Westbury Court Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

There was a comprehensive quality assurance system, but not all shortfalls found at this inspection had been identified. This was a breach of regulation regarding good governance. Leaders took prompt action to address the shortfalls, including additional training and one to one meetings with staff. There was a strong focus on learning and further training was planned to help staff navigate the new electronic care planning system. Staff were well supported and there was a shared vision of providing good quality care. Staff were complimentary about leaders and their management. There were systems which encouraged staff to speak up, although some staff were apprehensive with doing so.

The service was in breach of the legal regulation relating to good governance.

This service scored 62 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders told us there was a strong culture of promoting people’s rights and ensuring each person received a good standard of personalised care. This started with ensuring all new staff had a strong value base which was built on through additional training and support.

Staff confirmed this direction and demonstrated their commitment to people. Specific comments included, “We’re here to care for residents first and foremost” and “We look after individuals in the way that suits them best.”

There were systems to share the direction and culture of the service with staff. This included staff meetings, individual one meetings and training sessions.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff were complimentary about leaders and their management style. Specific comments included “[The registered manager] is absolutely brilliant, motivated and tries her hardest to get things right” and “[The registered manager] she is a good manager is very firm but fair. She is approachable and gives a lot of support.”

Leaders confirmed support was available throughout the organisation. They said senior leaders regularly visited the home for auditing but also general support. This included giving strategies and ideas on addressing shortfalls or challenging situations. All leaders were available ‘out of hours’ for advice and support as required.

People did not always feel they could speak up and that their voice would be heard.

Some staff told us they did not like to speak up. They said they could speak to leaders but were concerned about confidentiality within the management team and the possibility of repercussions. Other staff told us they knew when to raise concerns about poor care and felt confident in doing this. One staff member said, “I would be happy to report and keep going higher. I wouldn’t want to be treated badly if I was a resident.”

There were systems to encourage staff to speak up. This included a Freedom to speak up policy, meetings and supervision sessions. Leaders told us they spent much of their time around the service, and they operated an open-door policy. This meant they held regular informal discussions with staff, which encouraged views to be shared. Senior leaders regularly spoke to staff during their visits to the service.

Health and social care professionals told us any concerns raised were acted upon promptly. One professional however said communication was quite limited and they rarely got replies to emails in a timely manner.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Leaders confirmed the staff team was made up of various ages, cultures, religions, experiences and skills. They said additional support was provided to enable staff to work to the best of their ability. This included adjustments to the staff member’s working hours to help with childcare responsibilities and an interpreter to support communication skills.

Staff confirmed leaders understood family and health issues and amended their work accordingly. Staff told us they had undertaken training in equality and diversity.

The provider failed to have clear responsibilities, roles, systems of accountability and good governance. They failed to act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There were comprehensive quality assurance systems. However, despite regular audits being undertaken, shortfalls identified at this inspection had not been identified. This included the lack of detail in care planning and ineffective monitoring of some people’s fluid intake, bowel care, skin integrity and call bell response times.

Shortfalls with decision making processes such as mental capacity assessments and best interest meetings had also not been identified. This did not demonstrate effective oversight of people’s care.

There was further lack of oversight of care provision on the first floor during our inspection. For example, there were too few staff available to support people with their lunch on the first day, but too many on the second. This had impacted on people’s care but had not been identified until we brought it to the attention of leaders. Staff had also interrupted people’s mid-morning drink to assist them with their personal care. Staff told people they would make them another drink once their support was completed, but this was not undertaken. People were therefore unnecessarily interrupted but also had reduced fluid intake as a result. Leaders had not identified this practice.

Records identified monthly analysis of people’s weight, and any falls and wounds sustained. This ensured people’s clinical care was kept under review, and appropriate support was in situ.

Leaders told us some audits such as Health and Safety used photographs to clarify any findings. Any shortfalls identified within the audits were added to the ‘whole home’ action plan. Leaders and staff team worked through this, with support from senior leaders as needed. Senior leaders monitored the schedule of the audits and associated action plans to ensure they were completed in a timely manner.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Leaders told us they worked well with other health and social care professionals and could call on them for health or advice. They said they gained ideas from other leaders of services within the organisation and were part of various forums. The forum enabled increased knowledge of best practice and shared experiences to learn from.

One health and social care professional confirmed established relationships with leaders. They told us they actively collaborated in the planning and organising of people’s care, from the point of admission to ongoing care planning process. However, another professional told us “I would just love better communication, better planning and better organisation.” They said it was disappointing the home had declined the support of a pharmacist to further improve medicine administration.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Leaders told us the change of provider had been positive, and many improvements had been made to systems and the environment. This included refurbishment of some bedrooms and bathrooms to a high specification and the replacement of some furniture such as shower chairs. Leaders told us there were further plans to enhance the environment for people including the garden.

The new provider had introduced a new electronic system to replace the use of paper. Leaders told us this had been positive although there had been some challenges. Staff had received training and further sessions were arranged after the first day of our inspection. Some staff confirmed they were still learning their way around the new system, so it was work in progress.

Leaders told us ongoing learning and improvement was important to them and wanted to ensure people received the best service possible.