Westdene House

Westdene House is a residential care home providing personal care to up to 14 people. The service provides support to people living with dementia and age-related frailties. At the time of our inspection there were 12 people using the service.

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

Quality assurance processes were in place; however, audits of care records had not always identified some inaccuracies in some people’s care records. The inaccuracies had no negative impact to people and were rectified during the inspection. The registered manager told us of their plans to increase further monitoring of records. Other quality assurance processes were effective in identifying areas for improvement, such as, environmental checks and audits.

People told us they felt safe at the service. People appeared relaxed and spoke freely with staff and the registered manager. Staff understood their responsibilities to safeguard people from the risk of potential abuse and knew how to report concerns internally and to external professional bodies. One staff member told us, “If I saw something, I would tell the manager. If nothing changed, I would contact social care.”

People's needs were assessed, and risks associated to people’s health were mitigated. Where people had healthcare equipment, such as, catheters in situ, staff followed care plans to ensure they were supported safely and kept well hydrated. Staff received training relevant to their roles and demonstrated knowledge on how they provided safe care to people.

People received their medicines by staff who were trained and assessed as competent to administer them. Medicines were administered safely, staff carried out checks to ensure storage, documentation and administration was completed correctly. Relatives told us they were kept informed of their loved one’s changes to health and medicines. One relative said, “Staff keep me informed of any changes in [person’s] care or medication, or if they are unwell, communication is good usually by phone.”

People were supported by enough staff who knew them well. Staff told us there was enough time to spend with people, our observations confirmed this. A visiting social care professional told us, “The residents tend to be out in the social areas which is a positive. Interactions I've seen are positive, they (staff) have a good rapport with them (people), calling them by their first names. No concerns at all, the home is clean, it’s a small home so staff can be very individualised with the care they give.”

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 enabled to go out for walks, the local café and seafront. The registered manager had risk assessed trips out to ensure people were safe.

People were empowered to make and maintain relationships with friends and family. This was achieved by visits inside the service or people going out with their loved ones, where needed, people could contact relatives using video technology. People and their relatives told us staff and management listened to them and their opinions mattered. The registered manager held meetings and gathered views from feedback surveys. One person told us, “It's all pretty much nice. I am happy and if there were any queries, I would raise them.”

People had access to health care professional advice, staff sought advice in a timely way and followed professional’s directions. One healthcare professional told us, “They know the residents very well and they are very involved in their care. They are appropriate and reasonable with their requests. There doesn’t seem to be a huge staff turnover which is a positive sign. They are very welcoming; they follow appropriate processes.”

People were supported by a consistent staff team, led by a committed registered manager and management team. The registered manager told us they were proud of the commitment and resilience of the staffing team throughout the COVID-19 global pandemic.

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 11 December 2019) and there was a breach of regulation. 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 regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 and 16 October 2019. A breach of legal requirements was found in relation to quality assurance checks of equipment, medicines and infection prevention and control. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, responsive and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westdene House 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.

Westdene House is registered to provide accommodation for up to 14 older people that may require personal care. Some people at the home were living with dementia, mental health needs or physical health conditions related to old age and frailty. On the inspection there were 12 people residing at the home. The care home was one adapted building.

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

People told us they felt safe and were happy the care they received. Our observation confirmed this, we observed friendly interactions between people and staff and we saw people were relaxed in the presence of staff. A person told us, “It’s a lovely place, staff are kind, I’d give it top marks.”

People were supported to eat and drink well and people were complimentary about the homemade meals served, a person told us, “The food is really lovely.” Despite this, we identified that ensuring that dietary needs were reflected across all documentation was an area of improvement.

Although we saw improvements in the provision of activities and in recording what was important for people, people continued to not be supported to participate in activities of their choice and people continued to be at risk of social isolation. We identified this as an area of improvement.

People told us they felt safe. Staff knew how to keep people safe in an emergency. Evacuation plans were up to date for each person. People’s medicines were managed safely. Staff knew what action to take if they had any concerns about people’s safety or welfare. People’s risks were identified and assessed appropriately.

The provider had a range of audits and checklists to monitor the quality of care and to identify improvements, however ensuring the efficacy of these audits was an area of improvement. Checks on the safety of equipment used by people such as wheelchairs, hoists and slings were out of date. We told the provider and they took immediate action. We recommended that the provider increases their oversight of servicing all equipment to ensure there are no gaps in servicing.

Before they came to live at the home, people’s needs were fully assessed to ensure that staff could meet their needs appropriately. People had access to a range of healthcare professionals and services. Care plans guided staff about people’s needs and how to meet them.

No-one living at the home required end of life care at the time of the inspection, but if a person wanted to discuss advanced planning their preferences were recorded.

People and relatives knew how to make a complaint and felt confident that their feedback was listened to and acted upon.

People were supported by staff whose suitability was checked through a robust recruitment process. Staff completed relevant training to provide effective care to people. Staff told us they felt well supported, received regular supervisions and an annual appraisal.

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 requires improvement (published 16 January 2019) and there were breaches of regulation. We met with the provider and they 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 four regulations were met however one breach of regulation continued. The service remains rated requires improvement. This service has been rated requires improvement for the two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Westdene House is registered to provide accommodation for up to 14 older people that may require personal care. Some people at the home were living with dementia. The home provides short term/respite stays. On the inspection there were 12 people residing at the home.

Westdene House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in place. 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. On the day of our inspection the registered manager was away so we spoke to the person in charge who oversaw the day to day running of the home.

At our last inspection on 15 March 2016, the service was rated as ‘Good’ overall with the key questions of ‘Safe’ being rated as ‘Requires improvement’, as concerns were identified relating to the safe management of medicines. At this inspection medicines were being stored, managed and administered safely but other concerns around people’s safety were identified.

Staff did not always know people well enough to support them safely or to evacuate people safely in the event of an emergency. Evacuation plans were not up to date for people. People’s risks were assessed and documented but records were not always up to date and did not accurately reflect the needs of the person. Staff were given training and were trained in moving people safely but an instance of staff practice was observed to be unsafe. Records were not always accurate, for example care plans did not provide staff with clear or up to date information. If someone’s needs had changed plans did not always reflect this. Staff carried out a range of audits but these did not have clear actions to improve the service.

There were policies and procedures to safeguard people from abuse but staff did not always understand safeguarding processes. Records showed that staff did not arrange immediate or timely access to healthcare following incidents such as a fall where injuries may have been sustained. Staff told us that if a person fell staff did not immediately seek healthcare help to assess what care they needed. People’s health care needs were not always monitored however staff did liaise with health care and mental health services such as referrals for people.

People were not always protected from the risks of infection control and prevention and some areas of the home were not well maintained. People’s rooms and areas of the home were not always clean and there were unpleasant odours in certain areas throughout the inspection. We have recommended that there is a review of the frequency and effectiveness of the carpet shampooing regime at the home.

Records showed that people's capacity to consent to care and treatment was not always assessed in line with best practice guidance and procedures to make best interest decisions were not in place. People were not encouraged to express themselves or to be involved in their own care. Staff had basic awareness of the principles as set out in the Mental Capacity Act 2005 Code of Practice and Deprivation of Liberty Safeguards (DoLS) but records and staff’s understanding showed principles were not put into practice.

People were not always treated in a caring or respectful way by staff but some kind interactions were observed. People told us they were not supported to participate in activities of their choice or pursue hobbies and people did not receive support that was responsive to their individual needs and interests. Records showed that a weekly structured activity programme was in place and people were asked for feedback in resident’s meetings on activities. People’s privacy was not always supported by adaptations to the premises or by staff.

We observed a lunchtime meal, people were not always supported to eat and drink well. Drinks and snacks were not observed to be freely available throughout the day for people apart from water observed in some rooms. People were supported to have a balanced and nutritious diet and were supported to choose their meals from options provided to them. People were provided with a balanced diet that was suitable to their individual needs.

At this inspection we found five breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Westdene Rest Home is registered to provide accommodation for up to 14 older people that may require personal care. At the time of the inspection 7 people were living at the home this included two people who were receiving respite care. Some people were living with dementia.

A registered manager was in post who was also the provider owner of the home. 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.

Westdene Rest Home is at the end of a close near the seafront in Worthing. Communal areas included a dining room and a conservatory which led onto a court yard garden area. All bedrooms were single occupancy apart from one which was shared. All bedrooms had en-suite facilities.

We found the home to be clean and tidy and maintained to a high standard. Home furnishings such as pictures, flowers and ornaments decorated communal areas. The ambience of the home was warm and inviting.

Medicines were not always managed safely for people. The records and our observations did not demonstrate that all people had received their medicines as prescribed. This was fed back to the registered manager who had recognised this was an issue.

People and their relatives felt that Westdene Rest Home was a safe environment. There was sufficient staff who had been trained in how to recognise signs of potential abuse and protected people from harm. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. The service followed safe staff recruitment practices and provided a thorough induction process to prepare new staff for their new role.

Staff demonstrated how they would implement the training they received in core subject areas by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager.

Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. They also understood the associated legislation under Deprivation of Liberty Safeguards and restrictions to people’s freedom.

Additional drinks and snacks were observed being offered in between meals and staff knew people’s preferences and choices of where and what they liked to eat.

Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach.

People received personalised care. Care plans reflected information relevant to each individual and provided clear guidance to staff on how to meet people’s needs. There was a complaints policy in place. All complaints were treated seriously and were managed in line with the complaints policy.

People and staff told us they were happy with the activities that had been organised. During the inspection we observed staff sat talking to people about topics of interest to them.

People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and treatment. Relatives were also encouraged to give their feedback on how they viewed the service and where necessary support with the reviewing of the care plans alongside more senior staff.

The registered manager was open to feedback and promoted a positive culture in the home.

A range of quality audit processes overseen by the registered manager were in place to measure the overall quality of the service provided

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.