Archived: OSJCT Westbury Court

OSJCT Westbury Court is a residential care home providing personal and nursing care to 42 people aged 65 and over. At the time of the inspection 34 people were receiving care and support in one adapted building.

People had their own bedrooms and there were ample shared facilities; lounge and dining areas, bathrooms and toilets. Outside, people could enjoy the use of an enclosed garden.

People’s experience of using this service and what we found

People had benefitted from the work the registered manager and provider had completed, since the last inspection. This had led to improvements in people’s care experiences at OSJCT Westbury Court.

There had been some changes to the staff who provided support and leadership. Senior staff were clear about their roles and responsibilities. They had the skills and knowledge to provide other staff with the support they required. The working culture had changed, staff were committed to working as one team to support people’s wellbeing. People’s welfare and wellbeing had remained staffs’ priority, but staffs’ ability to provide more person-centred care to people had improved.

Changes in ways of working and communicating with external healthcare professionals meant staff were in a better position to support people’s health needs and get these needs promptly discussed and reviewed. Although the service needed a replacement activities co-ordinator, staff were taking turns in supporting people to enjoy a mix of social activities.

People told us they felt safe and cared for. Managers ensured there were enough staff with the appropriate skills to meet people’s needs. Staff worked in collaboration with external agencies to safeguard people from abuse and discrimination. People received the support they required to take their medicines. Arrangements were in place to keep the environment safe, clean and reduce risks of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. People who lacked mental capacity were protected because the principles of the Mental Capacity Act 2005 were adhered to.

People’s needs were assessed and risks to their health, safety and welfare identified and action taken to reduce or remove these risks altogether. There were daily arrangements in place to support effective communication, amongst all staff, about changes in people’s care and risks which they needed to be aware of. Care records were well maintained to ensure staff and visiting professionals had up to date information about people’s needs and risks, so these could be appropriately managed.

People and their representatives were involved in planning their care. Where appropriate, family members were consulted and kept well informed about people’s care and progress.

People’s preferences and personal choices were known to staff who supported these where it was safe to do so. People’s dining experience had improved, and people told us they had a choice in what they ate and drank. People’s differing communication needs were understood by the staff who took time to ensure people could express their views and be included in decisions about their care. People’s dignity and privacy was upheld. Staff applied a balance in how they supported people’s independence and their safety.

The provider had a complaints process in place. Complaints and concerns were managed well and resolved where at all possible to do so. Managers were visible and approachable, and people, relatives and staff felt able to talk with them when they needed to. Learning was taken from complaints and general feedback to improve the service.

Both the provider and registered manager had good systems in place to monitor the services and care provided to people. The provider supported the registered manager in ensuring the service remained compliant with necessary regulations and in line with their own standards and expectations. Plans were in place to make continuous improvements to the service and progress relating to these was monitored. Extensive refurbishment to the home was due to take place in 2020, aimed at improving people’s comfort and the facilities available to people.

Staff worked in collaboration with individuals and groups in the community so that people’s quality of life and social opportunities could be improved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 22 February 2019). At this inspection the rating improved to Good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Westbury Court is a care home, which provides personal or nursing care and accommodation, to a maximum of 42 people. At the time of the inspection 39 people were receiving care. People who received this care were predominantly aged 65 and over; some people lived with dementia, or with a learning disability or a specific physical disability.

People’s experience of using this service:

Following our last inspection in October 2016 the service had gone through several management changes. This meant the quality assurance systems were not always effective and consistently implemented and monitored and the service had not sustained their previous ‘Good’ rating. A new management team had been in post for three months. Prior to our inspection the provider had completed a comprehensive quality audit and identified shortfalls. A new management team had been in post for three months. Actions for improvement taken by this team and had already made significant improvements to people’s experiences and their quality of life.

Time was needed for further improvements to be fully completed, embedded and sustained. For example, personalisation of care and social activities, areas of staff communication and for care plan content to always remain updated and fully reflective of people’s care needs and preferences. Therefore, at this inspection we rated the service ‘Requires Improvement’ overall.

Everyone we spoke with told us they felt safe. People’s health needs were managed appropriately. Improved working relationships with other health care professionals meant people received their medicines as prescribed and they had access to timely health support. People received support to maintain their nutritional well-being and risks to people were assessed and managed effectively.

Some people and staff had moved to Westbury Court from another care home, which had closed. Therefore, people and staff were still developing new relationships with those they had not previously known or worked with. The management team were aware of the challenges merging of the services would present and had a clear action plan in place to manage this effectively.

People’s right to make their own decisions was supported. People were supported to make decisions for themselves. People who were assessed as lacking mental capacity to make safe decisions were protected from care or decisions which were not in their best interests.

The provider’s quality monitoring processes were in place to monitor the service provided to people. The provider was supporting the registered manager’s program of change and improvement. The registered manager had a clear vision of the standard of care they wanted delivered. They were supported by skilled and experienced senior staff who were also committed to the success of the improvement program. These staff were providing team building support and the leadership staff needed to work as one whole team for benefit of those who lived in the home.

Rating at last inspection:

The service’s rating at the last inspection in July 2016 was Good.

Why we inspected:

Our inspection on 3, 4 and 7 January 2019 was a scheduled inspection based on the previous rating.

Follow up:

We will monitor all intelligence received about the service to inform us of the service’s progress and of any risks, and to help us plan the next inspection accordingly.

Westbury Court provides care predominantly to older people. A maximum of 42 people can be accommodated but at the inspection 34 people were living in the care home. Accommodation was provided on two floors and a passenger lift gave access to the second level. Each person had their own bedroom with washing facilities and some had private toilet facilities. There were plenty of additional communal bathrooms and toilets. People were provided with areas to sit and a separate dining area. Communal areas were comfortable and varied in size with televisions and music systems. One communal room had been fitted with memorabilia and furniture from past years. This room was used as a quiet area to sit and for people who found the objects familiar and reassuring. A sheltered and safe garden provided outside space which could be enjoyed during the good weather. The care home provided the equipment people needed to be safely looked after and to promote independence.

The current registered manager had been in position since September 2015. They had started just after our last inspection had been completed. 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.

Risks to people’s health and welfare were identified and managed. There were arrangements in place to help prevent people experiencing harm or abuse. There were enough suitable staff to meet people’s needs. Staff had received training and support to be able to meet people’s needs safely and effectively. People’s medical needs were met and their medicines reviewed and administered safely. People received help to eat and drink and any nutritional risks were managed well. People were supported to make decisions and their choices and preferences were met by the staff whenever this was practicable to do. People who found this difficult to do, because of a lack of mental capacity, were supported and protected under the appropriate legislation. Any decision making carried out on behalf of a person was done in the person’s best interests.

People and their representatives were involved with the planning of their care and had opportunities to review plans of care with the staff. People’s recorded care plans were followed by the staff and records of care were accurately maintained. There were arrangements in place for people to join in social activities, either on a one to one basis or in small groups. Regular outside entertainment was booked for people to enjoy. People’s family and friends were able to visit at any time and their involvement encouraged and valued. People and visitors to the care home were able to raise a complaint or dissatisfaction and have this acknowledged, investigated and addressed. Complaints and any errors made by staff were viewed as opportunities of learning and a chance to look at how improvements could be further made.

How the care home was managed had changed significantly over the last year. The registered manager and her management team provided strong leadership. A consistent message had been delivered in relation to what their visions, values and expectations were. The staff culture had altered and a team approach was now in place with all staff understanding their roles and responsibilities. Where there were remaining pockets of resistance to the new way of working this had been, and remained being managed, fairly and in a supportive way. The registered manager however, had made it clear about what would not be tolerated and additional action was taken where needed to address on-going resistance.

People we spoke with and their representatives had noticed the changes and spoke about these positively. Staff members were also positive about the service’s future and were committed to an improved future.

The care files we looked at all contained the life story for each person who used the service. This gave staff valuable information about the person's life experiences. We saw that care plans were in place and these had been reviewed on a regular basis. The care plans were person centred meaning they reflected people's individual needs. The provider had systems in place to monitor the nutritional status of people who used the service to prevent risks of malnutrition. Systems were also in place for the safe administration of medicines.

We spoke to three people who used the service. All three people were very complimentary about the home, staff and the care they received. The comments we received included 'I am well looked after, everyone takes great care of me'.

One person told us 'its really nice here, friendly environment and staff'. Another person told us 'they look after me very well here, I'm very happy'.

Both staff and people who used the service reported a lack of staffing. However, we found this was being addressed by the manager and we saw no evidence that showed people's care was being adversely effected whilst further recruitment had taken place.