Westgate House

Westgate House is a care home providing personal and nursing care to 67 people, some living with dementia at the time of the inspection. The service can support up to 80 people.

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

People and relatives told us they felt the home was safe. Staff understood what action to take if they suspected somebody was being harmed or abused. Staff knew how to report accidents and incidents. People had risk assessments to keep them safe from the risks they may face. These were updated as needed and used to inform reviews of people’s care.

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 were supported by enough staff who had been recruited safely. The provider supported people safely with medicines.

The service was clean and odour free and staff followed safe infection control practices. Additional systems and guidance were in place to reduce the risk of infection during the pandemic.

Discussions with the manager and staff showed they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service. The provider had a complaints procedure in place and people and relatives knew how to make a complaint.

People had person centred care plans in place. They were actively involved in their care and contributed to the development of care plans and reviews. People had staff support to access activities in the home and the community. People’s end of life wishes was explored and recorded. People’s communication needs were identified. However, we made a recommendation about exploring communication alternatives for people whose first language is not English.

People and staff told us the management of the service were supportive. Staff told us they felt well supported by the manager. The service had quality assurance processes in place. The service worked well with other organisations to improve people’s experiences.

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. (Report published on 28 March 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 February 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to all the key questions which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

• Westgate House is a care home that provides personal and nursing care for up to 80 people.

• At the time of the inspection it was providing a service to 79 people.

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

People’s experience of using this service:

• People and their relatives could not be reassured that their complaints were investigated in a timely manner.

• The provider did not always follow suitable recruitment procedures to ensure people’s needs were met safely.

• The provider lacked effective quality assurance systems to ensure the quality and safety of the service.

• People were protected against avoidable harm, abuse, neglect and discrimination. The care they received was safe.

• People's risks were assessed and strategies put in place to reduce the risks.

• People's likes, preferences and dislikes were assessed and care packages met people's desired expectations.

• 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 provided positive feedback about the care, staff and management. They said the service was caring, timely, effective and well managed.

• People's care was person-centred. The care was designed to ensure people's independence was encouraged and maintained.

• People and their relatives were involved in the care planning and review of their care.

Rating at last inspection:

• Requires improvement (report published 15 May 2018). This is the third consecutive time the service has been rated Requires Improvement.

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

• We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around the recruitment of fit and proper persons, and complaints. Please see the ‘action we have told the provide to take’ section towards the end of the report.

Follow up:

• The service is required to provide an action plan to us because there were two breaches of the regulations.

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

• We made one recommendation in our inspection report, which we will follow up at our next inspection.

Westgate House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Westgate house provides nursing home care to up to 80 people. At the time of our inspection 79 people were living in the home. The home is divided across three floors. One floor provides specialist dementia nursing care, another provides general nursing care and a third provides nursing care to people with complex nursing needs including tracheostomy care.

There was a registered manager at this service. 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.

Recruitment and selection procedures were not always carried out in line with the provider’s policy and procedure and may have placed people using the service at risk of harm by unsafe recruitment and selection practices.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

Staff told us they received regular supervision and appraisals. However supervision and appraisal records did not always contain sufficient detail to demonstrate what had been discussed. We have made a recommendation about supervision.

The experiences of people who lived at the home were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. Staff had a good understanding of their responsibility with regard to safeguarding adults.

People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans in place to monitor and reduce risks. People had access to relevant health professionals when they needed them. Medicines were stored and administered safely.

Staff undertook training and received one to one supervision to help support them to provide effective care. The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is law protecting people who are unable to make decisions for themselves or whom the state has decided their liberty needs to be deprived in their own best interests.

People told us they liked the food provided and we saw people were able to choose what they ate and drank.

People’s needs were assessed and met in a personalised manner. Care plans were in place which included information about how to meet a person’s individual and assessed needs. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the service had an open and inclusive atmosphere and the registered manager was approachable and accessible. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff and resident meetings.

Westgate house provides nursing home care to up to 80 people. At the time of our inspection 78 people were living in the home. The home is divided across three floors. One floor provides specialist dementia nursing care, another provides general nursing care and a third provides nursing care to people with complex nursing needs including tracheotomy care.

The provider had recently appointed a new home manager who was in the process of becoming registered. 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.

There was variety in the quality and detail of care plans and risk assessments. Although some contained a high level of detail and personalisation, others lacked the detail required to support people in a personalised way and mitigate risks they faced. Risk assessments and care plans in place for people who presented with behaviour which could harm themselves or others did not tell staff how to support people to stay safe. Care plans and risk assessments were reviewed monthly although they were not always updated to reflect changes in people’s circumstances. Some people told us they were involved in the care planning process, but others did not feel they had been involved.

People were supported to take medicines and this was managed in a safe way. However, improvements were required with regard to the storage of refrigerated medicines, covert medicines and the administration of topical creams. People’s health needs, contact with and advice from health professionals were clearly recorded in people’s files.

Staff were knowledgeable about the different types of abuse people living in the home might be vulnerable to and were confident in the action they would take if they suspected people were being abused. Records showed appropriate investigation and response to incidents.

The provider had invested in new furniture and fittings in the home and it was well presented, clean and a welcoming environment. A room that had previously been under-used as a meeting room had been converted into a café room with tea, coffee and cakes available for people and their visitors to access freely.

The home had improved their records regarding deprivation of liberty safeguards and where people had legally appointed decision makers. However, records of consent to care were not clear and staff understanding of the Mental Capacity Act (2005) was limited.

There were enough staff deployed in the service to meet people’s needs. Checks were carried out to ensure that staff did not have criminal histories that would make them unsuitable to work in a care setting. Recruitment records were inconsistent regarding how interviews were conducted and references were not always collected in line with the provider’s policy. Staff received training in order to give them the knowledge required to perform their roles. Staff supervision and appraisal were not taking place in line with the provider’s policy and records of supervisions showed these were task focussed and did not give staff opportunities for development or learning. Staff who worked during the day attended regular meetings about the service, but night staff had not had any staff meetings since our last inspection.

Staff facilitated activities with enthusiasm. However, the purpose and structure of activities was unclear and potentially confusing to people living with dementia. People gave us mixed feedback about the quality and variety of activities on offer at the home.

People gave us mixed feedback about the food in the home. Some people told us the food was good, others complained about a lack of variety in menu options. Some people did not know they could choose to have meals that were not included in the published menu.

People told us staff were kind. We observed staff interacting with people in a caring and sensitive way. People were supported to maintain relationships with their family members and with their religious communities where they wished to do so. The home did not explore people’s sexual identity with them during the care planning process.

The home had recently introduced advanced care planning to support people and their relatives to prepare for end of life care. However, these had not been completed in an appropriate way and had caused some people and relatives distress.

People and their relatives knew how to raise concerns and make complaints. Complaints were investigated and responded to in an appropriate way. Managers completed analysis of complaints to ensure themes were identified and lessons were learnt.

People, staff and relatives spoke highly of the management team who had taken over the running of the service since our last inspection. The management team had taken clear action to improve the quality and safety of the service. There was some anxiety that the improvements achieved might not be sustained.

There were various audits and quality assurance systems in place which had identified and addressed issues with the quality and safety of the service. When issues were identified during the inspection prompt action was taken to address them.

We have made 11 recommendations for the service. These are regarding the administration of covert medicines, the administration of topical medicines, supporting people who present with behaviour which may harm themselves or others, recruitment practice, supervision of staff, engaging staff in organisational change, understanding and application of the MCA, menu planning, end of life care, supporting people who identify as lesbian, gay, bisexual and transgender, and activities.

At the last inspection in June 2015 the service was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as people were at risk due to poor infection control measures at the service. At this inspection we found these issues had been addressed and the service was meeting the requirements of Regulation 15.

Westgate house provides accommodation and nursing care to older people living with dementia and younger people with nursing needs. The service is registered with the Care Quality Commission to provide care for up to 80 people, 79 people were living in the home at the time of our inspection.

The home had a registered manager in post. 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.

People were not always protected from the risk of avoidable harm as risk assessments lacked details required to ensure they were supported safely.

The systems for ensuring the safe management of medicines were not used consistently across the service. The guidelines in place for people who had been prescribed medicines on an ‘as needed’ basis were insufficient and people did not have individual medicines support plans or risk assessments.

People told us, and records confirmed, the service did not always have enough staff on duty to ensure people’s needs were met. Activities staff were used to cover gaps in the rota and this meant people did not always have access to activities. People and their relatives said that activities provided did not meet the needs of people living with dementia, or those who could not leave their bedrooms. We have made a recommendation about activities.

People told us they felt safe, and staff were knowledgeable about safeguarding adults from harm. However, the service was not always raising safeguarding concerns as required.

Staff were recruited in a safe way and received the support and training they required to perform their roles.

Records of consent did not demonstrate that the service was seeking consent in line with legislation and guidance.

People and their relatives gave us mixed feedback about the food provided by the home. The home was working with people, their relatives and the provider’s hospitality team to improve the range of food provided to ensure it met people’s preferences.

People were supported to access healthcare services as required.

People’s care plans were not consistently personalised and it was not clearly recorded that people and their relatives had been involved in writing and reviewing plans of care. Relatives told us that changes were not always made when requested.

The home had a robust policy for complaints and records showed complaints were responded to in line with the policy.

People told us they thought staff were caring, and they were treated with dignity and respect. People were supported to maintain their personal relationships and practice their religions where they wished to do so.

People and their relatives gave us mixed feedback about the openness and availability of the registered manager. Some people found her easily accessible but other people said she was not available to them.

The provider completed regular and robust audits of the quality of care provided. However, the actions in place to address issues identified were not effective, as the same issues were identified repeatedly and during our inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found people's individual needs had been assessed before moving into the home. Care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. Staff had a good understanding of people's needs and people who used the service told us that they were given choices and treated with respect. Care files evidenced that a range of health care professionals were involved in people's care and treatment. Although care plans showed a holistic approach to care, daily records reflected a task based approach and we found little evidence that people's social, emotional and psychological needs were being fulfilled.

Appropriate equipment had been provided for those people who needed it. Equipment that we saw was clean and well maintained but not always stored appropriately.

The home has in place a satisfactory complaints procedure. However when we looked at the complaints records we found the information recorded was not always consistent with the information received by us from people who said they had made a complaint.

Records were not always accessible, accurate and up to date. We were concerned to find some health care records had been completed ahead of the task.

Staff were seen engaging with people that used the service at a level that suited them, including when tasks were being undertaken. We heard some people singing or gently dancing to music whilst others watched or went about doing an activity of their choice. For some people this was sitting on their own or moving freely around the unit. People were encouraged to interact, but were also allowed to be left alone, when this was their choice.

People told us that in general the food was good, one person said 'it is not too bad, a bit disappointing sometimes but there is always a choice.' We observed supper and saw that people were given the support they needed to eat their food in an encouraging and unrushed manner. We noted throughout our two visits that people were offered a variety of drinks and snacks between meals and condiments were available for everyone on the dining tables.

People that used the service told us that they were generally happy living at Westgate House. When people were asked about the care they received, people said that staff were kind and they were happy with their care. We saw that people looked comfortable in their environment and staff responded appropriately to people's needs.