Westcott House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider generally had a proactive and positive culture of safety based on openness and honesty. However, lessons were not always learnt to continually identify and embed good practice.

The registered manager largely understood their role to record accidents and incidents, and how to reduce the risk of these happening again. There were systems in place, including an accident and incident reporting policy and procedure, and staff knew how to record these. However, there was limited opportunities for the service to be proactive as systems for learning were not established or operating effectively.

Records showed accidents and incidents were reported to the local authority where this was appropriate and action was taken following incidents. For example, in relation to moving and handling the provider ensured staff understood their responsibilities to report concerns. The provider told us of plans to strengthen their ability to learn from events in the service.

The registered manager analysed incidents to look at patterns and possible ways to reduce them. This included a monthly analysis and discussions with the team on how to reduce risks. We saw significant progress had been made by the provider to instil a culture within the staff team of consistently learning lessons from incidents, but further time was required to embed this based on our findings.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff worked together with a range of services to ensure there was continuity of care. We saw referrals were made to ensure safe transitions such as to the community mental health team and the GP. One healthcare professional told us, “They communicate pretty well. They’re very organised but it’s been a big project. They’ve improved on this very much.”

There was a business continuity plan (BCP) in place which included information on what to do in the event of an emergency. The BCP contained information on what staff should do to enable to service to still operate in the event of an emergency, such as a loss of electricity.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff did not always understand what safeguarding meant and how they would report concerns internally and externally. Staff training records showed staff had completed safeguarding training, but some staff told us they did not remember learning from the training. This is a significant concern as this puts people at risk of harm. The provider acknowledged this and immediately sent us a comprehensive action plan of how this was being addressed, such as by increasing the number of in-person checks with staff rather than relying on online learning modules. Other staff were able to tell us how to recognise potential signs of abuse and what they would do to report these. One member of staff told us in relation to safeguarding people, “I will tell the nurse. Take a picture and put it on the system.”

People and their relatives told us they felt safe with staff with the majority of comments being positive but others stating staff could rush at times. Comments we received included, “I feel safe as they (staff) are wonderful”, “[Person] had a bruise one time and they told me about it. They always tell me”, “I go at least once a week, at different days and at different times, never the same sequence and [person] is always comfortable” and “Importantly [person] has told me he feels safe.”

There was a safeguarding policy and procedure in place, and the provider had undertaken spot checks in response to concerns they had received. The registered manager was aware of the majority of shortfalls we identified in relation to safeguarding people and they had developed a plan on how to ensure they had effective oversight of the culture in the service.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The provider understood their responsibility in relation to safeguarding people’s rights and what would constitute a restrictive practice. Applications were submitted to the local authority, and we saw that applications had considered the least restrictive ways, and they had involved relatives and healthcare professionals in the decision-making process.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were not always protected from avoidable harm as risk management within the service was not effective. We found care records were not always reflective of people’s current needs and risk assessments were not always clear in how to mitigate known risks, for example, the risk of isolation, developing pressure sores, falls or unplanned weight-loss. Daily records showed people were not always repositioned or weighed in line with their risk assessments. Whilst we did not identify direct impact from this, there was a risk people may not always have positive outcomes.

Staff did not always recognise the risk of isolation and how to reduce this. We found 2 people were in their rooms in the morning despite telling us they wished to be in a communal area with other people. Isolation can have a significant effect on people. We found 9 people’s air-flow pressure-relieving mattresses were not set to the person’s correct weight. Whilst we did not find evidence that this had directly impacted on people, it increased the risk of people developing pressure areas on their skin and had not been identified by the provider’s systems.

However, where people were admitted with pressure areas or sustained these at the service, staff worked together with the tissue viability nurse (TVN), undertook nutritional assessments and monitored their skin in line with TVN advice.

People and their relatives told us staff understood people’s risks in relation to their care. Comments in relation to whether staff managed risks in a safe way included, “Yes, they do and [person] is hoisted all the time”, “[Person] gets out of bed at night and injures herself. They have now lowered her bed quite down” and “[Staff] are always popping in and out to check on me.”

Staff understood risks in relation to people’s care and considered people’s wishes. Comments from staff included, “I let them do what they want to do, but support from behind. I leave them to be as free as they want to” and “We know who is at risk of falls and can fall out of bed that’s why we have a crash mat. We know those that can walk out of their room."

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care

Safety checks of the premises were undertaken regularly and the provider continuously looked at ways to make the environment safer. Fire safety checks had been carried out and the provider had worked with external partners to identify and address areas of improvement.

However, we also found one person’s bed rails were not suitable as their legs were placed over them and the bed had not been lowered to a safe height by staff. The provider was responsive to our concerns.

People and their relatives told us the environment people lived in was safe. One relative told us, “Big improvement with the new company who took over 2 to 3 years ago. Really lots of improvements.” Another relative commented, “I always say Dad is warm, comfortable and safe.”

People were not always supported by enough staff to ensure their safety, wellbeing and comfort.Whilst we observed there were sufficient staff on duty, there were areas of improvement in relation to the effective deployment of staff. For example, we observed people’s mealtimes were unorganised and people had to wait a long time for their meals even after they expressed to staff that they would like to have them. Staff told us they felt compelled to provide meals to people in communal areas first as there were not enough of them (staff). We also observed people having to wait a long time between the meal being placed in front of them and being assisted by a member of staff which meant meals had become cold before they were assisted. When we asked a person if there were sufficient staff at the service, they responded, “Not all the time, evening time is worse.” A member of staff told us in relation to people receiving meals due to the lack of effective staff deployment, “I feel people’s meals are not always hot.”

Where a person was receiving planned one-to-one care, we saw they were left unsupervised for periods as staff were called away to complete other tasks. This was not in line with their planned care and placed them at risk as the person’s one-to-one care was in place to ensure they were supervised when mobilising. The provider told us they had addressed incorrect records and implemented improved monitoring systems immediately.

The majority of people and their relatives told us there were sufficient staff to meet people’s needs. Comments in relation to staffing included, “As far as I am aware, yes”, “There is a lot of familiar faces, who have been there for years. They have very good retention of staff” and “Wouldn’t know about nights, otherwise I believe there is enough. My [relative] and I see our mother most days. So, in reality we are there a lot.”

Feedback from staff was mixed. Whilst some staff told us there were sufficient suitably skilled staff to meet people’s needs, others commented that this was not always the case. Comments included “I think there should be an extra day and night [carer] as a floater. One staff is enough for the [annex building], but in the main building you need at least 2 [housekeepers] because it is 3 floors”, “We have enough, because I didn’t feel a struggle when we are on shift. We are busy but we have enough staff” and “There is enough staff.”

Staff had completed training to undertake their role and had received regular supervisions. Staff rosters showed a regular staff team which meant there was continuity of care for people. One member of staff told us, “We have it (supervision) every 3 months. We are allowed to raise concerns. It’s really helpful. We can also ask for training.”

Staff were recruited safely to the service. This included requesting and receiving references from previous employers, right-to-work documentation, checking professional registrations and Disclosure and Barring Service (DBS) checks. DBS checks are carried out to confirm whether prospective staff had a criminal record or were barred from working with people at the time.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People and their relatives told us the environment was clean and staff understood their responsibilities in relation to infection control. One person told us, “They come in and clean my room. They clean it well.” A relative told us, “It is always very clean.”

We observed staff following infection prevention and control (IPC) procedures and where there were minor areas of improvement due to the age of the premises and some equipment, the provider was already aware of these and actively addressing them.

The provider had IPC policies and procedures in place and undertook regular IPC checks of the environment and equipment. They understood their responsibilities to report infection outbreaks to the relevant health authorities and records showed that staff cleaned the environment regularly, and they told us they had sufficient personal protective equipment (PPE). One member of staff told us, “We have plenty of PPE and cleaning equipment.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were stored securely and at appropriate temperatures. There was an adequate stock of prescribed medicines. Our observations and records showed that people were having their medicines administered as prescribed. Some people were administered medicines covertly. Covert medication refers to the practice of administering medicines to a person without their knowledge or consent, often by disguising the medication in food or drink. Staff carried out appropriate assessments and involved the necessary individuals including the GP and next of kin to ensure this was done safely.

Person-centred documentation was in place to support people with their medicines. Some people were prescribed medicines to be administered on a ‘when required’ basis for health conditions such as constipation and pain.

Clinical staff from the local GP practice reviewed medicines for people regularly. The home management worked with the GP practice and local health agencies to address people’s health needs.

There was a medicine policy in place. There was a process in place to report and investigate medicine errors and incidents. Staff carried out medicine management audits to identify gaps and make improvements. Staff received training and were competency assessed to handle medicines safely.