Westbury Court

Westbury Court is a care home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

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

At our last inspection we found improvements were required to reduce risk to people’s safety. At this inspection we found new risk assessments had been developed.

Specific to each individual, risk assessments included, moving and handling, resistance to support, skin integrity, swabbing for Coronavirus and visiting of relatives.

People at risk of dehydration or malnutrition had risk assessments in place with a monitoring and recording system to identify changes. Risk assessments were reviewed and updated regularly.

People were protected from the risk of abuse and staff were trained in recognising the signs of abuse and what to do about it. Medicines were stored, administered and managed safely.

At our last inspection we found areas of the home were not clean. At this inspection we found the kitchen had a very good (5 star) hygiene rating, kitchenettes, bathrooms and toilets were all cleaned and well maintained. The home was clean and tidy and smelt fresh.

Due to the Coronavirus pandemic, extra cleaning of all areas of the home and particularly high touch areas was undertaken. Staff had access to plenty of personal protective equipment and were using it correctly. Staff were very aware and fully trained in infection control procedures.

At our last inspection we found consent was not always gained according to the law. At this inspection we found improvements had been made. Mental capacity assessments and their corresponding best interests’ decisions were in place where appropriate.

Staff training on all of the providers mandatory training topics had improved and overall, 93% of staff had completed their refresh in areas such as safeguarding and mental capacity. Staff knowledge and confidence had increased. Training had continued throughout the Coronavirus pandemic and staff had received extra training on infection control procedures.

At our last inspection we found care was not person centred. At this inspection we found improvements had been made. People were assessed before moving into Westbury Court. New care plans had been developed which were thorough, detailed and holistic.

The multi-disciplinary team had added their expertise to care plan information, for example occupational and physiotherapy and specialist mental health services. Care plans were person-centred and contained details of importance to people including their family history and choices and preferences.

At our last inspection we found management and leadership was not strong or consistent. At this inspection we found improvements had been made.

Westbury Court had a new experienced home manager who was processing their registration with the Care Quality Commission. The home and deputy managers worked closely and well together. They provided a good leadership team which had impacted well on the staff group.

Due to the Coronavirus pandemic restrictions, people's vulnerability and communication needs we did not speak with people directly in the home. We spoke with the relatives of people to gain feedback from theirs and their family members perspective. We received good feedback from relatives, who, despite the restrictions on visiting were confident the care their family member received was good.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was requires improvement (published 02 December 2019) and there were multiple breaches of regulation. We issued a warning notice to ensure the provider made improvements. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 19, 20, 21 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment, Good governance, Need for consent and Person-centred care.

We carried out a targeted inspection on 2 December 2019 to follow up on the warning notice and found the service remained in breach of the Regulations.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westbury Court on our website at www.cqc.org.uk.

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.

Westbury Court is a care home providing personal and nursing care to 60 people aged 65 and over. At the time of the inspection, there were 49 people using the service.

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

The provider had made some improvements to the service. However, not all the requirements of the warning notice had been met. This was because the identification and management of risk had improved, but further action was required to ensure people’s safety.

The manager had reviewed the admission criteria and some people, who showed distress behaviours, had been moved to more appropriate care settings. This minimised the risk of people experiencing harm.

Distress management plans had been developed but not all were accessible to staff. This did not ensure people received appropriate, consistent support when anxious. Staff were not sufficiently supporting a person who was declining care. The best way to support the person, was not detailed in their care plan.

People’s risk of dehydration was not being safely managed. Records showed some people did not have enough to drink. The monitoring processes in place had not identified this. Staff were in the process of receiving nutrition and hydration training to give this area better focus and understanding.

Improvements had been made to the cleanliness of the environment. This included over-bed tables and skirting boards. However, some areas such the kitchenette on the first floor were not clean.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published 17 October 2019) when there were multiple breaches of regulations. Following the inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 15 November 2019.

Why we inspected

This was a targeted inspection based on the warning notice we served on the provider following our last inspection in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

We undertook this targeted inspection to check they now met legal requirements for Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers our findings in relation to the safe care and treatment in the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

Follow up

Following the inspection, the provider sent us an action plan, which stated the work required, and by when, to improve the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westbury Court on our website at www.cqc.org.uk.

Westbury Court is a purpose-built building, which has three floors. The ground floor accommodates people with residential care needs, whilst the first floor accommodates people living with dementia. The second floor supports people with nursing needs. All floors are accessible by a passenger lift and have a dining room with an adjacent kitchenette, communal lounges, and an assisted bathroom.

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

Not all risks to people’s safety had been identified and considered. There had been altercations between people on the first floor. Some had resulted in harm yet guidance for staff on how to manage such challenges, was not in place. Staff did not always identify situations which could escalate. This did not ensure people were safeguarded from harm.

People, their relatives and staff consistently told us there were not enough staff to care for people.

We made a recommendation to review the numbers of staff available throughout the day and night, by using observation, as well as the home’s dependency tool.

Improvements had been made to the management of people’s medicines, but further improvement was needed.

Not all people were given appropriate assistance to eat and drink. Some drinks were left on over-bed tables and went cold. Records to monitor people’s food and fluid intake were not fully completed. This did not demonstrate people had enough to eat and drink.

People were encouraged to make decisions but where there was doubt about a person’s capacity, mental capacity assessments had not always been completed. There were some restrictions such as low beds and pressure mats, which had not been properly authorised.

Staff were happy with the training they received and said they were a good team. Staff felt supported by each other but not necessarily by management.

People were complimentary about the regular staff who supported them. They said they were “caring”, “polite” and “respectful”. People and their relatives told us they had built relationships with these staff although agency staff were not always so good.

People’s privacy, dignity and independence were generally promoted. Systems such as ‘resident’ meetings were held to encourage people to give their views about the service they received.

Care was not always person centred. Some people did not look well supported, and records did not demonstrate regular nail and oral care had been given. Staff, particularly at night, were not always familiar with people’s needs. Each person had a care plan but key areas such as declining care, pain and dementia care needs, were not clearly described. Senior management told us a new person-centred care plan format was in the process of being introduced.

There was a designated activity team, who provided a programme of social opportunities. People engaged with the activities during the inspection and were complimentary about them. People and their relatives knew how to raise a concern.

There was a clear management structure, with designated roles and responsibilities. However, the auditing processes in place were not effective, as shortfalls in the service were not being identified. This meant at this inspection, the service had been rated requires improvement for the third consecutive time.

There was mixed feedback about people’s experiences of the service they received. The home worked in partnership with others such as health care and training providers.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 November 2018) and there were multiple breaches of 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 not enough improvement had been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about inadequate staffing and people’s care. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. This was because they had not taken sufficient action to mitigate the risks. Please see the safe and responsive key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westbury Court on our website at www.cqc.org.uk.

Enforcement

At this inspection, we have identified breaches in relation to safe care and treatment, need for consent, person centred care and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on the 26 and 27 September and 1 October 2018 and the first day was unannounced. The registered manager was aware of the subsequent visits.

Westbury Court is a care home providing nursing and residential care for up to 60 people. At the time of the inspection there were 50 people living at the home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is arranged over three floors. The ground floor accommodates people with residential care needs. The first floor accommodates people with dementia care needs and the second floor accommodates people with nursing needs.

A registered manager was in post. 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.

At the last inspection we found that medicines were not always managed safely. At this inspection we found the required changes had been implemented. However, processes around accurate recording required improvements. These included the application of prescribed creams, recording opened dates on medicines and fluid thickeners and accurate referencing of medicines in the medicine record book.

Medicines profiles included an up to date photograph of the person and essential information such as known allergies and how the person preferred to take their medicines. Most ‘as required’ (PRN) protocols were in place and those that were missing were actioned during the inspection.

People told us they felt safe at Westbury Court. Safeguarding processes were in place and the service sent us Notifications appropriately. Any safeguarding issues were discussed daily. Staff had received training in safeguarding, but not all staff we spoke with knew the procedures for whistleblowing.

There were comprehensive risk assessments in place for some people but not all areas of risk for other people had been minimised. We saw fluid and nutritional supplement monitoring charts which were not fully completed. Fluid thickeners were stored in an unlocked cupboard and were being administered by relatives who had not been risk assessed.

The home used a root cause analysis investigation tool to monitor incidents and accidents, identify themes and take appropriate actions. At the time of the inspection not many of these were up to date. The examples we reviewed were robust and gave the service guidance on the lessons learned from the incident.

People, their relatives and staff raised concerns about low staffing levels across the whole home. The home had a safe staffing dependency tool in place and the rotas showed that the home mostly staffed over the recommended safe level. However, these were ‘safe levels’ and did not necessarily reflect the quality aspect of the concerns raised around interaction time with people and staff being visible around the home.

Infection control practices around the home were in place and the home was clean, tidy and fresh. However, the kitchen was not clean and we observed some examples of poor food hygiene practices. The service had a rating of four stars for food hygiene from the local authority.

People told us their choices were respected and care plans contained person centred details relating to their health and social care needs. However, we found inconsistent recordings of people’s care needs in areas such as oral and skin care. This did not show that people had received support in these areas. People were fully assessed prior to moving into the home.

Staff training records showed gaps in the providers mandatory training and refresher courses. New training sessions were booked in for the Autumn. Staff had been identified to undertake ‘train the trainer’ and ‘care home assistant practitioner’ courses. This meant they would benefit the whole staff group with new skills.

Supervision and appraisal records showed gaps which had been identified by the registered manager. A schedule was put in place to address this. At daily staff meetings, senior staff were encouraged to record discussions and guidance (informal supervision) and to undertake group supervision.

The lunchtime service was a pleasant experience. People were assisted to the dining room where tables were laid and people had the opportunity to socialise. The feedback from most people was positive. There were on-going concerns from relatives around the quality of the food which were being addressed by the registered manager.

There was evidence of multi-disciplinary working between the staff and health and social care professionals. Guidance from professionals was in place and was followed by staff. People had full access to community health care.

The home was pleasantly decorated and furnished. However, the design, décor and furnishing of the first floor for people living with dementia was bland and unstimulating. There were no tactile or visually engaging furnishings or items of interest. The registered manager told us that plans were in place to fully adapt and re-decorate this floor to meet the needs of the people living there.

The lawful processes around consent were not always in place. Records were inconsistent and parts of the process were missing in some care and support plans. Where people were deprived of their liberty, applications to the local authority had been made but parts of the processes were missing.

The overwhelming positive feedback we received was that the staff were very caring. People were treated with kindness, respect and compassion. People’s rights to dignity and privacy were honoured and many people and relatives said they would recommend the home for people to consider.

We saw that care plans were reviewed and where changes to people’s needs occurred the plans were updated. Relatives were kept up to date with any changes, for example if their family member was unwell or an appointment had been made.

There were a wide and varied amount of activities and social engagement on offer for people to enjoy. The service had a Magic Moments Club which invited people from the local community to join in with events such as a Choir and Toddler Tuesday. These events were well attended.

The service had a complaints procedure in place. The registered manager responded to any concerns raised in a timely manner, investigated the concern and fed back to the complainant with the outcome. Some concerns were raised repeatedly around staffing and food. These were addressed in relative’s meetings but had a mixed response in relation to satisfaction.

People had their preferred end of life wishes recorded. We made a recommendation to the service to seek good practice guidance on end of life care planning to ensure that people’s daily changing needs were met at this time of their life.

Quality assurance and audit systems were in place. These identified areas for improvement that we had highlighted during the inspection. Improvement plans and performance reviews were in progress. Some improvements within these had been completed and some continued to fall short of the action plans in place.

We found that time was needed to embed the changes and fully engage the whole staff group into the vision and values which the registered manager had begun to implement.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in Regulations 12 and 17. We also made one recommendation to the service.

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

We undertook a full comprehensive inspection on the 4 and 5 July 2017. The first day of the inspection was unannounced. Since our last inspection in July 2016 Westbury Court has re-registered and therefore under the new registration does not have a rating. However, during our inspection under the previous registration we found the provider did not meet some of the legal requirements in the areas we looked at. After the previous inspection the provider wrote to us with an action plan of improvements that would be made in order to meet the legal requirements in relation to the law. We found on this inspection the provider had taken steps to make all the necessary improvements.

A registered manager was employed by the service and up until recently had been managing the service with the support of another regional support manager. Both these managers were present throughout our inspection. The service had recently appointed a new home manager who will be applying to become the registered manager. They will also be taking over the day to day management of the home. 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.

People’s medicines were not always managed safely. Processes for the crushing of medicines had not been followed. Some administration records of medicines were not completed. There were arrangements in place for the safe storage of medicines.

Whilst the provider had systems in place to monitor the quality of service to ensure improvements were identified these had not picked up the areas of improvement we had noted. Staff and people’s views on the service provided were sought and where necessary acted upon. Complaints were appropriately investigated and actions were taken to resolve the situation.

People told us they felt safe living in Westbury Court. Risks to people’s personal safety had been assessed and support plans were in place to minimise these risks. Staff had the knowledge and confidence to identify safeguarding concerns and were aware of the actions they should take if they felt people were at risk of receiving unsafe care.

The staff employed at Westbury Court were kind and caring in their approach towards the people they were providing care and support for. Interactions with people were friendly and supportive. People and their relatives spoke positively about the care and support people received. People’s dignity was maintained and their privacy respected. People were able to participate in a range of activities.

Care and support plans were personalised and detailed daily routines specific to each person. People’s needs were reviewed regularly. Handover between staff at the start of each shift ensured that important information was shared.

People were encouraged to make their own choices and remain as independent as possible. Staff sought permission before they provided care and support. Where people lacked capacity to make certain decisions, best interest decisions were made involving relevant others. Deprivation of Liberty Safeguards had been appropriately applied for.

There were robust recruitment practices in place that protected people from being cared for by unsuitable staff. Sufficient numbers of trained and experienced staff were deployed to ensure people’s needs were met.

All staff had a programme of core training and refresher training they were required to complete. New staff completed an induction training programme. Staff spoke positively about training and development opportunities. Staff told us they received sufficient support to enable them to do their jobs correctly.

People were supported to eat and drink sufficient amounts. Where concerns around the quality of food and choices had been identified an action plan was in place to address them. People had access to a range of health care professionals to maintain people’s health and wellbeing.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.