Westcliff Lodge Limited

We found the following examples of good practice:

Arrangements were in place for relatives to visit their family member in accordance with government guidance. Suitable measures were in place to screen all visitors and this included completion of a questionnaire, temperature checks, the wearing of Personal Protective Equipment [PPE] and rapid flow testing to keep infection risks to a minimum.

People were admitted into the service safely. People’s COVID-19 status was sought prior to admittance and people self-isolated in line with current government guidance.

Arrangements to assess current and emerging risks presented by the pandemic had been identified for staff and people using the service.

Appropriate infection prevention control practices were observed for staff, such as the wearing of masks, gloves, aprons and included good hygiene practices.

Most staff had received training on infection prevention and the correct use of PPE and specific training relating to COVID-19.

Cleaning schedules were in place and being followed. The environment was visibly clean and odour free.

Westcliff Lodge is a residential care home that provides personal and nursing care for up to 22 older people aged 65 and over. At the time of the inspection there were 22 people living at the service.

People’s experience of using this service:

Not all risks for people were allayed for their safety and wellbeing as these were not consistently identified or addressed quickly enough. The service does not always follow relevant national guidelines relating to medicines.

Not all care records fully reflected or accurately detailed people’s care and support needs. People received inconsistent opportunities to participate in social activities.

Quality assurance arrangements were not as robust as they should be. Improvements were required to ensure these arrangements were effective to monitor performance, risk and quality.

Staff knew how to keep people safe from harm and people told us they were safe. The registered provider had a system in place to recruit staff to ensure people would be supported safely. There were enough staff to meet people’s care and support needs in a timely manner. People were protected by the registered provider’s infection control practices and procedures.

Staff had the skills and knowledge to support people how they wanted. People received enough to eat and drink throughout the day. People were supported to access healthcare services and receive ongoing healthcare support as needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received care from staff who were kind and caring; and their comments about the care they received was positive. People’s dignity and privacy was respected, and their independence promoted and encouraged according to their capabilities and abilities.

The registered provider had a complaint process which people were aware of to share any concerns. People told us they felt confident to raise issues.

We have made recommendations about risk and medicines management. We have made further recommendations about care planning and social activities.

Rating at last inspection:

Following the last inspection, the rating of the service was ‘Requires Improvement’ (Last report published March 2018). This service has been rated ‘Requires Improvement’ at the last two inspections.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. If any concerning information is received, we may inspect sooner. A meeting will be arranged to meet with the registered provider and manager.

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

Westcliff Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal 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. The care home accommodates up to 22 older people and people living with dementia in one adapted building. At the time of the inspection, there were 20 people living at Westcliff Lodge.

Westcliff Lodge is a large detached house situated in a quiet residential area in Westcliff on Sea and close to all amenities. The premises is set out on two floors and each person has their own individual bedroom and adequate communal facilities are available for people to make use of within the service.

At the last inspection on the 10 and 11 November 2015, the service was rated ‘Good’. At this inspection, we found the service was rated ‘Requires Improvement’. This is the first time the service has been rated ‘Requires Improvement’.

Our key findings across all the areas we inspected were as follows:

An effective robust system was not in place to assess and monitor the quality of the service.

Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements.

Some aspects of medicines management required further development. Not all risks to people were identified and improvements were required to record how these were to be mitigated to ensure people’s safety and wellbeing. Improvements were required to ensure that people’s care plans reflected all of their care and support needs and how the care was to be delivered by staff. People received limited opportunities to participate in meaningful social activities throughout the day.

Training for staff was not as up-to-date as it should be. Specifically improvements were needed to ensure staff received appropriate training relating to medication, moving and handling, and to ensure this was embedded in their everyday practice. Staff recruitment practices required strengthening as these were not robust or in line with regulatory requirements. ‘In-house’ inductions were not always completed at the earliest opportunity and not all staff had received a robust induction.

The deployment of staff was not always appropriate and staffing levels not always maintained. There was no systematic approach linking people’s dependency needs to staffing levels.

People’s capacity to make day-to-day decisions had been considered and assessed. Staff demonstrated an understanding and knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act (MCA) 2005. The Care Quality Commission had been notified where [DoLS] had been authorised by the Local Authority.

People were protected from abuse and avoidable harm and people living at the service had no concerns about their safety and wellbeing. Staff described the registered manager and management team as supportive and approachable. Arrangements were in place for staff to receive formal supervision at regular intervals and an annual appraisal.

People received sufficient food and drink throughout the day and the dining experience was positive. People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required. Staff had a good relationship with the people they supported. People were treated with dignity and supported to maintain their independence where appropriate.

The cleanliness of the service was maintained to a good standard and people had access to comfortable communal facilities and their bedrooms were personalised.

We have made recommendations about the management of risk and care planning and, linking people’s dependency needs to staffing levels.

You can see what action we told the provider to take at the back of the full version of the report.

Our observations indicated that people living at the service were happy, that they felt safe and were well cared for. Comments included, "It's absolutely fine here and I have no concerns whatsoever" and, "It is lovely here." It was evident that people who used the service had a good relationship and rapport with the staff who supported them.

People's health and personal care needs were assessed and there were detailed care plans in place for care staff to follow so as to ensure that people were supported safely and in accordance with people's individual preferences and wishes. Staff spoken with demonstrated a good understanding of people's health and personal care needs and how each person wished to be supported.

The provider was able to demonstrate that a robust staff recruitment policy and procedure was in place and followed to ensure that people living at the service were kept safe. We found that previous identified shortfalls relating to staff induction, staff supervision and quality assurance had been addressed. Minor concerns relating to the management of medicines were identified as part of this inspection. The manager provided an assurance that corrective actions would be undertaken to address the issues.

Further improvements are required to ensure that medication practices and procedures are developed so as to ensure positive outcomes for people. In addition improvements are required to ensure that all newly employed staff undertake a comprehensive induction in a timely manner and all staff receive regular supervision. Effective quality assurance may assist the provider in recognising where there are gaps and areas for devlopement.