We carried out a review of the data available to us about Westbank Care Home on 6 July 2023. 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 Westbank Care Home, you can give feedback on this service.
Westbank Care Home is a care home providing accommodation with nursing and personal care for up to 40 people. Peoples’ needs were varied and included people with nursing needs and people living with dementia. At the time of our inspection there were 37 people using the service. Accommodation is provided on one level with four different wings and communal areas, for example lounge and dining room.
People’s experience of using this service and what we found
People told us they felt safe and were happy living in Westbank Care Home. One person said, “Oh yes I feel safe, I like the windows open, but they only go so far, and I have my call bell.” Another person said, “Oh yes I’m safe. I’m just comfortable. Everybody is very nice.” Relatives agreed. One relative said, “My [relative] is safe living here and they have always been happy living here. I think that shows they feel safe.”
Risks were managed and staff had enough information to keep people safe. People received safe care and support from staff who knew them well. Medicines and infection control were both managed safely, and lessons were learned when things went wrong. There were enough staff deployed to meet peoples’ assessed needs.
People were involved in decisions about their care and they received care which promoted their dignity and encouraged independence. One relative said their relative was given as much independence as possible.
Effective quality assurance processes were in place to monitor the service and regular audits were undertaken. Staff had received appropriate training. A new manager had been appointed since our last inspection and staff told us they found them approachable and supportive with an open-door policy. Nurses told us they had good support from their clinical lead.
People using the service and relatives all spoke positively about Westbank Care Home and the staff. One relative said, “I would have no hesitation in recommending the excellent care offered at Westbank Care Home to anyone.” People and relatives described staff as kind, understanding, caring and patient.
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.
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 14 January 2020).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service remains good based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westbank Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Westbank Care Home provides accommodation along with nursing and personal care for up to 40 older people, some of whom were living with dementia. Accommodation is provided over one floor in a large purpose-built building located in a residential area. At the time of the inspection there were 34 people living at the home. People had access to a large communal lounge, dining room and beautiful gardens to enjoy.
People’s experience of using this service:
Whilst the registered manager had created an open and positive culture and knew people well, further work is required to improve person-centred care to ensure people’s history, likes and dislikes are recorded. Activities needed to be further embedded to ensure that they were available to everyone living at the home and that people who chose to spend time alone were not at risk of social isolation. Further work was needed to improve the environment for people living with dementia, to enable them to live as independently as possible and ensure staff had access to the right training in dementia to support people.
A relative told us, “I think this is a happy place to be and I am very content with the way mum is treated and looked after. We are happy with the building and environment. The gardens are beautiful. It’s like walking into a hotel and it ticks all the boxes.”
People told us they felt safe and knew who to contact if they had any concerns. Systems supported people to stay safe and reduced the risks to them. Staff knew how to recognise signs of abuse and what action to take to keep people safe. There was enough staff to support people safely and the registered manager had safe recruitment procedures and processes in place.
Staff were trained in administering medicines. People knew what their medication was for and told us they felt reassured by the support with their medicines. People were protected by the prevention and control of infection. Staff wore gloves and aprons when supporting people.
People were supported to maintain their health and had support to access health care services when they needed to. 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 received kind and compassionate care. People and relatives told us staff treated them with kindness and we observed friendly interactions throughout the inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: Good (report published on 3 July 2017).
Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care.
Follow up: We will continue to monitor the intelligence we receive about this service and plan to inspect in line with our re-inspection schedule for those services rated Good.
This inspection was carried out on 19 April 2017 and was unannounced.
There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.
People experienced flexible and responsive care that met their needs and wishes. The registered manager had developed a creative approach to promoting engagement with the local community. Spending time with children, people from the local community and animals promoted people's emotional wellbeing.
There were sufficient numbers of staff to meet people’s needs effectively and keep them safe. Staff were recruited following robust procedures to ensure they were suitable.
People were protected from abuse and harm by staff who had received safeguarding training and who understood the procedures for reporting any concerns. Most risks to their wellbeing were assessed and appropriately managed, but we made a recommendation about checking pressure relieving mattresses.
People were asked for their consent and were enabled to make their own decisions about their care. Staff understood and followed the principles of the Mental Capacity Act 2005. People were not deprived of their liberty unlawfully. Staff encouraged and enabled people to maintain their independence in daily life.
People were supported to manage their medicines safely. People had their health needs identified in their care plan and met. People were supported to access external health care professionals to meet specific health needs. People had a varied and balanced diet and had enough to eat and drink. Staff provided sensitive and well planned care for people who were at the end of their life.
The risk of infection in the service was minimised due to safe practices and good standards of cleanliness. The premises had been recently refurbished to a high standard. They were well maintained and met people’s needs. Ongoing improvements were underway to develop a dementia friendly environment.
People were supported by a team of care and nursing staff that were skilled and competent in meeting their needs. Staff were supported in their roles and received appropriate training and development opportunities.
People and their relatives told us that the staff were kind and caring and attentive to their needs. The staff knew people well and interacted in a positive way with them that demonstrated respect for them as individuals. Staff were sensitive to people’s emotional and spiritual needs. People received care that was personalised to reflect their wishes and their needs. They were supported to take part in activities of interest to them and to continue with their hobbies.
People were regularly asked for their feedback about the service and they told us their views were listened to. People knew how to make a complaint about the service if they needed to and were confident to do so.
The registered manager provided strong and effective leadership that promoted the person centred principles of the service. Some excellent projects had been implemented recently to support people to engage with their local community and to raise awareness of the service. There were some strong plans in place to taking the service forward in the area of end of life care and with the dementia strategy.
There was not a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. A manager had been appointed to the service in March 2016. They had not yet applied to CQC to be registered.
At the last inspection on 29 January and 1 February 2016, we issued warning notices for breaches of regulation in relation to person centred care, dignity and respect, safe care and treatment, safeguarding people from abuse and improper treatment, staffing and good governance. We also found the provider was not notifying the Commission of significant events that affect people’s welfare.
At this inspection we found that the registered provider had made the improvements required by the warning notices and the requirement notice.
People were safeguarded from abuse and improper treatment. Staff were clear about how to recognise and report any signs of abuse and they were confident to do so. Staff were aware of the risks that related to each person and the plan in place to manage these.
Care and nursing staff were clear about when to raise concerns with the GP about health concerns. Staff had clear guidance in place to support people with their individual needs. People were protected by effective systems for ensuring they received the medicines they needed at the right time and in a safe way.
There were sufficient numbers of experienced and qualified staff on duty to provide the care people needed. The registered provider followed robust procedures for the recruitment of new staff. This ensured people and their relatives could be assured that staff were of good character and fit to carry out their duties. Staff had been provided with the training and supervision they needed to carry out their roles safely and effectively.
Staff spoke respectfully with, and about people. They were discreet when discussing people’s personal care needs. Individualised care plans about each aspect of people’s care had been developed. Staff were clear about people’s needs and how to meet these. However we recommend that the registered provider review the arrangements for personal care to ensure it reflects people’s wishes. People were supported to have sufficient amounts of food and drink to meet their needs. However, we found that people were not always referred appropriately to the speech and language therapists when they required support with swallowing. We recommend that that the registered provider ensure appropriate advice is sought from health professionals before decisions are made about the consistency of people’s food.
Some people who were living with dementia did not have clear plans for how staff should support them with memory loss or confusion. We recommend that the registered provider implement clear plans to inform staff how to support people to manage memory loss and confusion.
Improvements were underway to the range of activities that were provided to meet people’s social needs.
People and their relatives told us that there had been improvements to the management of the service since our last inspection. We recommend that the registered provider fully embed the improvements made to ensure a personalised service is delivered consistently to people. Audits were effective and ensured that improvements were identified and made. Where shortfalls had been identified action had been taken quickly to address these.
The premises and equipment were safe for people to use. There was building work underway to complete the refurbishment of the premises. The service held a policy on infection control and practice that followed Department of Health guidelines and helped minimise risk from infection. Personal evacuation plans, that reflected people’s mobility levels and individual needs, were regularly reviewed in case of an emergency.
The registered provider had complied with the requirements of the Mental Capacity Act 2005 (MCA). People had been asked for consent before care and treatment was provided and had been supported to make decisions about their care and treatment.
People and their families, where appropriate, were involved in their day to day care. They were encouraged and enabled to be as independent as possible. Staff did not hurry people and allowed them time to do things for themselves. People’s views were sought and listened to. Resident and relative meetings were held regularly. People knew how to make a complaint. Complaints were recorded and responded to appropriately.
We had received information of concern about the service from a number of sources prior to the inspection.
There was not a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. A manager had been appointed to the service in December 2015, but they had not yet applied to CQC to be registered.
At the last inspection on 24 March 2015, we asked the provider to take action to make improvements in respect of dignity, consent, governance, records and staffing. An action plan was not sent to us by the date we required when we published the final report. An action plan was submitted in July 2015 when we requested this again. The final date the registered provider had set for compliance with the breached regulations was 30 September 2015.
At this inspection we found that the registered provider had failed to make or sustain the required improvements they had outlined in their action plan.
People had not always been safeguarded from abuse or harm whilst using the service. Systems in place to reduce the risk of harm had not been effective. The risks to the welfare of people and the safety of staff had not been appropriately managed or reduced. People were at risk of developing pressure wounds and dehydration due to a lack of effective systems for reducing these risks. One person was at risk of choking and guidance to minimise this risk had not been followed.
There were insufficient numbers of suitably skilled and experienced staff deployed in the service to meet people’s needs. This meant that people waited unreasonable lengths of time for care and for their meals. Staffing numbers on occasions during December 2015 were seriously below the number required to keep people safe in the service.
Staff did not receive adequate induction or training to ensure they were competent in providing safe and effective care to people. The registered provider had not ensured that systems for the regular supervision of staff were effective to ensure they were meeting people’s needs.
Whilst we saw some examples of caring and compassionate staff we found that people were not always treated with respect or their dignity and privacy maintained. Staff were unclear how to respond appropriately to people who were confused or had memory loss.
People did not always receive a personalised service that reflected their needs and preferences. People were not supported to get up at a time they wanted. A lack of directive care planning meant that people’s needs were not always met.
There was a lack of effective leadership of the service. Audits and quality monitoring systems had not identified shortfalls in the provision of safe and effective care and plans to make improvements, following our last inspection, had not been successful.
People did not consistently have their nutrition and hydration needs met. People did not always have their health needs met in a timely way. People did not have care plans in place to enable them to improve their mobility and independence. We have made a recommendation about this.
Recruitment procedures were robust to ensure that people were suitable to work in the service.
People were provided with information about the service provided and were signposted to other services available to them.
People’s medicines were managed safely. A policy for the management of medicines was not available. We have made a recommendation about this.
People lived in a clean environment and systems were in place to reduce the risk of the spread of infection. The premises was under refurbishment to modernise the service taking into account the needs of the people who used the service, including those living with dementia.
People were supported to make decisions about their care and treatment and had their rights under the Mental Capacity Act 2005 met. People were only deprived of their liberty in line with the law.
People knew how to make a complaint. People’s views were sought through residents and relatives meetings and an annual survey, but the registered provider had not considered alternative and creative methods to seek the views of people with limited verbal communication. We have made a recommendation about this.
You can see what action we have told the registered provider to take at the back of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Following the inspection of this service we continue to liaise with the local authority who is working closely with the service to ensure people’s safety.
This inspection took place on 24 March 2015 and was unannounced.
Westbank is a care home that provides personal and nursing care to up to 40 older people. This includes people with a physical disability and some people living with dementia. There were 35 people using the service at the time of the inspection. The last inspection was carried out on 17 March 2014 when we found the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were met.
Westbank Care home is required to have 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. There was no registered manager at the service. The service had been without a registered manager since 6 March 2015. The provider had acted swiftly to appoint another manager who was yet to make an application to the Commission for registration. A registered manager from another service and the area manager had been overseeing the running of the service. They were continuing to work in the service to support the new manager.
During this inspection we found breaches 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.
There were insufficient numbers of suitably qualified, skilled and experienced staff to meet people’s needs. Agency staff were regularly used to cover staff vacancies and they did not always have a full understanding of people’s needs and the care they required. Staff had not received the training, supervision and support they needed to effectively and safely care for people. Staff were not organised in a way that ensured people received care and support at the right time. People were often left waiting for unreasonable lengths of times for their meals.
Where people needed to make a decision about whether to receive a potentially lifesaving treatment, the correct process had not been followed to comply with the Mental Capacity Act 2005 to protect people’s rights.
People were not consistently treated with dignity and respect. Staff talked over people’s heads and some staff did not engage with them in a respectful way during mealtimes. There were also examples of staff treating people with kindness and compassion, for example listening to them, showing warmth and providing care at an appropriate pace. However, this was not consistent and staff did not have time to spend engaging with people in a positive way.
The service had a set of vision and values that promoted person centred care, but these were not consistently delivered by staff. The registered provider had not ensured that there were effective systems in place to monitor the quality of care and identify where the vision and values were not delivered. The registered provider had developed an action plan for improving other areas of the service and was working on completion of this.
Record keeping was inconsistent, which meant the registered provider could not check that people had received the care they needed.
People felt safe in the service and staff knew how to recognise and respond to signs of abuse. Staff were confident to “blow the whistle” on poor practice and knew how to do so.
Risks to people’s safety had been assessed and minimised. Staff knew the procedures to follow in the event of an emergency. Equipment was serviced and tested regularly to ensure it was working well.
People received their prescribed medicines when they needed them and in a safe way. The storage of medicines was cluttered and nurses were sometimes interrupted by other staff when administering medicines. We have made a recommendation about the management of medicines.
The service was kept clean and hygienic. Steps had been taken to reduce the risk of infection spreading in the service.
Staff had not received sufficient appropriate training in dementia to ensure they were confident in communicating effectively with people and meeting their needs. The environment had not been assessed to ensure it met the needs of people with living with dementia. People living with dementia had not been supported in a person centred way to take part in activities of interest to them to avoid the risk of social isolation and boredom. We have made some recommendations about the care of people living with dementia.
The registered provider and managers understood the requirements of the Deprivation of Liberty Safeguards (DoLS) and had made applications to the relevant authority where people needed to be deprived of their liberty to ensure their safety.
People enjoyed their meals and had a variety of foods and drinks to choose from. People were provided with sufficient amounts of food and drink to meet their needs.
People had their health needs met and their health and welfare monitored. Staff reported concerns to the nurses on duty who contacted other health professionals as needed.
People had been involved in planning their care when they moved to the service, but had not always been aware of changes to their plan. The new manager had begun reviewing people’s care plans with people and their families. People had been asked about what was important to them, but this information had not been used to plan their care. This meant that people did not always receive person centred care.
People knew how to make a complaint if they needed to and felt confident to do so. The complaints procedure was available in written format only. We have made a recommendation about the complaints procedure.
Effective systems were in place for checking the suitability of staff employed to work in the service. The provider had ensured all employees had a police check and that references were checked before they started working in the service. All staff had been required to undergo an interview and to provide information about their previous employment and their qualifications.
The provider and the registered manager sought feedback from people that used the service and staff regularly. Both staff and people using the service told us they knew who they could talk to if they felt there was a problem or if they had a suggestion for how the service could be improved. The service was well led, with decisions about people's care being made by qualified nursing staff and the clinical manager.
Although there had been some recent difficulties providing the numbers of staff required to care for people this had been addressed and there were sufficient numbers of staff to ensure people were cared for effectively. We saw that staff were caring and patient when supporting people, however, some staff used over-familiar terms when addressing people which the manager said she would raise with the team.
The service was provided within safe and well maintained premises. The manager and the provider of the service carried out a range of quality and safety checks to ensure that people were receiving quality care and that their health and welfare were maintained.
People we spoke with told us they liked living at Westbank and were involved in making decisions about their care and support. They said they were given choices about their daily routines such as when to get up and go to bed, what to eat and what to do each day.
People told us that staff were kind, polite and respectful. They said staff respected their dignity and independence. One person said 'I do a lot myself, I can wash and dress, but I need help to shower'. Another person said 'Staff are always there if you need them'.
Relatives told us 'We are very happy with this place 'and 'We have got to know staff well, and they are helpful'.