Westvale House

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

Governance processes were not always effective in the monitoring of the service. Auditing tools were in place however, they had failed to identify some of the concerns we found during this inspection.

There were systems in place to record and analyse incidents. However, they were not always effectively investigated.

A safeguarding policy was in place and staff we spoke with understood their role within the safeguarding process and had received adequate training. People told us they felt safe.

Good practice regarding the safe administration of medicine was not always being followed. The oversight of medicine was not robust enough to ensure people were safely given their medicines.

The deployment of staff within the home was not always appropriate, we observed people being left for long periods of time without their assessed level of support.

The provider has recently recruited new members of staff and there has been a change in roles for some existing staff members, this appears to be having a positive impact on the home. Staff and people living at the service commented management were being supportive and things improving.

The management sought people’s feedback through meetings to gain a better understanding of what people wanted.

We observed positive interactions between staff and people who lived at the service. Staff knew the people they supported well.

The registered manager was receptive to feedback during the inspection and took some immediate steps to address some of the concerns raised.

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 Good (published 13 December 2018). The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection. We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

We undertook a focused inspection to review the key questions of Safe and Well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westvale on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the safe administration of medication, the risks of the health and safety of the people living at this service and good governance. We made recommendations in relation to the deployment of staff.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

We were assured the provider, management and staff at the home had taken appropriate action to help minimise the spread of any infection and help ensure people were safe during the COVID-19 pandemic.

Effective use was made of available COVID-19 testing for both people living at the home and staff members. Staff were also tested staff using rapid testing twice a week in addition to the weekly testing programme. This meant that most staff members were tested three times each week. Staff members were checked for symptoms at the start of each shift including the testing of their temperature. People living at the home were checked for the main symptoms of COVID-19, including their temperature, twice each day.

How the building was being used had changed to help prevent the spread of any infection. One conservatory area was being used as a testing zone for staff; staff could access the conservatory from outside to prevent the need to walk through the main building. There was also a separate designated staff entrance, which led to an area where staff could change and apply sanitiser gel and personal protective equipment (PPE) before coming into the main building. Staff were cohorted and assigned to work on one floor and each floor now had a separate staff room.

People coming to live at the home were supported to do so safely. This involved a period of supporting people to stay in their room and using additional PPE when interacting with them. Each person’s room had en suite bathroom facilities which reduced the need for people to share facilities.

Senior staff ensured that there was always a good supply of PPE and hand gel at convenient locations throughout the home. All staff had received training in infection prevention and control (IPC). The home was kept clean by a housekeeping team who had received additional time and resources to help them keep the home as clean as possible. The laundry team ran a safe and effective service for people living at the home.

Visiting within the main building was restricted. There was a purpose built, heated visiting pod in the grounds of the building that people’s friends and family could book for a socially distanced visit. Staff arranged for the visiting pod to be cleaned between each visit. Staff told us that this had been popular with visitors.

There was wi-fi and internet access available throughout the home and people had been supported to make video and phone calls to friends and family. When we visited people were having a socially distanced quiz in one of the lounge areas. Staff told us that they took as much time as possible to sit and chat and interact with people.

People and staff had been supported to take part in the vaccination programme with staff working in partnership with medical professionals to ensure this went smoothly.

The service had been well-led during the period of the COVID-19 pandemic. A series of changes had been made to the way the service was provided to help protect people as much as possible. The provider had supported the registered manager with a series of additional support meetings, training, action plans, policy changes, risk assessments, audits and made sure extra support was available for staff. The registered manager made regular checks on the safety of the service provided for people.

Staff told us that they felt supported and said that they felt proud of how they had been able to support people during the COVID-19 pandemic. One staff member told us, “It’s been very emotional, but we have made sure people are safe.” Another staff member told us, “We have supported each other to remain positive, cheerful and upbeat. This really helps the residents.”

At the last inspection we found that there was a breach of Regulation 17 of the Care Quality Commission (Regulated Activities) Regulations 2014. In that the registered person had failed to maintain an accurate and complete record in respect of the care and treatment of people with compromised tissue viability. Also that the registered person had failed to improve practice following the identification of record keeping issues during their auditing processes. At this inspection we found that improvements had been made.

Westvale House provides accommodation, personal and nursing care for up to 61 people, some of whom have dementia care needs over two floors. The home was built in 1989 and is located approximately three miles from Warrington town centre. The service is provided by Barchester Healthcare Homes Limited. At the time of our inspection the service was accommodating 51 people.

Since the last inspection there had been a change to the management structure of the home, there was a registered manager at Westvale House. 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 protected from the risks of abuse. Risks were identified and managed effectively to protect people from avoidable harm.

Recruitment processes were in place to make sure, as far as possible, that people were protected from unsuitable staff being employed.

Records of people's dietary intake could be improved with consistent portion management.

People received their medications as prescribed so that they remained well and pain free.

People receive support from staff who receive regular training. Effective processes are in place to monitor staff training needs.

People told us they were treated with care and kindness.

People were treated with respect and their dignity was upheld.

People's rights to make their own decisions were protected. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s needs were assessed and accurate records maintained so that their needs could be met.

People knew how and to whom they should complain.

Westvale House was previously inspected in November 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Westvale House provides accommodation, personal and nursing care for up to 61 people, some of whom have dementia care needs over two floors. The home was built in 1989 and is located approximately three miles from Warrington town centre. The service is provided by Barchester Healthcare Homes Limited. At the time of our inspection the service was accommodating 45 people.

There was a registered manager at Westvale House. 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.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of good governance. The registered person had failed to maintain an accurate and complete record in respect of the care and treatment of people with compromised tissue viability (a pressure area that can break down the skin and underlying tissue). You can see what action we told the provider to take at the back of the full version of this report.

The registered manager was present during the two days of our inspection and was supported by her regional director and a clinical development nurse. The management team were supportive, open and transparent throughout the inspection process and were seen to interact with people using the service and staff in a caring and supportive manner.

We observed that Westvale House provided a homely, comfortable and relaxed environment for people to live in. People were able to receive visits from family members and friends throughout the day and staff were attentive and responsive to the needs of the people living in the home.

We found that the needs of people using the service had been assessed and planned for so that staff understood how to provide person centred care and to keep people safe from harm.

The provider had established a programme of induction and ongoing training to ensure people using the service were supported by competent staff. Additional systems of support such as supervisions, appraisals, daily handovers and team meetings were also in place.

Corporate policies had been developed relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). Staff had received training in relation to this protective legislation and those spoken with understood their duty of care.

People were offered a choice of nutritious and wholesome meals that were provided in dining areas that offered a pleasant environment for people to socialise and eat their meals.

People using the service had access to a range of individualised and group activities.

Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need). Medicines were ordered, stored, administered and disposed of safely.

Systems to monitor key aspects of the service, obtain feedback on the standard of care provided and to respond to safeguarding concerns and complaints had also been established.

Relatives spoken with said "My Dad seems very happy. The staff are welcoming and friendly.They provide a lot of things for them to do" and "I would recommend it to anybody"

People told us they felt safe and had no concerns about their care.They knew how to complain should they wish to do so.

The provider had a comprehensive system for recruiting staff and supporting them with a range of training opportunities.

People said they felt well cared for by the staff that supported them. Everyone we chatted to was positive about the support provided.

Comment such as 'all the staff know me I have been here a while and they look after me well' 'I like it here there is always something going on for us to do' were made by people living at the home. Relatives spoken with said 'they look after my relative very well' another said 'Someone visits every day and the staff are always helpful'

People told us that they felt safe and had no concerns about the care and treatment they receive from staff. People said they could talk to the manager or deputy manager at any time and they would sort anything out. They said that they were always around to talk to and that all of the staff would listen if they had any concerns.

Relatives spoken with were happy with the care their relatives received.