Archived: Westview Lodge Care Home

Westview Lodge is a care home which provides residential care for up to 74 people. The service operates a intermediary service for people who need rehabilitation following an illness in hospital or crisis in their own home. It also provides care for older people and people living with a dementia. At the time of our inspection there were 73 people using the service.

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

Since the last inspection the regional manager and registered manager had made significant improvements to the operation of the service. Action had been taken to ensure staffing levels had been increased. The care records had been improved and a range of new care record templates had been created for people who used the intermediate service. Hazardous substances were stored and infection control issues had been resolved. They had looked at opportunities to improve every aspect of the service and were committed to improving the service further.

The registered manager and staff demonstrably showed people were valued and respected. Staff had time to place people at the heart of the service. The registered manager had used a local authority grant to improve the environment on the unit for people living with dementia. They had commissioned an external company to make large wall art depicting different parts of Hartlepool. They had purchased old local newspapers and scented flowers to go outside the murals of the local shops. They had also purchased specialist light fittings that looked like windows looking out on the sky. The environment had a calming effect on people and they appeared very relaxed and content.

The registered manager had also created dynamic communal areas such as a bar in one lounge that had a hydration station. People independently and frequently used this to get drinks. Staff had been actively engaged in the projects and supported the registered manager to make positive changes. Staff routinely made ‘mocktails’ and this added to people’s ability to remain appropriately hydrated.

The activities coordinators had developed a wide range of events. They made sure people had a life with meaning and clearly valued each person. Staff actively engaged in enabling people to enjoy a wide range of in-door activities as well as encouraging people to access community resources. The activity coordinators had also forged links in Hartlepool with different groups and business. The local school for people living with disabilities regularly visited. A local printer had enlarged a wide range of old photos of Hartlepool. These were on display throughout the home and were a talking point for people.

Staff were committed to delivering person-centred care. They actively promoted equality and diversity within the home. 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. We highlighted that staff had not always completed capacity assessments and ‘best interests’ decisions for restrictive practices such as people needing staff to go with them when they went out. The registered manager ensured this matter was addressed immediately.

Staff took steps to safeguard people and promoted their human rights. Incidents were dealt with appropriately and lessons were learnt, which helped to keep people safe. People's health and social care needs were thoroughly assessed. External professionals were involved in individual's care when necessary.

Appropriate recruitment processes were in place. Staff had received a wide range of training and checks were made on the ongoing competency of staff. Appropriate checks were completed prior to people being employed to work at the service.

The cook had received training around meeting people's nutritional needs. Staff effectively supported people to eat a nutritious diet and drink ample fluids. A range of menu choices were available.

The registered manager took appropriate action to deal with any concerns and complaints. The service was well run. The regional manager and registered manager carried out lots of checks to make sure the service was effective. The registered manager constantly looked for ways to improve the service.

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

Rating at last inspection

The last rating for this service was requires improvement (report published 31 October 2018) and there were two breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the service had made sustained improvements and addressed the issues identified at the last inspection.

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 per our re-inspection programme. If any concerning information is received, we may inspect sooner.

West View Lodge Care Home 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.

The care home accommodates 74 people across four units. At the time of the inspection 65 people were being supported in the home. The service supported up to 20 people who were assessed as requiring rehabilitation with a view to returning home. Over the course of a year up to 400 people access this service.

The service did not have 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.’

The provider had appointed a manager who had submitted their application to become the registered manager and was waiting for their fit person’s interview.

Following the last inspection in February 2018, the service was rated as 'Good' overall, with 'Requires Improvement' under 'Responsive'. This was due to risk assessment information not being transferred to care plans. At this inspection we found two breaches of regulations relating to safe care and treatment and good governance. As a result, the overall rating has deteriorated to Requires Improvement.

Risks to people had not always been identified, assessed or managed safely. In some cases, there was insufficient information or guidance in care records in relation to people's care and support needs.

The provider's system of assessment and subsequent recording did not give an overview of people's needs. It was difficult to ascertain the primary care needs of people and readily locate key information such as whether people needed adapted diets.

The staff in the rehabilitation service used care templates designed for people receiving respite care and these made it difficult for staff to readily identify what support people needed.

Staffing levels did not consider the dependency needs of people in case of an emergency.

Substances, which if ingested could cause harm to people, were not stored securely.

Issues relating to fire safety had not been addressed in a timely manner.

Conditions attached to people’s Deprivation of Liberty Safeguards authorisations had not been met.

The provider’s quality assurance process had not identified all the concerns found at this inspection.

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

The provider’s recruitment process was safe and robust. Checks were made to ensure only suitable people were employed.

Staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service. Accidents and incidents were recorded and monitored as part of the provider’s audit process.

Health and safety checks had been completed such as gas and electrical safety checks. Equipment used to support people had been checked and/or serviced.

Medicines were managed by trained staff whose competency to administer medicines was checked regularly. Medicine administration records (MAR) were completed correctly.

Staff felt supported and received regular training, supervision and an annual appraisal.

People were provided with a varied healthy diet. People’s health was monitored and when necessary staff ensured people had access to health care professionals when necessary.

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 relatives felt the service was caring. Staff provided support in a respectful manner ensuring people’s privacy and dignity was promoted. Where possible people were supported to be as independent as possible.

The provider ensured people were supported to attend a broad range of activities and entertainment within the setting. Plans were in place to use the provider’s transport to enable trips out.

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The provider had a complaints process in place which was accessible to people and relatives.

Staff were positive about the manager. They confirmed they felt supported and could raise concerns. We observed the manager was visible in the service and found people interacted with them in an open manner. People and relatives felt the management approach in the home was positive.

The provider worked closely with outside agencies and other stakeholders such as commissioners and social workers.

We last inspected the service in March 2014. At that inspection we found the service was meeting all the regulations that we inspected. Westview Lodge is a 74 bedded purpose built residential care home situated over two floors. It provides residential support for older people and people living with dementia care needs. The home also provides a transitional service for people recuperating from a hospital admission and preparing to return home. At the time of the visit 71 people were living at Westview Lodge.

The service had a registered manager in place. 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.

The home was clean and had recently been decorated throughout. The enclosed garden had been designed and created by people living at the home, staff and the support of the local Dementia Friends group.

People, relatives and staff we spoke with told us that there were enough staff on duty. Staffing numbers were sufficient to ensure people received a safe level of care.

Where risks were identified they were assessed and managed to minimise the risk to people.

Staff had a good understanding of safeguarding and were clear on what actions to take if they had concerns about a person’s welfare or safety.

The provider had an effective recruitment process in place which included ensuring appropriate checks were undertaken prior to an applicant commencing work.

Medicines records we viewed were up to date and accurate. This included records for the receipt, return, administration and disposal of medicines.

Staff understood and applied the principles of the Mental Capacity Act (MCA), and supported people to make individual choices and decisions.

People were supported during meal times and wherever possible were encouraged to be independent.

Staff had completed mandatory training the provider had deemed required to perform their role. Supervisions and appraisals were not conducted in line with the provider’s programme.

The home had a good working relationship with external professionals visiting the service. We saw evidence in care plans of cooperation between care staff and healthcare professionals including, occupational therapists, nurses and GPs.

People were treated with dignity and respect. Staff had a sound knowledge of the people they supported.

Where people had no family or personal representative the registered manager advised the home would assist people to obtain support from an advocacy service.

People were able to take part in a range of activities including bingo, crafts, gardening, baking and going on outings. Staff supported people to maintain family relationships and links with the local community.

Care plans were detailed and reflected people’s individual needs. Reviews were regularly completed.

The home had a happy atmosphere. Staff told us they enjoyed working at the home and they felt supported by the registered manager and senior staff.

A grab bag containing people’s personal emergency evacuation procedure (PEEP), torches, emergency blankets and the provider’s business continuity plan was accessible to staff in the event of an emergency.

The registered provider had developed a range of systems to monitor and improve the quality of the service provided. An electronic feedback point was available in the foyer of the home. People who lived at the home, relatives and staff were encouraged to provide constant feedback.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

One person we spoke with said, "Oh I can tell them anything and they do listen to us". People told us that they were very happy at the home and that staff were "lovely".

Throughout our SOFI observations we saw that there were a lot of smiles and laughter between people living at the home and staff and the home had a very relaxed environment.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were enough qualified, skilled and experienced staff to meet people's needs.

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. We also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.