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Westbourne House Nursing Home Requires improvement

We are carrying out a review of quality at Westbourne House Nursing Home. We will publish a report when our review is complete. Find out more about our inspection reports.


Inspection carried out on 23 May 2019

During a routine inspection

About the service:

Westbourne House Nursing Home is a care home which provides personal and nursing care for up to 71 people with a range of medical and mental health needs. The home also provides intermediate care for people who are admitted to the service from the community or from local hospitals. Intermediate care is undertaken via a National Health Service contract to help ease the pressures on the acute health care services in the area. People receiving intermediate care were receiving rehabilitation to support them to return home or to an alternative care setting.

At the time of this inspection the service was mainly caring for people who were using the service on a temporary basis; some of whom only used the service for a very short period after being discharged from hospital. On the first day of this inspection there were eight people living in the service on a permanent basis and 50 people using the service on a temporary basis. On the second day of this inspection, six of the people using the service on a temporary basis had been discharged back to their own homes. There were therefore 52 people using the service when we concluded this inspection.

People’s experience of using this service:

Most people using the service only resided there temporarily whilst they improved their health or regained independent living skills. They had access to a range of health professionals who were based at the service to support the provision of intermediate care. Staff worked alongside these health professionals to help rehabilitate people.

People told us they felt safe. Staff understood how to protect people from abuse and they were confident the manager would act upon any concerns they raised.

There were enough staff deployed to keep people safe, however people and their relatives told us they thought the service was sometimes short staffed, particularly during the night. Staff told us they thought there were enough staff to meet people’s needs.

People’s medicines were not always managed safely. We found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; safe care and treatment.

People told us staff were kind and caring. We observed staff treated people with dignity and respect. Staff knew people well and they provided care and support in accordance with people's preferences. Staff supported people to remain independent.

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 and their relatives said staff appeared to be well-trained and knew what they were doing. Staff told us they were happy with the training they received. They thought it supported them to deliver effective care to people.

People knew how to make a complaint if they had any concerns about the care and support they received. People were provided with information about how to complain if they needed to.

The care plans and risk assessments for people using the service on a temporary basis needed to be more personalised. However, the care records for people using the service on a permanent basis were better quality as staff had had more time to develop them.

The provider and registered manager understood most regulatory requirements however they had not notified the Care Quality Commission of some events they were required to tell us about. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The managers monitored the quality and safety of the service. However, the quality assurance system had not identified all issues we found during this inspection in respect of medicines management and the quality of some care plans. Improvements to the quality assurance system are therefore required.

We received positive feedback about the way the home was run. Staff and health professionals

Inspection carried out on 20 October 2016

During a routine inspection

The inspection took place on 20 October 2016. It was undertaken by two adult social care inspectors and was unannounced. At the last inspection of this service, which was undertaken on 11 November 2013 no breaches of regulation were found.

Westbourne House is registered to provide accommodation for 71 people who require nursing or personal care with a range of medical and mental health needs. It is in the Fir Vale area of Sheffield, close to all local amenities. The service can take people who are living with dementia. At present 29 beds are allocated for the provision of intermediate care for people who are admitted to the service from the community or from local hospitals. This is a provision undertaken via a National Health Service contract which commenced at the service in August 2016. The intermediate care beds have been allocated at the service to help ease the winter pressures on the acute health care services in the area. One unit of 14 beds is located on the ground floor, as well as 15 beds on the first floor of the service. On the ground floor of the service a 20 bedded unit was provided which cared for people living with dementia, there were 17 people living on this unit at the time of our inspection. Rooms on the first floor were used for residential, nursing and intermediate care.

The service has a registered manager. 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.

Staff knew how to protect people from abuse and knew they must report concerns or potential abuse to the management team, local authority or to the Care Quality Commission (CQC). This helped to protect people.

Staffing levels provided on the day of our inspection were adequate to meet people’s needs. Staff understood the risks to people’s wellbeing and knew what action they must take to help minimise risks to people’s wellbeing.

Staff helped people to maintain or increase their independence working alongside health care professionals. This enabled some people to leave the intermediate care beds at the service and go back home or reside in other local care services.

Staff were provided with training in a variety of subjects which was updated periodically to help develop and maintain the staff’s skills. Supervision and appraisal was provided to all staff which helped support them and identify further training or development needs.

People’s nutritional needs were assessed and monitored. Their special dietary needs were provided. Staff encouraged and assisted people to eat and drink, where necessary. Advice was sought from relevant health care professionals to ensure people’s nutritional needs were met.

People were supported by staff to make decisions for themselves. Staff reworded questions or information to help people living with dementia understand what was being said. We saw people chose how to spend their time and gave consent to their care and treatment.

People who used the service were supported to make their own decisions about aspects of their daily lives. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

Activities provided at the service were varied and creative which helped to stimulate people. People were encouraged to maintain their hobbies and interests, where possible.

General maintenance occurred and service contracts were in place to maintain equipment so it remained safe to use.

A complaints policy and procedure was in place. This was explained to people living with dementia or to their relations so they were informed. People’s views were asked for formally through surveys and informally on a daily basis by the staff. Feedback

Inspection carried out on 11 November 2013

During a routine inspection

We found people�s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us they had the choice to do things they wanted and when they wanted to.

People told us that they were happy living at the home and satisfied with the care and support they received. Their comments included,� Lovely staff,� �I�m so happy here,� �Would recommend this place to anyone,� �I can�t fault any of them [staff] I couldn�t be happier,� and �They [staff] are kind, I�m settled here.�

Relatives we spoke with said that they were happy with the care their loved one received. They told us, �We�re very happy with the care, we visit every day and we can go home relaxed knowing he is safe and well cared for� and �He has some special carers [staff] who mean a lot to him.�

At this inspection we saw that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people.

We found that people's needs were identified in care plans. Records showed that people had been involved in the care planning process.

Medication records checked were up to date and medication was stored securely.

The provider had an effective recruitment and selection procedure in place to ensure that staff were appropriately employed.

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had been maintained.

Inspection carried out on 31 January 2013

During a routine inspection

People experienced care delivered in an unhurried and patient manner. We observed staff supporting people to decide whether they wanted any food or a drink. They used communication methods appropriate to the person�s needs and took time to ensure that they communicated with them in a way people appeared to be comfortable with.

People�s files contained documentation showing that they agreed to each care package that had been devised.

Where people needed specific equipment as part of their care delivery, for example to help with their mobility, it was readily available. Where staff were using equipment to help people they did so in a safe and appropriate manner.

Staff were encouraged to identify areas for growth and development, and managers gave meaningful feedback to staff to help them develop their skills.

A thorough investigation was carried out by the provider in response to any complaints they received. We saw that individual responses were sent to complainants when the investigation had been completed.

Inspection carried out on 21 November 2011

During a routine inspection

Some people at Westbourne House have some conditions that mean we had difficulty talking with them. Other people were able to express their views clearly.

Due to people�s communication needs we used a formal method of observation during the site visit. We call this the �Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who use services for a period of up to one hour and recording their experiences at regular intervals. This included people�s mood, and how they interacted with staff members, other people who use services, and the environment.

Throughout the observation we saw all staff treat people with dignity and respect by using a positive, friendly and kind approach. We observed examples of good communication skills by staff that utilised eye contact and touch to engage people who use services. For example, one person who was sitting quietly regularly had their hand held while the carer talked to them and assisted them to have a drink.

We were able to talk to a number of people who use the service at this home, including relatives. Generally people told us they were very happy with their care and felt staff were friendly and supportive. We were told how the people�s rooms and the home are kept very clean and the majority were very happy with the food they received.

We spoke with 6 relatives who were visiting the home and they confirmed that they were very satisfied with the care provided. One told us "We have no worries or concerns about the home and think it's good in every aspect." And another confirmed that "Our mother's quality of life is much better here than it was before she came to live in the home."

One relative said �This a wonderful and a very special home, the care is excellent and we couldn�t wish for better.�

A visiting health care professional said that they visited regularly and said �The care is very good here.�

We spoke with Sheffield Local Authority, Contracting, Commissioning and Safeguarding and they told us that they had not identified any concerns at the home.

Reports under our old system of regulation (including those from before CQC was created)