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Westgate House Care Centre Good

Reports


Review carried out on 8 July 2021

During a monthly review of our data

We carried out a review of the data available to us about Westgate House Care Centre on 8 July 2021. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Westgate House Care Centre, you can give feedback on this service.

Inspection carried out on 16 April 2021

During an inspection looking at part of the service

Westgate House Care Centre accommodates up to up to 109 people, some of whom were living with dementia. The service provides accommodation over three floors. There were 90 people living at the service at the time of this inspection.

We found the following examples of good practice.

All visitors to the service had their temperature checked, undertook a rapid COVID-19 test, completed a health questionnaire and were provided with personal protective equipment (PPE).

Visits were being re-introduced by appointment only, with times allocated to avoid potential infection transmission with other visitors and to allow for the visiting area to be thoroughly cleaned between visits. They were also undertaking training in how to test for COVID -19, handwashing, and putting on and taking off of PPE.

The provider had developed policies and procedures in response to the COVID-19 pandemic.

Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed. PPE was placed throughout the service, with ample supplies available. Staff were seen to be adhering to the PPE guidance and protective measures in place.

The service was clean and hygienic. Robust cleaning schedules were in place. People's rooms and areas frequently touched by people and staff such as door handles were cleaned regularly.

Inspection carried out on 7 January 2020

During a routine inspection

About the service

Westgate House Care Centre is a purpose-built residential care home providing personal and nursing care to 94 people aged 65 and over at the time of the inspection. The service can support up to 109 people.

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

People who used the service, their relatives and the staff team all told us the service was exceptionally well-led. Relatives praised the staff and management for the care provided and the positive impact it had for people and peace of mind for relatives. We saw many examples where the management ethos and leadership enhanced people’s feeling of safety and wellbeing. The management team had excellent oversight of the way the home operated and nurtured the staff team to take ownership and have pride in the care they delivered.

The management team demonstrated an open and candid approach when improvements were identified. Staff felt listened to, their opinions were valued, and they felt truly supported both as staff members and as individuals. The provider’s robust quality assurance systems promoted high quality care and helped to ensure that people received a safe and effective service that was caring and met all their needs with a holistic approach. The registered manager maintained a strong influence on people receiving excellent care and support by ensuring reflective practice opportunities were provided for staff. These were very effective in putting actions in place and learning into daily practice.

People felt safe living at Westgate House Care Centre and were protected from the risk of abuse. Staff were trained in recognising and reporting any concerns. The provider operated a robust recruitment procedure to help ensure staff were suitable to work at the home. There were enough skilled and competent staff on duty to meet the needs of the people using the service. Risks to people’s health and wellbeing were assessed and their care was planned to remove or reduce the level of risk. People received their medicines from staff who were skilled, and competency assessed to safely administer medicines. The environment was pleasant and bright creating a clean and fresh place for people to live.

People's needs were assessed so that they could receive the care and support they needed. Staff received training needed to support people's differing needs. People were supported to eat and drink a balanced diet which met their needs and individual preferences. People were supported to maintain good health and prompt referrals were made to external professionals when health needs changed, or people became unwell. 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 treated with compassion, kindness and respect. People’s relatives complimented staff for their empathy and support, both for the person and for their families when people reached end of life. The registered manager consulted with people and staff about decisions made in the home, it was clear that any changes made were centred around, and driven by, people’s wishes, health and wellbeing.

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 07 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 27 June 2017

During a routine inspection

The inspection took place on 27 June 2017 and was unannounced.

Westgate House Care Centre is a purpose built care home providing nursing or personal care for older people. The home has a purpose built unit for people living with dementia and also provides nursing, intermediate and rehabilitation care. The home is registered to provide care for up to 109 older people and there were 94 people living at the home when we inspected.

The home had a registered manager. 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.

At the last inspection of this service in July 2015 the service was rated Good. At this inspection the overall rating remained as Good however, there were some aspects of the service where people would benefit from some improvements being made.

People received the support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed. However, the meal time experience on one unit needed further development to help ensure people had a positive experience and the system in place to monitor people’s fluid intake was not robust. We noted some examples where staff used terms that did not promote people’s dignity and where staff did not always seek people’s consent. For example, moving people in their wheelchairs without explaining what was going to happen.

People felt safe living at Westgate House Care Centre. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

Inspection carried out on 06 July 2015

During a routine inspection

The inspection took place on 06 July 2015 and was unannounced.

Westgate House Care Centre is a purpose built care home providing nursing or personal care to older people. The home has a purpose built unit for people living with dementia and also provides intermediate and rehabilitation care. The home is registered to provide care for up to 109 older people and there were 93 people living at the home when we inspected.

The home had a registered manager. 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Westgate House Care Centre and some were pending an outcome.

When we last inspected the service on 24 October 2014 we found they were not meeting the required standards and they were in breach of regulations 9, 10, 12, 13, 14 15, 20 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations 9, 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had taken action to address the identified concerns.

There were suitable arrangements for the safe storage, management and disposal of people’s medicines, including controlled drugs. The environment was clean and fresh and the atmosphere throughout the home was calm during the inspection. Staff knew how to recognise and report allegations of abuse. Staff recruitment processes were safe and a range of training was provided to staff to give them the skills and knowledge required to undertake their roles.

People told us that staff were kind and caring. Appropriate care and support was delivered in a way that promoted people’s safety and protected their privacy and dignity. Meetings were arranged to support people and their relatives to share their views and opinions on the service provided.

We received positive comments about the management team and the management ethos from people who used the service, their relatives and the staff team. The provider and manager monitored and sought feedback about the services provided to identify areas for improvement and drive forward improvements in the home.

Inspection carried out on 21 and 24 October 2014

During a routine inspection

This inspection was carried out on 21 and 24 October and was unannounced.

At our last inspection we found the service to be meeting the requirements of the regulations, However, at this inspection we found the service to be in breach of Regulations 9, 10, 12, 13, 14, 15, 20 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report summary.

Westgate House Care Centre is a nursing and residential care home that provides accommodation and personal care for up to 109 older people some of whom live with dementia. The home has three floors with a residential dementia care unit on the ground floor and nursing units on the upper floors.

The provider had recently appointed a manager who had submitted their application as a registered manager on 07 October 2014. 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 and associated Regulations about how the service is run.

The CQC is required to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to some people who lived at Westgate House. The provider had therefore, acted in accordance with the MCA 2005 and DoLS.

There were insufficient numbers of care staff available to meet people’s care needs. We observed that people had lengthy waits for personal care in circumstances that compromised their dignity and care needs.

Guidance published by the Department of Health for prevention and control of infection in care homes had not been followed. There were a lack of cleanliness and infection control procedures in place throughout two of the three units at the home and we noted a prominent malodour in both. This meant that people were not adequately protected from the risk of infection.

Effective and safe recruitment practices had been followed.

Medicines were safely ordered and stored but not safely managed in the home. Staff who administered medicines had been appropriately trained. However guidance for when required (PRN) medicines were not clear which resulted in people being administered medicines when they may not require it. People were not encouraged to manage their own medicines and where people were prescribed medicines that made them drowsy these had not been regularly reviewed in line with published guidance.

People and relatives gave mixed views about the food provided. People who required assistance with their meals did not always receive this.

Where people were at risk of malnutrition or dehydration staff ensured people’s fluid and food intake was monitored effectively to ensure they had adequate amounts to meet their needs. However, we found that healthy snacks were not always offered to people, and those at risk of malnutrition had not always had their meals fortified to support a high calorific dietary intake.

People’s individual needs were not met by the adaptation and decoration of the service. Rooms were sparsely decorated with some rooms cluttered with chairs and equipment. The ground floor which supports people living with dementia was not decorated to ensure people were orientated and stimulated.

Staff were supported by the manager and told us the training they received supported them to provide care to people.

People were happy with the care they received from staff and we observed positive interactions when staff assisted people with their care needs. People were generally treated in a courteous and respectful manner.

People and relatives were aware of how to make a complaint and the manager responded to them effectively. People’s personal preferences were not always acted upon when providing care and support and records relating to people’s care did not always sufficiently detail the care needs of the person or what had been reviewed. Records were also written illegibly at times.

Activities were in place but were not reflective of people’s specific interests or needs, particularly where people lived with dementia.

There was a quality assurance system in place, however robust auditing had not always been completed. Prior to the appointment of the new registered manager, the provider had not ensured robust auditing had been completed. Action plans were not always in place to address issues of concern, such as staffing. Where concerns had been identified there had not been a timely response to reduce the risk of harm for people who used the service.

Inspection carried out on 19 August 2014

During an inspection looking at part of the service

At a previous inspection of Westgate House Care Centre in June 2014 we had found that people were not protected from the risks of unsafe or inappropriate care because accurate and appropriate records were not maintained. Our concerns were such that we issued a Warning Notice to the provider.

We revisited Westgate House Care Centre on 19 August 2014 to assess compliance in this area and found that some improvements had been made.

Inspection carried out on 11, 12 June 2014

During an inspection looking at part of the service

We looked at the personal care or treatment records of people who use the service, carried out a visit on 11 June 2014 and 12 June 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and reviewed information sent to us by commissioners of services. We talked with commissioners of services.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

What people told us and what we found

At our inspection on 03 and 04 March 2014 we found that the service was required to make improvements in relation to treating people with dignity and respect, their consent arrangements, the care and welfare of people who used the service, recruitment methods and the accuracy of people�s records. The provider submitted an action plan on 17 April 2014 which told us they would be compliant with the regulations by 15 May 2014.

We inspected Westgate House Care Centre on 11 and 12 June 2014 and found the provider had made some of the improvements, we had requested by 15 May 2014. At this inspection we were supported by three inspectors and one expert by experience. We looked at 12 people�s care records. We also spoke to the provider, manager, the unit managers for the three floors of the home, and 15 members of care staff on duty. We have served warning notices on the provider and manager requiring them to be compliant with the Health and Social Care Act 2008 by 18 July 2014. We will follow up this warning notice to ensure compliance has been reached.

We set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We found that care was not consistently planned and delivered in a way that was intended to ensure people�s safety and welfare.

We found on two floors that pressure mattress settings were consistent with the weights of people who used the service. However on one floor we found that all pressure settings were set to firm, regardless of the weight of people.

Is the service effective?

We saw that most of the risk assessments and support plans had been reviewed and updated following our last inspection. We looked at the care notes for people whose plans we had viewed and saw that in most cases care was recorded as being delivered in accordance with the plans. However these had not been completed for all people who used the service.

Overall people�s daily care records were up to date and reflected the care provided to people. However we found examples where the care plan had not been followed, reviewed or updated.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Where applications had needed to be submitted at our previous inspection, proper policies and procedures had been followed. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service caring?

We observed staff interaction with people who used the service and noted that interactions were positive. Staff were attentive and kind and appeared to know the people well. However we also found that for two people who used the service, staff were unaware of their particular needs. These two people presented with particularly high and complex needs.

During our previous inspection we found that all the bedroom doors for people were left open, this did not promote people�s dignity and privacy. At this inspection we found that staff had reviewed this with people and their relatives and people�s doors were only open where they had requested this.

We found that staff were in the process of reviewing all people�s care records and were involving people who used the service and their relatives. This meant that they were able to seek the views of those people who best understood the needs of the person.

Is the service responsive?

The views of people who used the service were sought, encouraged and recorded in their care plan. However these views and preferences were not always carried out. We noted that preferences in relation to activities and bathing had not been provided for example.

The service listened to people�s experiences, concerns and complaints to improve the quality of care they received. We saw that recently the manager and staff had held meetings with residents and relatives to seek their views and opinions. However it was too early to determine how the manager had reviewed the responses and learned lessons from these views.

Is the service well led?

The service did not always promote a positive management culture that was positive, and open. We were provided with one record which we determined had been doctored during our inspection to provide us with a false impression of recruitment procedures. We confirmed the false entry made on the record with staff working on duty who had made the entry.

We found that recruitment processes for employing new care staff had been reviewed. We saw from records we looked at that staff employed at Westgate House Care Centre had been thoroughly vetted to ensure they were of good character and experienced to work with vulnerable adults.

Inspection carried out on 3, 4 March 2014

During an inspection in response to concerns

We inspected Westgate Care Centre due to concerns that had been raised. These suggested that people were not treated with dignity and respect, that their consent had not always been sought and that they were receiving inappropriate care.

During our inspection on 03 and 04 March 2014 we found that people�s dignity was not maintained. We noted that people's bedroom doors had been left open and people were visible from the corridors in various states of undress. We also found that the needs, wishes, preferences and decisions of people who used the service were not at the centre of the assessment, planning and delivery of their care, treatment and support.

We found that the provider had not sought the required consent from people who acted on behalf of those who had complex needs and lacked the mental capacity to make or understand decisions themselves. Where the provider had not acted in accordance with relevant guidance and legislation people may have been unlawfully restricted because their preferences and views had not been sought.

We spoke with people who used the service and their relatives. Some of the people we spoke with were positive about the care they received. One person told us, �[Carer] is fantastic, so gentle and kind and knows just what I need, in fact most of the staff are very caring.� However people did not always feel involved in the planning of their care. One person who used the service told us, �I don�t know what�s in my care plan, I would like to see it but the staff don�t have the time to show me, I trust that they know what�s best.�

We found that people were not always cared for by suitably qualified, skilled or experienced staff. This was because the provider had not sought to ensure that staff were suitably skilled or qualified prior to commencing employment. One staff member we spoke with told us, �I didn�t have an assessment [of my skills] by the unit manager, and I haven�t spoken to them about how I am getting on. They just take my word that I am doing okay.�

We found that people's care records were not stored securely, nor were they always accurate and appropriate.

Inspection carried out on 26 June 2013

During a routine inspection

During a previous inspection on 23 April 2013 we found that people's dignity was not always maintained and staff did not always treat people with respect. We also found that people who used the service and their relatives did not always feel involved in the planning of care. We followed up with an inspection on 26 June 2013 and found that the provider had made improvements in these areas. People told us that they felt involved in their care, and that staff listened to their requests. One person told us, "My routine is set in stone, and the staff respect that, I know what I want, how I want it done and when. I like things done a certain way and it's important my wishes are followed."

We found that the provider had taken steps to improve the environment that people lived in. During our inspection on 26 June 2013 we found the home was clean, welcoming and free from odours. The provider had recruited further domestic staff, and had reviewed their use of detergents. One person who used the service told us that, �It is much nicer here now, I am happier to have friends and family visit me.�

We previously found during our inspection on 23 April 2013 that people's records were not stored securely. We also found that records relating to resuscitation of a person were not completed sufficiently. During our inspection on 26 June 2013 we found that the provider had taken action to remedy these issues. People's records were stored securely and documentation had been completed appropriately.

Inspection carried out on 23 April 2013

During a routine inspection

We found that the home involved people in decisions about their care. However we also found that people's dignity was not always respected.

We found that care records were comprehensive and contained individual goals for people to achieve. One member of staff told us, "If any care worker comes here to work, we make sure the records are clear and up to date. That way anybody can read how to care for that person."

People we spoke with told us that the food they received was good. One relative said, �They do get a good meal here.� One person who used the service said that the food was �very nice�.

We found that the home had an infection control policy in place and staff had received training in how to manage and reduce the risk of infection. We saw that the home had achieved a five star food agency rating for cleanliness, meaning that people received food that had been stored, prepared and cooked in a very hygienic environment. During our inspection we also found that the home had a bad odour for the majority of our visit. People who used the service told us, �Sometimes the bedroom was cleaned but not the bathroom."

We found that staff had received appropriate training for their role and medicines were only administered by trained nurses. We saw that medicines were given to people appropriately and when they required them.

Records were comprehensive and fit for purpose, however we found that people's care records were not stored securely.

Inspection carried out on 2 May 2012

During a routine inspection

Three people told us that they the home was a good place to live in. One person commented: �It is wonderful here, they are very kind and help us how we want.� All three people told us that staff respected them, asked them if they were happy with care and listened to them. All three people felt safe. One person explained that they would tell the unit manager (calling them by names) if, �there was any problem, or we wanted something, or to say what we want.�

People explained that they had an opportunity to express their views through their residents meeting, that they called �Residents Committee�, through �Residents and Families Meeting�, through yearly survey or speaking directly to unit managers. One person explained how appreciative they were when staff helped them write their views on the written survey form.

Several people told us that they preferred to sleep with their bedroom door open, but when staff were helping people with personal care the doors were closed to ensure respect for people privacy and dignity. One person wanted to have their doors closed and staff respected this preference and kept the door closed.

Two people commented that staff were knowledgeable and skilled in helping them with all the tasks and particularly singled out the unit manager as, �Very well trained and skilled.�

All three people confirmed that they were consulted about their care plan when care plans were reviewed and stated that they had choice regarding their care and provision provided within the home.

One person stated that transport services that take them out were excellent and well coordinated. The same person explained that there were enough staff per each shift to respond when people called them.

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