Archived: Westfield Care Home

Westfield Care Home is registered to accommodate up to 45 older people in one building. Some of these people were living with dementia. At the time of the inspection, 12 people were using the service.

Two registered managers were present during the inspection. 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.

During the home’s previous inspection on 26 January 2017, we rated the home overall as ‘Requires Improvement’ although the service was rated as Good for the questions, ‘Is the service effective, caring and well-led?’ During this inspection, we found improvements had been made and the overall rating has now improved to Good.

The home was clean and tidy. However, the provider was currently working towards making required improvements to ensure it met the local clinical commissioning group’s infection control standards. People’s medicines were managed safely however, protocols for the consistent administration of as needed medicines were not always in place. The risks to people’s safety had been assessed and care plans were in place to support people safely. Some risk assessments would benefit from more personalised information to ensure they were always specific to people’s individual needs. People were protected against the risks of experiencing avoidable harm. Staff could identify the potential signs of abuse and knew who to report any concerns to. People were supported by an appropriate number of staff to keep them safe. Accidents and incidents were regularly reviewed, assessed and investigated by the registered manager.

People’s physical, mental health and social needs were assessed and provided in line with current legislation and best practice guidelines. People were supported by trained staff who had their performance regularly assessed. Staff felt supported by the registered manager. People spoke positively about the food. The risks in relation to people’s nutrition and diet had been assessed and appropriate action taken. The registered manager had built effective relationships with external health and social care organisations and people’s health was regularly monitored. The environment had been adapted to ensure people who had mental or physical disabilities were able to lead fulfilling lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People enjoyed living at the home and felt the staff treated them with dignity, respect and were kind and caring. Staff listened to what people had to say and they had formed positive relationships with people. Staff were knowledgeable about their needs and people were involved with making decisions about their care. People’s diverse needs were respected. People were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates.

People’s care records were detailed and person centred. Some records required reviewing to ensure they were reflective of people’s current health needs. People felt their personal preferences and choices were respected. People were treated equally, without discrimination and systems were in place to support people who had communication needs. People were encouraged to take part in group activities and the provider had plans in place to provide more individualised activities for people. People felt able to make a complaint and were confident it would be dealt with appropriately. End of life care was not currently provided, however, systems were in place to support people with this if they needed it.

People felt able to give their views about the service. Relatives had been asked for their views and responded positively about the home. Staff felt valued and able to give their views about the how the service could develop and improved. The registered manager was keen to develop their role and skills. They were supported by the provider in doing so. Quality assurance processes were in place to assist the registered manager with monitoring the home and the quality of the service people received.

On the day of our inspection there was a registered manager in place. 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.

The majority of the home was clean and tidy. However we did identify some areas that could pose a risk to the spread of infection, for example some chairs were worn and required cleaning. The home was secure although we did note the room to the sluice was unlocked. Staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were assessed and reviewed. There were enough staff to keep people safe during the inspection although some people felt more staff may be needed to enable them to get the support they needed. People’s medicines were managed appropriately and safely.

People were supported by staff who completed an induction prior to commencing their role. They had the skills and training needed and their performance regularly reviewed to enable them to support people effectively. The principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had been followed when decisions were made about people’s care. People were supported to maintain good health in relation to their food and drink. People’s day to day health needs were met by staff with referrals to relevant health services were made where needed.

Staff were kind and caring and on the whole treated people with respect and dignity. People’s privacy and dignity were maintained. People were involved with decisions made about their care and day to day support needs. Where able, people were encouraged to do things for themselves. People were provided with information about how they could access independent advocates. People’s friends and relatives were able to visit whenever they wanted to.

People and relatives felt activities were lacking in the home. People’s care records contained guidance for staff on how to support them with their day to day care and support needs. These records were regularly reviewed. People were provided with the information they needed if they wished to make a complaint.

People were encouraged to provide feedback about the quality of the service and this information was used to make improvements where identified. Quality assurance processes were in place to ensure people and others were safe in the home. People spoke positively about the registered manager but felt they could be more visible throughout the home. The registered manager understood their role and responsibilities and was keen to make improvements at the home.

During the inspection we spoke with a relative of a person who used the service, two registered managers, a nurse, cook and two care assistants. We reviewed, in detail, the care plan records of one person who used the service as well as their and four other people's bathing records logs. We observed staff interaction with people throughout the home. At the time of the inspection there were twenty two people using the service.

During the inspection we focused on these five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe and secure.

A relative we spoke with told us, “Apart from the issues I have raised, I am sure my family member is safe.” The issues raised by this relative can be found in the main part of the report.

Is the service effective?

We reviewed the records and care received regarding one person who used the service. The care provided was not always effective. On the advice of the district nurse in March 2013 this person remained in their room for the majority of the day with little interaction with other people. The relative of the person raised concerns that this could have a detrimental effect on their family member’s mental state.

Bathing log records, which recorded how often a person had received a bath, showed long periods of time where people had not received one. Records showed one person had not received a bath for over two months with no explanation why. ‘Body washes’ were given to people who did not receive a bath.

Is the service caring?

We observed staff interact with people in a caring manner. They treated people with respect and were patient in their approach.

Is the service responsive?

We observed staff respond to people’s day to day needs in a timely manner. However a hearing aid lost by a person in March 2014 had not been replaced. The registered manager told us they had tried to obtain a replacement hearing aid for this person; however the person’s care plan records did not reflect this. Therefore this person’s needs were not responded to in a timely manner.

Is the service well-led?

The registered manager acknowledged records were not always accurately completed to reflect the care and support people received

During the inspection we focused on these five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Care plan records contained information and guidance for staff that enabled them to provide care and support that met people’s needs and kept people safe. People who used the service appeared well presented and during observations with staff seemed happy with the level of care and support they received.

A person who used the service told us, “I do feel safe living here; I’ve never had any problems. I feel happy.” A relative we spoke with told us, “The staff seem very nice; they take care of my mum well. They seem to know what they are doing; I’ve never had any concerns when watching them help people, like using hoists for example.”

Staff spoken with were aware who to report allegations of abuse to, both internally and externally. The registered manager had effective safeguarding reporting procedures in place. They were aware of their responsibility to ensure that all allegations were appropriately reported to the relevant authorities.

Appropriate checks had been made before staff commenced work at the home. References, criminality and qualification checks had been completed. Staff received on-going training and development and were supported to complete external qualifications relevant to their role.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. While no applications had needed to be submitted at the time of the inspection, proper policies and procedures were in place. The registered manager could explain the procedure for submitting an application, should one be required. Staff had received training on DOLS but some of the staff’s knowledge was limited. This could result in people being unintentionally deprived of their liberty.

Is the service effective?

In the care plans we looked at we saw attempts had been made to ensure that where people did not have the capacity to consent to decisions, mental capacity assessments had been conducted. However, they were not always completed where required.

We saw the provider had made and overall assessment on people’s ‘mental ability’, but the language used to describe people’s ability, and the process used to come to that decision, was not clear. For example in one care plan we looked at it stated a person, ‘Has capacity to make some decisions’. No examples were given as to which decisions a person could or could not make, which could cause confusion for staff when providing care.

Staff spoken with had a good knowledge of people’s needs. They could explain the care and support each person who used the service required and how they ensured the support was effective. We observed an activity where staff members were offering to assist people with having their nails done. Staff were friendly and sensitive in their approach and did not force people to engage with the activity if they did not wish to.

Care plan records showed people’s needs were assessed and reviewed. Where appropriate, external professionals such as chiropodist and dieticians had been consulted to offer guidance in order to ensure people were given the right care and support that met their specific need.

Is the service caring?

We observed staff throughout the day interact with people during activities, serving lunch and in administering medication. Staff were friendly and caring in their approach. People who used the service appeared happy with the care staff and one person was observed saying to a care assistant, “I don’t know what I would do without you, you are wonderful.”

A care assistant we spoke with told us, “I absolutely love my job, I love being able to help people and put a smile on people’s faces. It makes my day when I’m able to do something that helps them.”

A person who used the service told us, “The staff are brilliant, I feel comfortable going to them if I need to.”

Is the service responsive?

We saw staff responded to people’s needs throughout the inspection. We saw people being assisted to the toilet and to the dining room. People were not left to wait for long periods for staff to respond to requests for assistance. Call bells were responded to in a timely manner.

We looked at records which confirmed that people’s interests, beliefs and needs had been recorded. Staff were aware of people’s individual needs and could explain how they adapted their approach to respond to people in a caring and effective way.

Is the service well-led?

The registered manager showed us plans they intended to put in place which would regularly monitor the quality of the service provided and whether people’s needs were being appropriately met. We saw some reviews of documentation and staff performance were undertaken. However, there was limited documented evidence that any of these auditing procedures had been implemented and were operating effectively. There did not appear to be a consistent approach to reviewing any aspect of the service provided.

Care plan records in places lacked detail and at times were contradictory. For example in one care plan it was stated that a person, ‘Does not walk’, yet on another document it stated that they were ‘fully mobile’. The registered manager told us they had difficulty in managing the amount of work required to effectively manage all aspects of the home. This included the regular reviewing of the quality of the care plans. They told us they were planning to delegate roles and responsibilities to other members of staff where appropriate.

People’s views were welcomed and relative questionnaires had been issued. However there was no procedure in place to ensure that all relatives had received a copy of the questionnaire and no deadline was given for its return. This meant it was difficult to analyse any of the results received and difficult to use the results to drive improvement in the home. However staff, people who used the service and the relative we spoke with all told us the registered manager was an approachable person who welcomed people’s opinions and tried to act on them.

One staff member we spoke with told us, “I find the manager very approachable, I get on well with her and can talk to her about anything.”

A person who used the service told us, “The manager is nice; the home seems to work well.”

We saw evidence that people experienced care and support that met their needs and protected their rights. One person who used the service told us, 'The staff are very helpful, they do much more than they need to.' A relative we spoke with told us, 'The care seems pretty good, the staff seem friendly and they really try."

We saw that staff were trained for their role and we observed them assisting people who used the service in a friendly and knowledgeable way. A person who used the service told us, 'The care meets my needs; there is nothing I find lacking.' A relative of a person who used the service told us, 'Staff seem very well qualified for their role.' A member of staff we spoke with told us, 'I feel well trained.'

We saw that records relevant to the management of the service were stored securely and were accurate and up to date.

We found the provider had complied with the actions we set.