Archived: Westbury House Nursing Home

Updated 29 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory function. These inspections checked whether the provider was 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.

We carried out this focused inspection on a number of key areas in response to concerns raised at previous inspections in March and April 2016.

This inspection took place on the 31 May and 6 June and was unannounced. The inspection was conducted by two adult social care inspectors on both days.

Before our inspections we looked at previous inspection reports and notifications received by the Care Quality Commission. A notification is information about important events which the service is required to send us by law. We also reviewed the provider’s action plans to ensure that they had taken the action they had detailed as completed.

We also spoke with a health and social care professional regarding the care delivery at the home.

During the inspection we spoke with three people, the provider, the provider’s Clinical Lead who was responsible for nursing care decisions, a member of agency staff, a regular member of care staff, the receptionist and a visiting GP. We also looked at seven care plans and associated daily care notes. During the inspection we spent time observing staff interactions with people as they moved around the home. On the 6 June 2016 we spoke with the receptionist, two nurses, the provider’s financial controller, a relative and two staff.

Updated 29 July 2016

We undertook an unannounced focused inspection of Westbury House Nursing Home on 31 May and 6 June 2016 as a result of concerns raised during previous inspections in March and April 2016. We inspected the service against three of the five questions we ask about services: is the service Safe, Effective and Well led. This inspection was completed as we had increasing concerns regarding the care provided to people living at the home. These included concerns regarding the lack of appropriate reporting of incidents which had posed a significant threat to people’s health and wellbeing and risk assessments not being appropriately detailed to manage risks to people’s safety. Concerns also included insufficient staffing levels to be able to meet people’s need safely and staff not being in receipt of the most up to date and appropriate training to be able to meet people’s individual needs. We were also concerned that the home was not appropriately well led by a visible registered manager.

We carried out an unannounced comprehensive inspection of this service on 22, 23 March and 4 April 2016 where eight regulatory breaches were identified. Following these inspections the provider wrote to us to say what they would do to meet these legal requirements. During the inspections we checked whether the provider had completed their action plan to address the concerns we had found. The provider had made inadequate improvements to address the original concerns; and at these inspections additional concerns were also raised. At this inspection we found that the provider continued to be in breach of Regulations and had not made necessary improvements to ensure people’s safety and welfare.

As a result of our inspection on 31 May 2016 we wrote a letter to the provider to highlight our concerns and to request written confirmation that sufficient numbers of suitably trained staff would be deployed to ensure people’s safety by 2 June 2016. The provider met and spoke with the Care Quality Commission (CQC) on 2 June 2016. Following this meeting the provider submitted a staffing plan on 3 June 2016 showing the staffing levels which would be deployed in order to meet people’s needs safely.

We revisited the home on 6 June where it was identified that our concerns had not been appropriately addressed. We were not assured that people were receiving safe and effective care from sufficient numbers of suitably trained staff. As a result action was taken by the CQC to ensure people’s safety, health and welfare.

Westbury House Nursing Home provided accommodation and nursing care for up to 35 older people who had physical disabilities and neurological related diseases and disorders. These included Huntingdon’s disease and acquired brain injuries as a result of illness or accident. This also included people who required care on a short term basis referred to as ‘respite’ care. At the time of our inspection 31 people were using the service.

Westbury House is a large four storey period building set in expansive grounds on the outskirts of West Meon. West Meon is a small village situated between the towns of Winchester and Petersfield in Hampshire. The house comprised of two units where both residential and nursing care was provided. A wing of the house separated by a locked door was used as living accommodation for those with the most complex behavioural needs for their own and other people’s safety.

This report will refer to the two units collectively as ‘the home’ throughout this report unless individually specified.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At previous inspections in March and April 2016 we had identified that the registered manager was regularly absent from the service. They were not in day to day control of the service providing consistent managerial support for staff. During our inspections in May and June 2016 neither the provider or the registered manager were present at the home.

Our inspection of 21 and 22 March and 4 April found a number of breaches of the Health and Social Care Act 2008 and associated regulations.

These breaches were across a number of regulatory areas. Safeguarding concerns were not appropriately reported or investigated therefore external agencies could not assure themselves that appropriate action was being taken to address the identified concerns. People’s risk assessments were not completed fully or identified as necessary where required to ensure staff knew how to give safe care. There were insufficient numbers of suitably qualified and experienced staff deployed to meet people’s needs. Communication between people using the service and staff was not always clear due to a lack of English language known and English language skills training provided to staff from non-English speaking countries. Recruitment procedures were not robust and did not fully and accurately determine that people were suitable for their role of providing safe care. People were at risk of infection due to insufficient cleaning practices and Medicines were not always appropriately secured placing people at risk of accessing medicines not prescribed to them.

People at risk of weight loss had not been appropriately identified and steps taken to ensure they were appropriately referred to healthcare professionals so the reason for this weight loss could be addressed. The provider had not complied with the requirements of the Mental Capacity Act 2005 (MCA). There was a lack of documented processes to identify when someone should be receiving care in their best interests. Staff had not received specialist training in areas such as Huntingdon’s disease and motor neurone disease to be able to effectively meet the needs of the people they were supporting. People were not always involved in their care planning therefore care was not always provided in the way people wanted or needed.

The registered manager had not appropriately recorded notifications to the CQC advising us of serious incidents and allegations as part of their regulatory function to enable us to monitor the safety of the service. There were no regular checks or a system of quality monitoring in place to ensure that improvements could be made to the quality of the service provided to people.

As a result of the concerns identified on 8 April 2016 we wrote an urgent letter to the provider advising them they would no longer be able to admit or readmit people to Westbury House without our prior consent. This was to ensure that we could check that appropriate care planning and support documentation was in place prior to people’s moving into the home.

Prior to our inspection on 28 May 2016 the local authority supported Westbury House by providing three additional members of staff to support the current staff working at the home. This included one nurse and two members of care staff for both the day and the night shift. This was to ensure that there were sufficient numbers of staff to meet people’s needs.

During our inspection on 31 May we focused our attention on a number of people who had been identified at risk of not receiving safe and effective care and treatment. As a result a number of concerns were identified.

Despite our letter to the provider on 8 April stating that they were not able to provide care to people without our prior authority one person had been readmitted to Westbury House on three separate occasions without CQC written permission. Another person had also been admitted since 8 April again without CQC written permission. This was in direct breach of our Notice of Decision to restrict admissions.

During our inspection on 31 May we could not see that people were being supported to maintain their independence. One person we had previously identified on 4 April as not being supported to leave the home to visit friends when requested were still not having their needs met. This person expressed their desire to leave the home however we could not see that provisions had been made to support them with their choice to leave the home.

There was insufficient equipment available to meet people’s needs safely. Those who required additional support with their moving and handling needs which required the provision of equipment had not always had their needs met.

We could not see that people had always consented to receive care from Westbury House Nursing Home. Not all the people living at the home had provided written consent to live at the home. No action had been taken to identify whether or not their placement at the home was as a result of a best interest decision when people were unable to make their own decisions.

People who were losing weight had not received appropriate referrals to healthcare professionals to ensure their needs in relation to their weight loss were appropriately assessed. No specific guidance had been provided to staff on how to make sure that people’s nutritional and hydration needs were being met.

The provider did not ensure that people who were at risk of dehydration had effective care plans in place which provided the appropriate guidance to staff as to how much fluid a person should be consuming in a day to ensure their on-going health and welfare.

People living with diabetes and at risk of suffering hyperglycaemic or hypoglycaemic episodes did not have their conditions managed effectively. This led to people being at risk of suffering a diabetic coma which if untreated could lead to a serious deterioration in a person’s health eventually resulting in death.

Staff were not always provided with sufficient guidance to maintain and support people’s health and wellbeing nee