Background to this inspection
Updated
2 February 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 24 and 25 November 2015 and was unannounced. The inspection was carried out by two inspectors, a specialist nurse advisor and an expert by experience. An expert by experience is a person who has personal experience of either using, or caring for someone who uses this type care of service.
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at previous inspection reports and notifications we had received. Services tell us about important events relating to the care they provide using a notification. This enabled us to ensure we were addressing potential areas of concern.
The Westbury residential and nursing home is registered to provide personal and nursing care for up to 51 people. There were 44 people who were currently residing at the home. During our inspection we spoke with 19 people and with ten relatives and friends.
We spent time observing people in the dining and communal areas. We used the Short Observational Framework for
Inspection (SOFI). SOFI is a specific way of observing care to assist us to understand the experiences of the people who could not talk with us.
During our inspection we spoke with the registered manager and the area manager, rehabilitation support worker, team leader, care workers, a nurse, kitchen assistant, the chef, a housekeeper and a maintenance contractor.
We used a number of different methods to help us understand the experiences of people who use the service. This included talking with people, looking at documents that related to people’s care and support and the management of the service. We looked around the premises and observed care practices throughout the day.
Updated
2 February 2016
The Westbury residential and nursing home is registered to provide personal and nursing care for up to 51 people. At the time of our inspection there were 44 people living at the home. The inspection was unannounced and took place on the 24 and 25 November 2015.
The service had a registered manager who was responsible for the day to day running of the home and had been in post for approximately two months. 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 received their medicines on time; however, medicines were not kept safe as the medicine rooms were unlocked at the time of our inspection. The medicine rooms were not kept within the required temperature to maintain the integrity of medicines and some medicines were not disposed of appropriately.
The recording of medicines highlighted a lack of signatures on the MAR charts. There was conflicting information in the records around the application of creams and how often they should be applied. Protocols were not in place for all medicines prescribed to be administered as and when required.
People and relatives told us the staff were very kind and caring and we observed that staff treated people with respect and dignity. Staff were enthusiastic about their role and were dedicated to giving people a good quality of care. People received good care at the point of delivery although care records were not person centred.
The service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA) when people lacked the capacity to give consent to receiving care.
Staff received some training; however, we found that staff had not received sufficient training in relation to the MCA, Deprivation of Liberty Safeguards, supporting people with dementia and positive behaviour management. Staff were supported through a system of supervision and appraisals.
People were able to take part in activities within the home if they wished to. People told us the food was good and we observed people were given drinks and snacks throughout the day.
People said they felt safe living at the home. Staff were aware of their responsibilities towards safeguarding people and showed a positive attitude to this.
There was a complaints procedure in place; the service investigated complaints and responded in a timely way.
People and relatives told us they did not feel there were sufficient numbers of staff at all times. The provider recorded call bell response times however this information was not fully analysed in order to ascertain the reason for long call bell response times. Some audits did not fully identify the issues we found.
We found 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 this report.