Westfield Rest 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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to 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.

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

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.

Staff told us they felt supported and involved in improving the service and they considered they worked well as a team. The registered manager supported staff to understand the aim of the service, which was to deliver good care which met people’s needs and promoted their rights.

They told us the provider and registered manager promoted teamworking. Comments we received included, “[Registered manager] has put a lot of work into things here and it’s getting better all the time.”

People told us the registered manager was visible and supportive; during the assessment we saw people spoke openly and freely to the registered manager.

Leaders had the skills, knowledge, and experience to lead effectively.

The provider employed a registered manager who worked with other stakeholders, people and relatives to shape the service and deliver care. People said the registered manager was approachable and was available if they needed to speak with them on an individual basis.

Staff spoke positively about the provider and the management team. Staff said they felt supported, and they were able to discuss any concerns they had with them. One staff member said they were, “Very confident I’d be listened to.” Relatives praised the registered manager. One relative commented, “I have nothing but praise for [registered manager] as she is very approachable and informative on all matters pertaining to [family member].”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us the management team were available during the day and in the evenings, nights and weekends. There was an on-call system where staff could contact a member of the management team if advice was needed. Staff told us they were confident to speak up and believed appropriate action would be taken.

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.

The provider had a supportive culture which valued staff. Staff told us they felt valued and were confident the registered manager and provider promoted inclusion and equity. Staff could give examples of how their individuality was recognised and their rights upheld. One staff member shared how adjustments had been made to their working pattern in response to changes in their life.

The provider did not always have effective systems in place to drive improvement. There were significant shortfalls in relation to audits and checks carried out to identify risks. This meant the provider did not always act effectively to a range of risks.

Audits did not consistently identify shortfalls and improvements were not always made. For example, shortfalls in the safe management of medicines had not been identified through the audits carried out. In addition, audits had not identified lifting and moving equipment required servicing. Audits had not identified that wardrobes were not securely fixed to walls and that non tamperproof window restrictors were required in one part of the home. These shortfalls had not been identified through formal and informal audits and checks. All these shortfalls presented risks of harm to people, and the provider had failed to ensure they were safely and effectively overseen.

The provider understood their duty to work in partnership, so services worked seamlessly for people.

The provider and registered manager were working with external stakeholders to improve the service and told us they welcomed any guidance and support that would positively impact people’s experience. For example, the provider was taking action to improve fire safety at the service. The provider and registered manager were also working with the local authority to implement changes which would improve the service.

Staff told us they valued the advice and support from visiting professionals. A staff member commented, “They’re all very helpful and good to work with.”

The provider did not have effective processes in place to support continuous learning, innovation and improvement across the service. There were shortfalls relating to the implementation of lessons learned.

The provider did not always respond effectively to the expert advice of others. External contractors had identified work on the electrical system was needed to maintain the safety of the electrical system. This had not been completed. The registered manager told us they had previously been made aware that wardrobes should be fixed to walls. This had not been completed.

The provider did not always have effective systems to identify shortfalls and enable learning. At this assessment we found that the audit systems had not identified the concerns we found.