Westwood Lodge Care Home

We found the following examples of good practice.

The provider was facilitating visits for people who used the service safely. People who were going out were encouraged to wear masks while in public places.

The service was clean. Enhanced cleaning was being carried out including frequent touch points such as handrails and door handles.

People were encouraged to be socially distant from each other when in communal areas. Staff worked on set floors of the service to help stop the transmission of infection between people.

An infection prevention specialist had recently visited the service, the registered manager had acted on their advice for improvements in infection control practises.

We found the following examples of good practice.

We received information staff did not consistently wear face masks, however we found staff were complying with this requirement when we visited.

Although the home was clean, some areas were worn and needed updating. The registered manager advised these were being addressed as part of an on-going refurbishment programme.

The service had implemented enhanced cleaning, which included frequent touchpoints. All visitors were screened before entry and asked to wear appropriate PPE.

People were supported to maintain contact with others, whilst some people accessed the local community independently.

We found the following examples of good practice:

• Appropriate measures were in place to reduce the risk of infection. Personal protective equipment (PPE) was appropriately stored and used by staff. Staff had undertaken additional training in infection prevention and control and regular audits were carried out.

• Enhanced cleaning was taking place of frequently touched surfaces. All visitors were required to wear appropriate PPE and follow good hand hygiene practices.

• The provider was following national guidance for anyone moving into the home. Admissions were carried out safely and appropriate risk assessments were in place.

• People were supported to keep in touch with their family members via outdoor visits, window visits and video or telephone calls.

Westwood Lodge Care Home provides accommodation for up to 44 people with personal and nursing care needs. People had a range of health care needs including those with mental health, drug and alcohol misuse related conditions and those living with dementia. At the time of the inspection the service supported 33 people.

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

People felt safe and comfortable living in the home and receiving support from staff. Risks to people’s health and welfare as well as the environment were managed well. The manager understood their responsibility about safeguarding and staff felt confident protecting people from abuse. Medicines were managed in a safe way. The provider learned from accidents and incidents to reduce future risks. Staff were recruited in a safe way and checks on nurses took place to ensure they were fit to practice. There were enough staff to meet people’s needs.

At the time of the inspection the service did not have a registered manager and the Commission had not received an application from the provider. There was a manager in post who was effectively overseeing the day to day running of the home.

People’s needs were assessed prior to moving into the home. Staff were inducted into the service and received ongoing training. Staff felt supported in their roles and received annual appraisals. The frequency of supervisions differed amongst staff and requires review.

We have made a recommendation about the provider ensuring the performance of all staff is regularly monitored and recorded.

People were encouraged to enjoy a balanced diet and supported with their nutritional needs. People had access to a range of health care professionals to maintain or improve their health. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff thought highly of people and supported them in a respectful and dignified manner. People were encouraged to live their lives in the most independent way possible and to do things for themselves, where possible. People were supported to access advocacy services.

Care plans were person-centred and detailed to instruct staff how to support people in line with their wishes. People’s communication needs were detailed within care records and staff knew how to communicate with them effectively. People knew how to raise concerns and were confident they would be dealt with. The provider had a complaints procedure that was followed in practice.

People and staff were positive about the management of the service. Staff felt the manager was approachable and they could raise any issues or concerns with them at any time. People, relatives and health professionals were consulted about the quality of the service through surveys. Staff were involved in the ongoing development and improvement of the service via regular meetings. An effective quality assurance process was in place.

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 21 December 2018) and there was one breach in 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 regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the Effective and Well-Led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in April 2018 the provider was placed in special measures. We found a breach of regulation 12 as care and treatment was not safe. We also found breaches of regulations 9,10 and 17 as people were not always treated with dignity and respect, care was not always person-centred and good governance was poor.

Following the inspection, the provider sent us a detailed action plan to explain how they would address these concerns. We also met with the provider and registered manager and they gave us their assurances that the issues found would be taken extremely seriously and rectified.

At this inspection the provider had made many improvements, but we still found some previous issues were outstanding which needed to be addressed. The overall rating is no longer inadequate, which means they are no longer in special measures.

Westwood Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Westwood Lodge Care Home provides accommodation for up to 44 people with residential and nursing care needs. People had a range of health care needs, including those with mental health, alcohol misuse related conditions and those living with dementia. At the time of the inspection, there were 31 people living at the service.

The service had a registered manager who had worked at the service for many years with the last two as registered manager. 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. The service also now had a deputy manager who had been appointed since our last inspection.

People told us they felt safe, and although improvements had been made, further action was required and this needed to then be maintained.

Medicines management had been improved, however, we observed some poor practice. Although no person came to harm and it was dealt with immediately, this type of issue had been raised at the last inspection as a concern.

People’s needs had been assessed prior to moving into the service and care plans had been developed. However, care plans were not always in place for all identified need and they were not always reviewed in a timely manner. Risk assessments had improved but not all had been put in place. There were two different care plan formats in use, including a newer version which was much more person centred. The registered manager was aware that further work was required.

Quality monitoring systems had improved and a range of audits and checks had been implemented, including infection control and medicines monitoring systems. The audits had not always identified what we had, and the registered manager said they would be reviewed further. A quality assurance person had been employed for a period of months to oversee and support the registered manager while these new processes were put in place.

The provider had spent considerable amounts of money in improving the environment for the people who lived there, including a new wet room, carpeting and new flooring. Staff told us people appreciated the money spent and it had made a difference to everyone.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Everyone we spoke with were complimentary about the care provided by staff. We observed very positive interactions and people’s dignity and respect were maintained at all times.

People told us they were satisfied with the improvements in their meal time experience and the food prepared. Food was served at suitable temperatures and people were supported where necessary with their dietary needs. We have made a recommendation about meal time experiences to ensure they are well planned and encouraged social events at all times.

Staff at the service had worked hard to ensure the environment was clean and tidy for people and were keen to maintain this. Staff wore protective clothing appropriately, including the use of aprons and gloves. Infection control was now fully monitored to ensure good levels of hygiene were maintained.

Activities were provided for people, including crafts and access into the local community. Observations over three days found further review was needed particularly with those people who lived with dementia or who were immobile. During the inspection process the provider also increased the monthly activity allowance as we found it was not sufficient, with occasions when staff spent their own money.

Staff were supported with regular supervision sessions and yearly appraisal. Appraisals were due to take place in the next month. Robust recruitment procedures were in place and staff had been risk assessed where necessary. Staff had received training in various topics to support them in their roles and the provider had planned further training to take place, including eLearning.

We found one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance.

You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection in January 2017 the provider had not ensured that people were protected against the risks associated with unsafe and unsuitable premises. They did not ensure that robust systems were in place to assess, monitor and improve the quality and safety of the service or to mitigate the risks relating to the health, safety and welfare of people using the service. Records were also not accurate or completed fully. These issues were breaches of regulation 15 (premises and equipment) and regulation 17 (Good governance). Following the inspection, the provider sent us a detailed action plan to explain how they would address these concerns.

At this inspection the provider had made some improvements but we found other issues needed to be addressed. Following the inspection we wrote and invited the provider to attend a meeting with us to discuss the concerns we had found. We will report on this at the next inspection.

The overall rating for this service is now inadequate and the service has been placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they

do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Westwood Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Westwood Lodge Care Home provides accommodation for up to 44 people with residential and nursing care needs. People had a range of health care needs, including those with mental health, alcohol misuse related conditions and those living with dementia. At the time of the inspection, there were 31 people living at the service.

The service had a registered manager who had worked at the service for over 10 years, the last two as manager. 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. The provider was currently seeking to appoint a deputy manager to support the registered manager in their role.

Although people told us they felt safe living at the service, we found some areas of concern which needed to be improved.

The Registered manager had not maintained clean and hygienic facilities for people living at the service. Staff did not always follow correct procedures to maintain hygiene, including the lack of proper use of aprons and gloves. The provider had not monitored this area which led to poor infection control procedures being followed. After the inspection, the registered manager told us they had addressed some of the concerns we had raised and later sent us an action plan on how they would address this.

Medicines were not always managed appropriately. We found a number of areas which needed to be improved, including giving medicines before food as prescribed, thickeners being stored in unlocked cabinets within one of the dining room areas and ensuring that correct records were kept to support staff.

People’s needs had been assessed and individualised care plans and risk assessments developed. Some care records had detailed information for care staff to follow. Other care records lacked specific detail about how to support people, including missing risk assessments and care plans not in place. Reviews of care plans were not always timely, detailed or appropriately recorded.

People said food and refreshments at the service needed to improve and was not always hot. Meals were not always delivered in an appetising way, for example people with pureed meals. We found this not person centred.

We have made a recommendation to the provider in connection with ensuring they follow best practice with the input from dietician teams when necessary.

Quality monitoring systems were not always in place at the service, including for example, those in connection with infection control. We found checks had not always uncovered what we had during the inspection. We deemed that the registered manager and the provider did not have full oversight of the service because of this.

The provider had completed equipment and premises checks at the service, including gas, electric and fire safety. We have made a recommendation to the provider in this area to update their fire risk assessment in light of our findings.

People said staff were kind and caring. Although we found some staff practices were not respectful and less dignified than they should have been. For example, food being left on people’s faces after being supported to eat and appropriate bedding not being in place for one person.

Activities took place within the service, but we deemed these were limited and have made a recommendation to the provider to review these and the deployment of staff.

Staff told us they felt supported and had received induction, training, supervision and yearly appraisal. The registered manager knew they were behind in some support sessions and were working through this.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People felt that the staff at the service kept them up to date with information and enabled them to be involved with planning and review of their care needs.

The service had responded to the changing needs of people and supported people if the intention was to move on to different living accommodation by helping them with skills they needed to either retain or build upon, for example, completing laundry tasks, shopping or cooking.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person centred care, dignity and respect and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Westwood Lodge is a care home providing accommodation and personal care for up to 44 people. The service is primarily for people with mental health needs and also provides nursing care. At the time of this inspection 37 people were living at the home.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to keep people safe from harm. Staff were aware of their responsibilities for recognising and reporting any signs of abuse.

Staffing levels were based on occupancy levels within the home and we observed there were sufficient staff deployed to safely meet people’s needs. Staff were deployed flexibly throughout the home to enable them to respond to people’s changeable needs.

Processes were in place to assess the risks to the health and safety of people, staff and visitors. Actions had been taken to mitigate and manage the majority of risks identified. However, the service did not have robust plans in place to continue the service in the event of an emergency and timely action was not always taken to maintain the home to an acceptable standard.

People were assisted to take their medicines safely by staff who had been appropriately trained, although there was a lack of oversight of medicines management. Staff were supported in their roles through the provision of regular training, supervision and annual appraisals. Staff told us they felt well supported and enjoyed working in the home.

The service worked within the principles of the Mental Capacity Act 2005 although care records we reviewed did not capture people’s consent to their care and treatment. Records also did not accurately reflect people and their representative’s involvement in their care planning and treatment.

People were supported with their nutrition and hydration needs and to access healthcare services in order to maintain good health. Appropriate and timely referrals were made to other healthcare professionals, who told us the service was proactive and that staff responded promptly and appropriately to any advice or guidance given.

The service had a well-established staff team, and staff had developed positive, caring relationships with people using the service. Staff were kind, caring and patient in their interactions with people using the service and showed genuine warmth and empathy.

People were encouraged to retain their independence and staff respected people’s privacy and dignity. Care was person-centred and based on people’s individual needs and preferences. The staff team reviewed people’s care plans on a regular basis to ensure they remained appropriate to people’s needs. Where changes were required these were made promptly.

Systems were in place for the service to identify, receive, record and respond to complaints. People we spoke with told us they had no complaints about the home or the staff who cared for them.

The registered manager had worked at the home for approximately 10 years and was very knowledgeable about people living in the home. Staff were complimentary about the registered manager and their leadership of the service, as were external healthcare professionals we spoke with.

Although some systems were in place to monitor and review the effectiveness of the service, these did not provide full oversight of the service and were limited in scope. Records maintained by the service were not always complete and lacked details of actions taken. This meant we could not always be assured the processes and procedures adopted by the service were appropriate or protected people using the service from potential harm.

We found breaches of the regulations relating to the premises and equipment and good governance. You can see what action we told the provider to take at the back of the full version of the report.