We carried out a review of the data available to us about Westhope Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Westhope Lodge, you can give feedback on this service.
Westhope Lodge is a residential care home providing accommodation and personal care for nine people living with a learning disability and/or autism, at the time of the inspection. The service is registered to provide accommodation and personal care for up to nine people in one adapted building.
The service has been developed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were deliberately no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
People received exceptionally kind and compassionate care. Staff showed real empathy to the people they supported. It was evident that people felt respected and valued through their interactions with staff. One person told us they loved living at the home and staff were, “kind” and “funny.”
People’s views and choices were at the centre of how people were supported. Staff took time to understand how people wanted their care to be delivered and respected their wishes without fail. People’s independence was consistently promoted by staff who empowered people to achieve good outcomes.
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. A healthcare professional told us, “I would say they go over and above a ‘duty of care’. its heart-warming to see the difference it has made when people listen to the people in their care.”
People were safe, and staff understood how to manage risks to people. People’s medicines were managed safely, and people lived in a clean and hygienic environment.
People had access to a range of activities that met their individual interests. People were active in their local community and were supported to maintain relationships that were important to them.
The home was well-led. People, their relatives and staff were very complimentary of the registered manager. There was a positive atmosphere at the home. One member of staff told us, “We have such a lovely house, we joke together and have a real family ethos. We all care about each other as family.” There were quality assurance processes in place to continually improve the quality of the care people received. Staff worked well with other professionals to meet people’s needs.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 good (published 15 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
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.
We undertook this announced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. Improvements had been made and the overall rating for Westhope Lodge has been revised to good.
Westhope Lodge is registered to accommodate up to nine people. It specialises in providing support for people who have a learning or physical disability. At the time of our inspection there were seven people living in the service.
There was a registered manager 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.
The staff we spoke with were aware of their role in safeguarding people from abuse and neglect and had received appropriate training.
We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good knowledge of this.
The service asked people and other stakeholders to fill in surveys about the quality of the service and people’s feedback was included in plans for future improvements. There were effective systems in place for monitoring the quality and safety of the service. Where improvements were needed, these were addressed and followed up to ensure continuous improvement.
When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.
Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.
We saw risk assessments had been devised to help minimise and monitor risk, while encouraging people to be as independent as possible. Staff were very aware of the particular risks associated with each person’s individual needs and behaviour.
People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I think there are enough staff, I feel safe”. Another said, “I’m happy here, I feel safe, there’s always staff about”.
People were supported to eat and drink sufficient to maintain a balanced diet. One person told us, “I’m very fussy with food, but they get me what I want”. People were supported to maintain good health, to have access to healthcare services. We looked at people’s records and found they had received support from healthcare professionals when required.
People’s needs had been identified, and from our observations, people’s needs were met by staff. People’s individual care plans included information about who was important to them, such as their family and friends and we saw that people took part in lots of activities in the service and in the community.
There was positive interaction between people and the staff supporting them. Staff spoke to people with understanding, warmth and respect and gave people lots of opportunities to make choices. The staff we spoke with knew each person’s needs and preferences in detail, and used this knowledge to provide tailored support to people.
There was a complaints procedure, and evidence that people were consulted about the service provided. We saw that ‘house’ meetings took place for people to comment on their experience of the service.
Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.
The staff members we spoke with said they liked working in the service and that it was a good team to work in. They told us staff meetings took place and they were confident to discuss ideas and raise issues with managers at any time.
The inspection took place on 16 August 2015 and was unannounced.
Westhope Lodge is registered to accommodate up to nine people. It specialises in providing support to people with a learning or physical disability. The accommodation is provided on the ground floor and first floor of a purpose built property and there is level access throughout with a shaft lift to the first floor. There is a communal lounge and dining room area and level access to an enclosed garden to the rear of the property. The service shares the use of a minibus with two of the providers other services in the area. There were eight people living at the service at the time of the inspection.
The service had not had a registered manager in post since June 2015. 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. An acting manager had been recruited and been in post for four weeks when we undertook our inspection. We identified a number of shortfalls at this inspection that the acting manager was already aware of but had not yet formulated an action plan to address.
The provider’s quality monitoring and quality assurance processes had not always been followed. Accidents and incidents had not been analysed to identify whether there was any emerging themes and trends. The medicines audit had not identified the stock of medicines did not correspond with that stated on the records and some care plans and staff files were incomplete whilst others were in need of updating. People, their representatives, and staff were all encouraged to express their views at meetings and complete satisfaction surveys. The outcome of the surveys had been summarised and feedback received showed a high level of satisfaction. However there was no record of what action had been or was being taken to address the shortfalls identified and help drive improvement in the service. Likewise meeting minutes did not include a review of the previous meetings minutes or what actions needed to be completed by whom and by when. There was no action plan available to view for how the provider was going to address the shortfalls the acting manager and their own quality assurance processes had identified. This is an area we assessed the provider was required to improve in.
We were told some people lacked the capacity to give their consent to care and treatment and to agree to restrictions that were placed on them, for example to be under constant supervision and to having bed rails in place. However, mental capacity assessments had not been completed to assess this and applications to the local authority had not been made for them to authorise the deprivations of liberty these people were subject to. Therefore we could not be assured that staff knew what decisions people could make for themselves and when they needed the support of relevant people to help them make a decision. This is an area the provider was required to improve in.
Staff told us they would be confident reporting any concerns about people’s safety or welfare to the acting manager or nominated individual. One staff member told us "I would let my manager know if I suspected abuse was going on. I know that they would deal with it but failing that I would go to their manager. If not them, then further up the line”. However when incidents that affected people’s safety and welfare had occurred, the local authority safeguarding team had not been informed and incidents had not been analysed to identify any emerging themes or trends. Therefore we could not be assured that the relevant steps had been taken to reduce the risk of reoccurrence and people were being fully protected from harm. This is and area we assessed the provider was required to improve in.
Some staff recruitment files were held at the providers head office or at another of the provider’s services so were not available to view. Therefore it was not possible to establish how the acting manager had assessed that it was safe for these staff to work at the home or that they had the skills and experience they needed to support the people. This is an area we assessed the provider was required to improve in.
The acting manager and staff told us over recent months they had not always operated with the staffing levels the provider had assessed they needed to meet people’s needs. They explained they had two staff vacancies which they were in the process of recruiting to. One staff member said, “Holiday times can be difficult but I suppose that’s the same everywhere. We’ve also lost two seniors (senior staff members) recently so that’s a problem too”. When asked if staff had enough time to spend with people and provide person centred care another staff member told us, “Yes, no problem. We spend all day with people. It’s the job really”. This is an area of practice we identified as needing to improve.
The provider’s procedures for administering people’s medicines were safe but staff had not always followed them. Staff did not have specific guidance for follow in relation to when ‘as and when needed’ medicines should be administered and the stock of some medicines did not balance with the stock indicated in medicine records. This is an area of practice we identified as needing to improve.
People told us they felt safe and we saw staff keeping people safe by offering support when needed for example encouraging and supporting them to move and by providing specialist diets. One staff member said to us about a person that needed a soft textured diet “They can eat most foods but not anything very dry or crumbly like biscuits because they could choke on them.” One person said “I’m safe here alright. The doors are locked and there are staff here all the time”. They told us there was a call bell system in place so they could alert staff if they needed help and they knew how to use it. We saw people could move freely about the premises including those who used wheelchairs.
People were supported to be independent and participate in a range of activities. We saw people were coming and going throughout the day, going out shopping, going to the local café and going into town with support from staff whilst others had chosen to stay at home. A weekly timetable of activities had been formulated for each person which was in an accessible format and each person had key worker who co-ordinated their care and arranged holidays for them. However people’s preferences in relation to activities were not always catered for. For example it was recorded that one person had wanted to undertake a course and go to the gym but had not been supported to do so. This is an area of practice we assessed as needing to improve.
Staff knew the people well and were aware of their personal preferences, likes and dislikes. We saw staff communicated effectively with people and using sign language to communicate with one person. Care plans were in place detailing how people wished to be supported and were illustrated with photographs and symbols to aid people’s understanding of their content. However, not all aspects of these plans were up to date and accurately reflected peoples current care needs and preferences. This is an area we assessed as needing to improve.
Staff felt supported and received the training they needed to meet people’s assessed needs. They had obtained or were working towards obtaining a nationally recognised qualification in care. They were knowledgeable about their roles and responsibilities and had the skills, knowledge and experience required to support people with their care and support needs. However improvements were needed in relation to staff personal development and appraisals to make sure staff continued to have the competencies they needed.
People told us and we saw that staff were patient and kind. We observed that people were relaxed in the company of staff and each other, chatting and sharing jokes. We heard staff giving reassurances to people and explanations as to what was going to happen and when. We saw those who were able to, were encouraged to make their own drinks and breakfast. We heard staff offering choice throughout the day for example asking people how they wanted to spend their time and what they would like to eat. One person had pet birds and we saw staff helping them to clear out the bird cage talking to them about the birds while they did so. People were supported and encouraged to maintain relationships with people that mattered to them and there were no restrictions on visiting. People had the opportunity to go on an annual holiday or day trips out of their choice and the provider’s vehicle was adapted to accommodate wheelchairs. One person was also supported by volunteers from the Royal Society for Deaf People and enjoyed regular outings with them.
Staff told us they kept up to date with changes to people’s care by receiving verbal updates from one another, reading entries in records, attending staff handovers and staff meetings. People were supported with their healthcare needs and staff liaised with their GP and other health care professionals as required. For example one person received support from a physiotherapist and staff supported them to complete exercises as the physiotherapist had advised and another person was supported to have thickened drinks as prescribed by a speech and language therapist. One person told us “The staff are good; they come and help me when I need them.” Another person told us “I think they have the training, they help me with appointments and ringing the doctor if I’m not well”.
Feedback about the acting manager and staff was positive. They described an ‘open door’ management approach, where the acting manager was available to discuss suggestions and address problems or concerns.
We identified four areas where the provider was not meeting the requirements of the law. You can read what action we have told the provider to take at the back of the full version of the report.
This summary is based on our observations during the inspection, discussions with four people, two relatives, the manager, two carers and a representative of the provider. We also reviewed records relating to the management of the service and three people's care and health records.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
The service had taken action to protect people against the risk of unsafe care and treatment. People's needs had been reviewed. Each person had a care plan in place that reflected their current needs and wishes.
Records relating to people's care and treatment were accurate and could be located promptly.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, the manager demonstrated knowledge of their responsibilities in respect of this.
Is the service effective?
Staff understood how to support people. They had clear information to refer to and knew where to record information relating to people's care and health needs. One member of staff said, 'It's more structured and clearer on what to do, that's a great help'
A new call bell system had been introduced. Each person now had access to a call bell in their bedroom and bathroom so that they could easily summon assistance if required.
Is the service caring?
People were supported by kind and attentive staff. During the afternoon some people were engaged in arts and crafts, others were spending time with relatives or were busy with external activities. People told us that they were happy living at the service. One person said, 'I get on very well with the carers in here'. Another told us, 'The staff are very kind'.
Is the service responsive?
People, their representatives and staff had been asked to complete feedback surveys. The manager had reviewed the results. Action plans were in place to address concerns and to act upon suggestions. People were also invited to attend residents' meetings. At the most recent meeting they had discussed and made plans for the Christmas period.
Is the service well-led?
The manager and provider had taken action to address the concerns raised at our last inspection.
New systems to regularly assess and monitor the quality of the service provided were in place. The manager carried out regular checks in order to manage risks and make improvements. The manager produced a weekly report for the provider, who in turn carried out monitoring visits at the service.
This summary is based on our observations during the inspection, discussions with six people, two relatives, the manager and five members of staff. We also reviewed records relating to the management of the service, four people's care and health records and four staff recruitment files. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the service for one hour during the morning and lunchtime period.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
We found that people were not always protected against the risks of unsafe care and treatment. This was identified at our visit in October 2013. We asked the provider to tell us how they would ensure that the planning and delivery of care met people's individual needs and ensured their safety and welfare. At this visit we found that the provider had not taken sufficient action to ensure that care was appropriately planned. We also found that people's needs were not always monitored or reassessed on a regular basis to ensure that they were receiving appropriate care. This is being followed up with the provider and manager.
Records relating to people's care and treatment were not always accurate and could not always be located promptly. We have asked the provider and manager to tell us what they are going to do to ensure that accurate records are maintained to protect people against the risks of unsafe or inappropriate care and treatment.
The service had appropriate systems in place to manage medicines. Medicines were stored, administered, recorded and disposed of in a safe way.
We looked at the recruitment processes and found them to be safe and thorough. The service had carried out relevant checks to ensure that staff had the necessary skills and aptitudes to work with people living at Westhope Lodge.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, the manager demonstrated knowledge of their responsibilities in respect of this.
Is the service effective?
In general we found that staff were knowledgeable about people's care needs. We found, however, that in some areas of people's care staff were unclear on the support required. This meant that people were at risk of receiving inconsistent support which might not be in line with their needs.
People told us that they were happy living at the service. One person told us, 'I clean my own room, I like to remain independent'. Another said, 'I do the veg for dinner'. As some of the people living at the service were unable to speak with us directly of their experience, we spent time observing the care and support that they received. Staff demonstrated skill and experience when supporting people. One person that we spoke with told us, 'I'm alright'. A relative said, 'I have no complaints'.
Is the service caring?
People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We spoke with six people. They were satisfied with the care that they received. They told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'I like it here, nice people'. A member of staff said, 'I get on with all the residents. They make the job a lot of fun'.
Is the service responsive?
Since our last visit more activities were available. The range of activities took account of people's interests, capabilities and understanding. The service had a varied activity programme in place which included in-house activities as well as trips out. During our visit we observed people participating in a number of activities that stimulated and entertained them.
People told us that they were able to raise concerns or make suggestions and that they were consulted about changes in the service. We found that the service listened and responded to questions and feedback received from people and from staff. One relative told us, 'I've never had any trouble with anyone here'.
Is the service well-led?
Since our last inspection a new manager was in post and registered with us. We found that improvements had been made in relation to emergency planning and activities. We found, however, that the provider and manager had not taken sufficient action to address the concerns raised at our previous inspection.
We saw that the new manager had introduced systems for monitoring the quality of services provided. Whilst there was evidence that the systems had delivered some improvements, we found that they were not yet fully effective. We have asked the provider and manager to tell us what they are going to do to regularly assess and monitor the quality of the services provided.
We spoke with the relatives of two people following our visit. They expressed satisfaction with the home. One told us, 'I think it's a very good home'. The other said, 'The staff are very kind, X is well looked after'.
We spoke with four members of staff and the manager. Most of the staff that we spoke with told us that is was a good place to work. One said, 'I love it, I've been taught so well by everyone'. They also told us that they would like to have more time to spend with people and to share in activities.
We found that people looked well cared for and observed that they had a good rapport with the staff. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. Staff were welcoming and we saw that they supported people with kindness and respect. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss. We found, however, that the provider had not always ensured that people received care and treatment in a way that met their individual needs. Some staff were unclear on emergency procedures, such as what to do in the event of a fire.
We saw weekly individual activity timetables for people. When we visited we found the people sitting with staff. People were engaged and were enjoying their individual activity.
The provider told us that feedback from people and their representatives was used to assess and monitor the quality of the service, and to make changes.
We found staff were supported and received appropriate training to carry out their roles in meeting people's needs. The provider told us they operated an open door policy for staff.
We observed a lift in use which allowed people easy access to move around the home.
Two visitors told us that they were very pleased with the care and support their relative was receiving. They said that the registered manager and staff were approachable and that they had been consulted about their relatives care and support needs. They told us they were always welcomed into the home and that their relative was treated well.
Two people told us they felt safe and that they would speak to the registered manager or their key worker if they had a problem.
Care records confirmed that people are fully involved and consulted about the care and support that they received. Daily records showed that people participated in a range of activities that they had chosen and enjoyed.
Staff knew the people living at the home well and had a good understanding of their support needs.