Westbrook House Integrated Care Centre

We found the following examples of good practice.

• Bedrooms in the designated care setting had ensuite bathrooms.

• The designated care setting was uncluttered and clean. The area had its own equipment and a kitchenette for preparing snacks and drinks.

• The designated care setting had its own outside space and communal areas were large enough to support social distancing.

• There were cleaning schedules in place with daily and weekly check sheets and monthly auditing by the cleaning supervisor.

• The designated care setting was clearly identified, the unit was not physically separate from the rest of the home but the doors in between were closed. Arrangements for entry and exit were safe. Staff breaks were managed to support social distancing.

We were assured of the provider's safe management of infection, prevention and control. However, the service was not suitable for the purposes of a Designated Setting because there were still service users living in the proposed area, plans had not been agreed to confirm a designated staff team and building works to reconfigure the space had not started.

Further information is in the detailed findings below.

Westbrook House Integrated Care Centre is a residential care home providing accommodation and personal care for older people. The service can support up to 60 people. At the time of the inspection not all the accommodation was being used. There were two units open for up to 30 people in total. One unit provided ten short term enablement beds to support people to develop their independence in order to return to their home. There were six people in this unit during the inspection. The other unit provided short term assessment and respite for up to 15 people living with dementia. There were seven people in this unit during the inspection.

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

At the last inspection there were concerns suitable arrangements had not been made to support people to safely manage catheters and to support people living with diabetes. At this inspection these risks were well managed, and staff had received training in these areas. People told us they felt safe. Risks to people were identified, assessed and managed safely. The environment was safe as health and safety and the risk of fire was well managed. At the last inspection there were concerns that ‘as required’ medicines were not managed safely, and the provider had not ensured medicines were stored at safe temperatures. At this inspection these medicines and storage temperatures were managed well. Medicines were managed safely, and people received their medicines as prescribed.

At the last inspection the provider’s quality audits had not identified the shortfalls we found at the inspection. At this inspection the provider had ensured the delivery of high quality and safe care. Quality assurance systems were used effectively to monitor all aspects of the service. The management team analysed all feedback to ensure any improvements needed were made. The management team and provider had clearly understood their role and responsibilities and had met all their regulatory requirements.

People were protected from abuse and avoidable harm. Staff knew their responsibilities for this. Allegations of abuse were effectively reported, investigated, and appropriate action was taken to ensure people were protected from any further harm. There were enough staff to keep people safe and meet their needs. Staff responded promptly to people’s needs and people were supported by a consistent staff team. Staff were recruited safely.

The service was clean. Cleaning checklists were in place and completed and this was monitored by the management team. Staff knew how to prevent the spread of infection. Accidents and incidents were recorded, monitored and action was taken to prevent a reoccurrence. These were analysed for any lessons learnt.

People's needs were fully assessed, and the service achieved a lot of positive outcomes for people who had been enabled to return home. People's nutrition and hydration needs were met, specialist dietary needs were known, and the associated risks were managed. People were given a good variety of choice in their meals and were encouraged to drink enough. People were supported to maintain good health and the management team worked closely and flexibly with other health professionals and agencies to ensure people had access to the health care they needed.

The provider had ensured the service's facilities were accessible and comfortable and met people's needs including those people living with dementia. Staff had a good induction to the service and received appropriate training and regular updates to care for people. Staff were competent, knowledgeable and skilled in their roles and were supported by the management team.

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 told us the staff were caring and they were happy with the care they received. Staff treated people with respect, were engaged with people and responded to their needs. People’s needs around equality and diversity were promoted. People were asked about their views on their care and these were used to make improvements to the service. People were involved with their care planning and staff showed a good understanding of people’s needs and preferences. People told us their privacy and dignity were respected and information about people was held securely. People were encouraged to maintain and increase their independence.

People’s care plans were person centred as they had involved the person and those important to them. This meant people had choice and control over their care. People's communication needs were known and understood by staff and information was shared with people in ways which met their needs. People could make a complaint if they needed to. All complaints were logged and responded to appropriately and had been used to make improvements to the service.

People were supported to maintain relationships which were important to them and encouraged to take part in activities they liked, and which were meaningful to them. The service was not supporting anyone at the end of their life at the time of the inspection. People’s wishes and arrangements for their end of life care were recorded, where known.

There was an open and person-centred culture in the service. Staff told us the management team were approachable, and they could raise any concerns with them. The management team demonstrated a commitment to ensuring they provided person centred and high-quality care and were responsive to feedback during our inspection. The management team understood their responsibilities for the duty of candour, had informed the relevant people of any incidents or accidents; and provided written apologies in response to complaints.

People and those important to them were engaged with the service. Visitors could complete feedback forms, and these were used to make improvements. Staff were engaged with the service and staff surveys showed positive results. The staff and management team worked in partnership with other healthcare services to ensure people’s needs were fully met in a timely way.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 March 2019) and there were two breaches of regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

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.

Westbrook House is a residential care home that accommodates up to 60 people. At the time of the inspection, not all the accommodation was being used. There were two units open for up to 30 people. One unit offered short stay enablement beds to support people to improve their skills and independence to return to their own homes, there were 10 people in the unit during the inspection. The second unit, provided support and assessment of needs for people living with dementia, there were four people in the unit during the inspection.

People’s experience of using this service:

People told us they felt safe and staff supported them in the way they preferred. However, potential risks to people’s health and welfare had not always been assessed and there was not always guidance for staff to reduce the risks. Medicines were not always managed safely. Audits had been completed but had not identified the shortfalls found at the inspection.

People were treated with kindness and respect, they were supported to be as independent as possible. People were actively supported to express their views about their present and future care needs. Staff monitored people’s health and referred them to health professionals when required. Health professionals such as physiotherapists were involved with people’s care to enable them to be as independent as possible and return to their homes. Professionals held regular meetings to discuss people’s needs and the support they would need in the future. People’s preferences about their future care were supported and put in place whenever possible and were reflected in their care plans.

People and visitors were asked their views about the service; the responses were analysed and the results displayed within the service. There was a complaints procedure available to people. People told us they had a choice of meals which they enjoyed. There were enough staff to meet people’s needs, who had been recruited safely and knew how to keep people safe from abuse.

There was an open culture within the service, any incidents were recorded and analysed to improve the care people received. Staff worked with other agencies to ensure people benefited from joined up care to enable them to live their life as fully as possible.

The service was purpose built and was adapted to support people to be as independent as possible. The service was clean and odour free.

Rating at last inspection:

Good (report published 17 September 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service no longer met the characteristics of Good in all areas. The domains of safe and well led are now rated Requires Improvement. The overall rating is now rated Requires Improvement overall.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

The service is run by a registered manager who was present during our inspection. 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 registered manager is supported by a deputy manager and unit managers.

People said they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take to keep people safe. Staff were confident to whistle blow to the registered manager or organisations outside the service if they had any concerns and were confident that the appropriate action would be taken.

Risks to people’s safety were identified, assessed and managed. Assessments identified people’s specific needs, and showed how risks could be minimised.

Recruitment processes were in place to check that staff were of good character and safe to work with people. Information had been requested about staff’s employment history, including gaps in employment. There was a comprehensive training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff who knew them well. Contingency plans were in place to cover any emergency shortfalls of staff.

People received their medicines safely and people received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The registered manager and unit managers had submitted applications in line with guidance.

People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. People were able to make choices about how they lived their lives, including what time to get up, what time to go to bed and any preference of staff gender.

Staff had received training on the MCA and understood the key requirements of the MCA and how it impacted on the people they supported. They put these into practice effectively, and ensured that people’s human and legal rights were protected. Staff undertook lead roles on each unit as ‘MCA champion’.

Regular environmental and health and safety checks were completed to ensure that the environment was safe and that equipment was in good working order. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

People were provided with a choice of healthy food that they told us they liked. When people were not eating enough they were seen by a dietician or their doctor. Staff followed the guidance given when fortified drinks and diets were required.

People were supported to maintain good health and had access to health care professionals when needed. Staff had strong working relationships with health professionals, such as, the GPs and community nursing team.

People were happy with the care and support they received. People received their care in the way that they preferred. Care plans contained information and guidance so staff knew how to provide people’s care and support. Staff were knowledgeable about people’s likes, dislikes and preferences. Care plans included detailed life stories so staff could speak with them about familiar events.

People and their relatives were involved with the planning of their care. Care and support was planned and given in line with people’s individual care needs. People spoke positively about staff and told us they were kind and caring. Privacy was respected and people were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people.

People, their relatives, staff and health professionals were encouraged to provide feedback to the registered manager about the quality of the service. People said their views were taken seriously and any issues they raised were dealt with quickly. People told us they did not have any complaints about the service or the support they received from the staff.

Staff chatted to people throughout the day, regularly suggesting ideas to keep people active and supporting them with various activities.

People, staff and health professionals told us the service was well-led. Staff said they felt supported, that the registered manager and unit managers were approachable and that they worked closely as a cohesive team.

The registered manager and unit managers coached and mentored staff through regular one to one supervision. Staff were clear about what was expected of them and their roles and responsibilities and told us they felt supported by the management team.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager and unit managers had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We visited each of these units and spoke with the people using the service, family members and staff. Everyone we spoke with said they were happy with the service they received. One relative we spoke with told us. 'I'm really happy with the service; my father has made a huge improvement since coming here. He has returned to the person he was before he was unwell.

Staff worked with other professionals to plan and provide a service which supported people to become independent again. A person told us, 'I couldn't walk when I came here and now I only need a stick'. Three relatives that we spoke with told us that staff had the skills to meet their relative's needs and they had seen their relative improve in a few weeks.

Staff knew people well and treated them with dignity and respect. People looked comfortable and at ease with staff. We found that staff were supported to provide a safe service. Relatives told us, 'The staff are really lovely and definitely caring' and 'The staff don't seem to be able to do enough to support people'.

People had been involved in planning of their care and were supported to make plans for their future care.

The provider had checks in place to ensure that the service was safe.

We spent some time with the people and observed interactions between the people and the staff. People were moving around the home at their own pace and were being supported by the staff to go where they wished.

We saw that people were responsive in the company of staff. They were able to let staff know what they wanted and we saw staff responded in a caring and positive way.

The staff we spoke to had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

A relative told us that they were satisfied with the care and treatment their relative was receiving on Ogden unit. They said they did not have any complaints but would not hesitate to contact the manager if they did have.