Westwood House

We found the following examples of good practice.

Visitors had their temperature taken and were asked questions about their health to identify signs of infection. Supplies of personal protective equipment (PPE) and hand sanitiser were available, enabling all staff and visitors to put on PPE before having contact with anyone who used the service. The entrance area was regularly sanitised and benefited from clear signage.

The premises were kept in a clean and hygienic condition throughout. We observed a storage area used for cleaning materials. This was well stocked and included a specialist anti-viral cleaning product. We reviewed cleaning schedules, which showed areas which could pose a higher risk of cross-infection, such as surfaces and door handles, were sanitised twice each day.

We observed changes made to the service’s environment to help promote social distancing. The dining area had been adapted to ensure seating was at a safe social distance. The service had used tape on sofas and garden benches, to indicate where people should not sit closely together. These measures did not appear to detract from people’s enjoyment of communal spaces. We observed people appeared relaxed and were interacting in the lounge and dining areas.

PPE stock levels were monitored on a weekly basis, and the centralised system could identify shortfalls in stock and automatically reorder. We observed staff wearing appropriate PPE. Staff had received training on infection prevention and control, and this was followed by an assessment of competency, and spot checks, to ensure staff were adhering to correct practice.

Audits took place to monitor infection prevention and control across the service. The service’s infection control policies included a home management COVID-19 policy. This provided detailed guidance for the service on managing all aspects of their response to the pandemic.

The home was registered to regularly test staff and people using the service for COVID-19 infection. The service had a good supply of testing kits. Prior to our inspection, a staff member showing no symptoms of infection received a positive test result. The service’s response included an immediate deep clean of the premises, liaison with other agencies and re-testing for all staff and people using the service. The results from these tests were negative, demonstrating how the measures in place successfully prevented a wider outbreak of infection at the service. During the pandemic, except for the one recent positive test, all other test results have been negative.

Some people using the service could not consent to COVID-19 swab testing. Where staff believed a person was unable to give informed consent, the service documented a mental capacity assessment and best interests decision. We reviewed documentation which showed people including GPs and advocates had been appropriately consulted about decisions. When testing occurred, each person using the service was supported by a staff member who knew them well. People were regularly updated regarding the submission and results of their tests. This helped to alleviate anxiety by ensuring people using the service felt fully informed.

Local lockdown restrictions had impacted visitor arrangements. At the time of our inspection, the local lockdown had recently ended. The service was asked to submit visiting policy proposals to their local council and were awaiting further feedback. We reviewed examples of visiting risk assessments, which were highly personalised for each individual.

The registered manager explained how the service had supported people using the service to understand the risks of COVID-19, the use of PPE and why lockdown measures were in place. This included supporting people to understand television coverage and use of videos and pictorial guidance. Family members were regularly updated using telephone and letters.

During the pandemic, people had been unable to access the clubs they previously attended. The service had worked creatively to ensure people using the service accessed activities they enjoyed. Indoor and outdoor spaces had been utilised for activities including barbeques, badminton, line dancing, karaoke, baking and a VE day tea party. The service also supported people to maintain contact with family members using digital technology. We heard the service had worked with families to coordinate digital celebrations for birthdays and other special events.

The service had 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.

People receiving support from staff at Westwood House received highly individualised person- centred care. Support plans contained detailed and personalised care plans and we saw that many people had been supported to have a full and meaningful life. People benefited from a large range of activities and interests provided, to ensure they were kept occupied, if they chose. There were many excellent opportunities to optimise people's social and stimulation requirements.

There was clear guidance for staff on how to meet people’s individual needs and support them to develop their confidence and have their preferences met. We saw that people were relaxed and staff demonstrated a caring attitude. The service had ensured people’s communication was maximised, which assisted an increased understanding and reduction of distress.

As the values and vision of the organisation and service had been integrated into everyday practice, people living with learning disabilities were able to achieve what they wanted in their lives and overcame obstacles to achieve positive outcomes.

People and their families, where appropriate, were fully involved in the development of their care planning along with health and social care professionals and Westwood House staff.

The service was exceptionally well-led. The service actively promoted a positive, inclusive and open culture. All staff showed a passion and commitment to providing the best support to enable people to have full lives. The registered manager had taken time to look into ways to improve safety and share this practice within the organisation. There were robust quality assurance systems in place, which monitored the service, identifying potential areas for improvement, and actions were taken to improve these.

Staff were highly motivated and worked as a team and shared a common ethos of providing high quality, compassionate care with regard to people's individual wishes and support needs. Staff were valued, well-supported and supervised by the management team.

Staff knew how to keep people safe, and how to report any concerns. There were enough staff to keep people safe. People received their medicines as they had been prescribed.

Risks to people were identified promptly and effective plans were put in place to minimise these risks, involving relevant people, such as relatives and other professionals. Where risks were more complex, comprehensive guidance was in place to guide staff, including the most effective approaches to use, or particular communication methods suited to the individual. Guidance was in place for staff so that they could mitigate risk, and support people to take sensible risks as safely as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA). We observed staff treated people as equals and individuals, offering them options whenever they engaged with them. Staff always endeavoured to enable people to maintain their independence and to make their own decisions.

People's privacy and dignity were highly respected, and this also was reflected in the detailed guidance provided within people's care records.

People were supported to follow healthy diets, and this had a positive impact on their wellbeing. They were also supported to access healthcare services when they needed to.

Westwood House is a care home without nursing for up to 10 people. On the day of our inspection, nine people were being supported and one person was in hospital. The care home is located in Swindon. The service has been operating at this location since December 2010.

There was 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 safe. Arrangements were in place to protect people who used the service from the risks of abuse and avoidable harm. Staff were knowledgeable about safeguarding and could describe their responsibilities and roles in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

There were enough staff on duty and they were clear about their responsibilities to protect people who lived at the service. The service had safe and appropriate recruitment processes to ensure staff were suitable to care for people.

People had been assessed for risks, such as drinking too many fluids and assessments were in place to monitor and reduce these risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicine as prescribed.

Staff had received an effective induction before they started working with people. They had received all the relevant training and good support and guidance from the management team. People spoke highly of the staff and described how they felt cared for.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA). The MCA protects the rights of people who may not be able to make particular decisions themselves. Where restrictions were in place for people these had been legally authorised and people were supported in the least restrictive way. Appropriate guidance had been followed where people’s freedom was restricted.

People told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

People were addressed and supported in a caring and respectful way and staff were kind and friendly towards people in the service. People had enough to eat and drink and were supported by staff to eat food they enjoyed. Mealtimes were flexible to meet people’s individual needs. Activities were tailored to reflect people’s individual preferences. These included activities in the home as well as trips out into the community. People were supported to access health care professionals to ensure their health care needs were met. People’s needs were reviewed on a regular basis and external professionals were involved as necessary.

The service benefitted from good leadership. This was evident across the service with positive feedback from individuals, staff and professionals. There were clear and well-kept records in the service which evidenced that the service supported people safely and effectively by helping people to achieve their goals. Management systems were in place to assess and monitor the quality of the service provided. This included gathering views regularly from people who used the service, their relatives and professionals.

Staff spoke very positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service. People told us the service was friendly, responsive and well managed. People knew the registered manager and staff and spoke positively about them.

On entering Westwood House we found the atmosphere to be warm and welcoming. We spoke with people who use the service, a visiting family member and staff. We observed staffs understanding of the care and support needed. The people who use the service we spoke with said that staff "look after them well" and a family member said their relative was "really happy."

We looked at people's individual records which incorporated their personal profile, support plans and risk assessments and found they encompassed the safety and well-being of people who use the service. The family member and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues they could "talk to the manager."

We looked at the cleanliness of the home and the management of medicines and found the provider had adequate systems in place. We reviewed the provider's quality management system and records and found that people were given the opportunity to provide feedback on the service and staff had received relevant training and supervisions.