Westerley Care 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. At our last assessment we rated this key question good. At this assessment the rating has changed to 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 provider was in breach of legal regulations in relation to managing risks to people, safeguarding, staffing levels and training. There were not always enough staff deployed at night and only one night staff was trained to administer medicines. Risks to people and safeguarding concerns were not always managed well.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager had an electronic system for incident reporting. Managers received an alert when staff completed incident reports and reviewed them for any required actions. We reviewed the incident tracker which was downloaded monthly and saw examples of actions taken such as referrals to other services and measures to help prevent them happening again. Staff were informed of any incidents at shift handovers. A staff member said, “My manager shares and updates all the information that we are supposed to know.” However, when staff identified minor injuries such as bruises, action taken was less clear. These were recorded by staff as health issues on the system and those we reviewed did not have documentation beyond reporting to the team leader and we saw no evidence of investigation as to how they had occurred. We fed this back to the registered manager who acknowledged there were some gaps in documentation to be addressed.

The registered manager 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.

People’s relatives confirmed they accessed other services as required. A relative said, “[Person] goes to the dentist regularly, has chiropody regularly and hairdresser. They will contact GP who will visit if needed.” A professional told us, “The care home provides an excellent standard of care, looking after residents with full dedication and attention. The staff and management are highly conscientious, particularly when a resident becomes unwell. They act promptly and seek medical assistance without delay.” Another professional said, “If a patient needs to attend an outpatient appointment, a member of staff will accompany them if a relative is not able to.”

The registered manager had not made safeguarding referrals as required. We reviewed records and found staff documented unexplained injuries such as bruises and scratches and informed the team leader. Although in those we looked at the deputy manager was able to explain how these were likely to have occurred, there was no documentation to support how they were assured of this, and whether they had ruled out the possibility of abuse and neglect. As a result, the safeguarding procedures were not followed and none of the information had been shared with the safeguarding team.Prior to the assessment we were aware of other safeguarding concerns which had not been reported to the local authority or CQC. However, the provider told us of action taken to help prevent this happening in future.

Staff we spoke with were not able to explain what safeguarding was or give examples of types of abuse they would be expected to report. There was a safeguarding policy; the register manager described the procedure, and staff were trained in safeguarding. Most people and their relatives confirmed they felt people were safe. A person said, “Oh yes very well looked after and I am quite safe.” However, given the lack of reporting and staff understanding, we were not assured safeguarding concerns were managed as required.

The registered manager did not always manage risks to people well. Staff recorded the fluid intake for all people using the service and managers received an alert if the person had not met their target. We saw an alert the day before our visit showed all 26 people had not met their target of 1200ml, which was the same for everyone. Not all people were at risk of low fluid intake, so some of this monitoring was unnecessary and we would expect the daily targets to differ depending on the individual needs of the person. Following our inspection, the registered manager told us the 1200ml target generated an alert during the day to remind staff to check people were on track to meet their individual targets.We reviewed the records for some of those who relied on staff to ensure they drank enough and found targets were not met for 2 weeks and some intake was significantly lower than the target. This meant people were at risk of dehydration and the process to monitor this was not effective. The registered manager told us people received additional fluid via lollies and jellies but the volume of fluid these contain would not account for the shortfalls identified.Following our inspection, the registered manager provided a chart which showed the liquid volumes these were equivalent to and a chart they were recorded on. However, the records we reviewed did not clearly show whether the volume of fluid contained in jelly or other food items was included in the overall fluid intake of the person for monitoring and alerting purposes.

Staff completed risk assessments; these tended to be quite brief, the risk level was not always recorded, and mitigations for the risks were not always clear. These tended to be included in people’s care plans, but we found some information had not been updated consistently throughout the records so these accurately reflected people’s needs and risks to them. For example, a person’s skin integrity care plan stated they needed support to mobilise from time to time. Elsewhere in the same person's care record it stated support of 2 staff was required with hoist.

People’s records were not always clear about modified diets. For example, we reviewed a person’s nutrition care plan which stated they were on a pureed diet. They had a choking risk assessment, which had no score/risk level and did not mention a Speech and Language Therapy (SALT) assessment. The manager told us the dietician had suggested different textured food to encourage eating. This appeared to mean there was no risk of choking, but it was not clear. Another person had a choking risk assessment with a score of zero suggesting no risk; elsewhere in their record it said they were on a soft diet. During our visit we also observed staff supporting the person to eat whole sausages. We did not see any evidence staff had been trained to prepare food to appropriate textures. This meant people may receive meals which had not been prepared to the appropriate texture, putting them at risk of choking. During our second visit a manager booked this training for staff.However, following the inspection we were sent training certificates which showed the kitchen staff had completed dysphagia training in December 2024; this information was not provided when we discussed this with managers during our second visit.

Notwithstanding the above, most people and their relatives felt people were supported to manage risk. A relative told us, “They check the room every hours. There is a lot of reinforcement that [person] needs to call for help.” Another relative said, “The only real risk is choking, [person] has foods pureed and drinks thickened – they are careful not lay [them] down immediately after meals.”

The service’s environment was not always suitable to support delivery of safe care. The building required refurbishment, and some aspects of the layout were not ideal. We found the living spaces downstairs did not allow for relaxation; the 2 adjoining lounge areas and café felt quite hectic with staff in and out, a TV on in both lounges and music also on as part of activities. There were bright colours on all the walls – decorated to look like a florist, post office etc – which, whilst positive for some people could be over stimulating for others. The home was very warm, even though there were fans throughout, which also contributed to the high noise levels. Whilst no one we spoke with described this as an issue, most of the people living at the service were not able to speak with us.

The registered manager had attempted to make the most of the options given the constraints of the building. For example, 1 lounge area was intended to be a quieter area, but this did not really work due to the proximity to the other lounge through an archway. Upstairs there was a room designed to look like a pub for people to sit with their relatives – there was no bar, but it was decorated and had board games etc. This was a nice area, but 1 person’s room was only accessible via the ‘pub.’ This was not ideal because the idea was for people to have private time with their families here which the person would disturb to go to and from their room.

We found some damage to flooring, which was addressed immediately when we told the manager, and some side tables were damaged. However, equipment such as hoists and slings were in a good state of repair and clean.

The registered manager had planned to relocate to new premises and had just found out this could not go ahead. Therefore, they had plans for a full refurbishment of the existing premises to include additional communal space on the ground floor.

The registered manager did not always make sure there were enough qualified, skilled and experienced staff deployed to meet people’s needs. They did not always make sure staff received effective support, supervision and development.

People were not always supported by enough staff at night. 2 staff provided care across 3 floors. This meant if they were supporting someone who required 2 staff, such as hoisting, there were no staff available to respond to call bells or potential emergencies. A person said, “We need more staff during the night, only 2 of them moving around – 30 residents at least 25 need assistance to go to bed so those staff are busy putting people to bed – we cannot make coffee for ourselves, so it’s a long wait if you want anything.”

At our second visit, the registered manager told us this had only been an issue since our first visit as 2 staff had left, and recruitment was ongoing. However, we found a rota which was dated prior to our first visit which showed only 2 staff for the night shift, suggesting this was an ongoing situation. The registered manager told us the staff shortage was mitigated by an option to call staff who lived in their on-site staff accommodation. They told us 1 of the 4 staff who lived there were allocated as a sleep-in shift to be disturbed as required, but this was not indicated on the rota. Therefore, we were not assured this was a formal arrangement and there was a risk night staff may not know who to call for support or for on-site staff to be called at random when they were meant to be off duty.

Most night staff were not trained to administer medicines. People’s regular medicines were administered by trained day staff. However, the lack of training to manage medicines for night staff meant there were often occasions where people would not be able to have medicines prescribed to be given if required, for pain relief for example. We fed this back to the registered manager who told us staff would call someone to come in and administer for them. However, this may cause a delay for people to receive medicines in a timely way, and we were not assured staff were aware of this procedure. A staff member told us, “Night staff are not being provided with the same medical training as day staff. This leaves us unprepared to manage medical situations that can and do arise during the night.”

The Registered manager did not always assess or manage the risk of infection well. Whilst most of the home was clean, we found room for improvement in some areas such as dirty skirting and a pedal bin left open. A shower room had an unclean shower tray. Some toilets looked dirty although this appeared to be staining from cleaning products. We fed this back to a manager who told us they were on a list for replacement. However, we reviewed the most recent Infection Prevention and Control (IPC) audit and saw none of the concerns we found were identified during the audit.

Staff wore personal protective equipment (PPE) and washed their hands. A person told us, “Yes they always wash their hands and wash our hands too.” Another person said, “Yes they wear gloves and aprons.”

People received their medicines as prescribed. A person said, “Yes I get it when I need it.”

We observed staff putting thickener in people’s drinks, for those who needed it. However, we noted this was all being taken from a tub which was prescribed to 1 person. Staff confirmed they bring a tub out and use it for everyone who needs thickener. We fed this back to the registered manager who agreed they should not be doing this and would speak with staff. Following our visit, guidance around the use of thickeners was shared with staff.

People who were prescribed medicines to be given when required (PRN), had protocols for staff to refer to so they knew when and how to administer them. However, there was a risk people would not receive PRN medicines if they needed them at night because there were not enough staff on night shifts trained to manage these medicines.

Staff were able to describe the action they would take if a person refused their medicines or if an error was made.