2013

During a routine inspection

At the last inspection five compliance actions had been made to bring the service into compliance. This follow up inspection was check what action had been taken.

We looked at whether the service was now involving people in decisions about their care and treatment. People told us they felt involved and staff always asked them what help they needed. Staff spoken with told us how they ensured they involved people in their care. We also looked at three support plans that were written in a person centred way to ensure that people received the care and treatment in the way they wanted.

At the last inspection concerns had been raised by the lack of involvement and leadership from the provider Mr Les Downing. During this inspection staff confirmed that Mr Downing was a much more visible presence and felt that things had improved as a result. We saw some records that indicated that Mr Downing was in more day to day contact with the manager.

Concerns had been raised at the last inspection at the poor quality monitoring. During this inspection people using the service said they were happy with the care and were asked about it. Staff told us that things had improved since the last inspection. We saw records that indicated that regular monitoring of the service took place and that a robust quality monitoring system had been created.

Inspection carried out on 24 August 2012

During an inspection in response to concerns

People and visitors we spoke with told us that they were happy with the care and support provided at Westcotes Rest Home. They told us that staff were polite and courteous and that the service was relaxed and friendly.

However one set of relatives we spoke to said they were an unhappy with the care provided and were looking for a different home which catered for people with partial sight. They also stated that they'd had concerns about the management of their relatives personal finances. This has been investigated by the police and the allegations were not upheld. No further action will be taken due to a lack of any substantiated evidence.

Some people who used the service said they had been involved in meetings to talk about activities they would like to take part in. They had been asked for their views about the day to day running of the service. We were told that some people had undertaken activities at Westcotes Rest Home and that some people had been shopping for clothing supported by staff. One of the trips that had been talked about was a trip to a local farm park. However, on tyhe day of the the picnic trip to a local farm park that had been planned a few weeks ago only two people chose to go. People said they were too tired or didn't feel like going out. The trip still took place, with staff willing to work additional hours to make sure it could go ahead.

People told us they were encouraged to engage in a range of activities and were given choices. This presented challenges. Not all residents said they wanted to take part in activities or go out on trips.

Some of the people who lived at Westcotes Rest Home said they enjoyed each others company. However, it was noted that one gentleman said he preferred his own company. This was catered for by the staff team. The home was large enough to accommodate a number of separate lounge areas. Two people said they were encouraged to pursue hobbies.

People told us that many staff had looked after them for a number of years and people thought this helped in understanding their needs.

Inspection carried out on 30 January 2012

During an inspection to make sure that the improvements required had been made

We asked people who resided at Westcotes Rest Home for thier views. Comments included: - “a member of staff has promised that they’ll take me to a football match, I haven’t been to a football match for years. They’ve said they’ll take me to a safari park later in the year as I love animals.” “A member of staff sat with me and asked me about by life and what was important to me. They wrote down what I liked and didn’t like including what time I like to get up and go to bed.” “The manager spoke with me about my care asking me how I’d like my care to be provided.”

We found people who used the service had been involved in meetings to talk about activities they would like to take part in and had been asked for there views about the day to day running of the service. We found that people had been undertaking activities at Westcotes Rest Home and that some people had been shopping for clothing supported by staff. People’s comments about the meals and mealtimes had brought about changes.

Inspection carried out on 1 September 2011

During a routine inspection

People we spoke with told us that they were generally satisfied with the care and support they receive but told us that they are sometimes bored and have little to do. People told us that a majority of staff were good but that some could do with being more caring.

Through talking with people and observations we made we found that staff make decisions on behalf of people about the day to day running of the service without consulting with them. Records do not record the views of people who use the service or their relatives however we found some of the care plans we looked at to be signed by them.

People are supported by staff who do not receive regular up to date training and who are not formally supervised.

The service does not have a quality assurance system which has meant that care planning, medication, supervision and training of staff or the involvement of people using the service have not been monitored and therefore significant shortfalls have been identified which has the potential to impact on the quality of care and support people receive whilst in addition have the potential to compromise their rights and the choices they make.