Archived: Westwood House

This inspection was unannounced and took place on the 4 October 2017. At our last inspection in December 2016, we identified two breaches of regulations. Regulation 12 safe care and treatment and regulation 18 staffing. We asked the provider to take action to make improvements with regard to medicine management, the management of risks at the service and staff training and supervision. At this inspection we checked to see if the provider had made the necessary improvements. We found that improvements had been made.

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

People told us they felt safe living at Westwood House. Relatives we spoke with agreed with what they told us. The staff team were aware of their responsibilities for keeping people safe from avoidable harm and knew to report any concerns to the registered manager or a member of the management team. The management team were aware of their responsibilities around the safeguarding of people and training on how to keep people safe from harm had been completed.

People's needs had been identified and the risks associated with people's care and support had been assessed and managed. Where risks had been identified these had, where ever possible, been minimised to better protect people's health and welfare.

Plans of care had been developed for each person using the service and the staff team knew the needs of the people they were supporting, including their preferences.

People felt there were currently enough members of staff on duty each day because their care and support needs were being met. Care and support was provided at a pace that suited people and the staff team had the time to talk with the people using the service.

People received their medicines safely. Systems were in place to regularly audit the medicines held at the service and appropriate records were being kept.

Checks had been carried out when new members of staff had started working at the service. This was to make sure they were suitable and safe to work there. An induction into the service had been provided and ongoing training was being delivered. This provided the staff team with the skills and knowledge they needed in order to meet people’s needs.

People told us the meals served at Westwood House were good. Their dietary requirements had been assessed and a balanced diet was being provided. The registered manager was reminded of the importance of maintaining records to reflect that people were offered drinks throughout the 24 hour period. Particularly where people were at risk of dehydration.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on going healthcare support.

The staff team supported people to make decisions about their day to day care and support. Where people required additional support to make decisions, advocacy support was available to them. Where people lacked the capacity to make their own decisions, assessments of their capacity to consent to aspects of their care had not always been made. It was also not always clear what specific decisions people were unable to make.

The staff team felt supported by the registered manager. They explained they were given the opportunity to meet with them regularly and felt able to speak with them if they had any concerns or suggestions of any kind.

People told us the staff team were kind and caring and they were treated with respect. Throughout our visit we observed the staff team treating people in a friendly, caring and considerate manner.

Relatives and friends were encouraged to visit and they told us that they were made most welcome by the staff team. A complaints procedure was in place and the people using the service and their relatives and friends knew what to do if they had a concern of any kind. They were confident that any concern raised would be dealt with properly.

Staff meetings and meetings for the people using the service and their relatives were being held. These provided people with the opportunity to have a say and to be involved in how the service was run. Questionnaires were also being used to gather people's feedback.

There were systems in place to monitor the quality and safety of the service being provided. Regular audits on the documentation held had been completed and regular checks on the environment and on the equipment used to maintain people's safety had been carried out.

The registered manager understood their legal responsibility for notifying the CQC of deaths, incidents and injuries that occurred or affected people who used the service.

The service provided personal care for up to 16 adults most of who were aged 65 years and over. At the time of our inspection there were 11 people using the service.

The service had a new manager who had commenced their role three months before our inspection visit. They were in the process of applying to become the registered manager for the service. 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 had systems in place for assessing the risks associated with people’s care and reporting accidents and incidents. However, we found that staff did not use these systems correctly to ensure that they supported people to stay safe.

People did not always receive their medication as prescribed. We found concerns in relation to the administration of people’s medicines. We also found concerns associated with temperatures that medicines were stored at. We also saw that some of people’s liquid medicines were not labelled with the date of opening. This is important to ensure they are used within the recommended timescale.

Staff did not always have the skills and experience they required to carry out their role effectively. They told us that they did not always feel that the training they received equipped them to support people effectively. This included training to manage medicines safely and to complete people’s records correctly.

People’s records did not always reflect the support they received. This included not correctly reflecting their wishes about resuscitation towards the end of their life. This meant that there was a risk that people could be resuscitated and treated against their wish and best interest.

People were not always supported to engage in meaningful activities and to avoid social isolation. Staff told us that due to other work commitments the time the activities coordinator spent on activities was limited. At our last inspection at Westwood House, we saw that a person was supported to follow their interest in gardening and staff supported them to grow their own crops. At this inspection, we saw that they no longer continued with this activity. The manager told us that they would begin to make plans to engage and plan activities around people’s interests.

People felt safe at the service. This was because staff understood what may constitute abuse and avoidable harm and their responsibility to safeguard people from harm.

There was a suitable number of staff on duty to meet people needs. Agency staff were used to cover any staff absences. People told us that staff responded promptly when they requested support from them. We found that the provider had safe recruitment practices which assured them that staff were safe to support people before they commenced their employment with the service.

The staff we spoke with demonstrated a varied understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this. Staff supported people according to the conditions of the DoLS authorisation.

We received mixed responses about the food and the varieties that people were offered. We found there was limited variety at both lunch and tea time and the menus were repetitive. The provider was in the process of improving the menu.

People’s feedback and records showed that they had regular support to access health care professionals. However, we saw that staff had not referred people to dementia outreach and falls managements services where they needed this support.

People complimented the caring attitudes of staff. They told us that staff treated them with dignity and respect, listened to them and supported them to be as independent as possible. Throughout the visit we observed that staff interacted with people in a warm and compassionate manner and supported people at their individual pace.

Staff supported people and their relatives to be involved in decisions about their care. People’s family and friends could visit them without undue restrictions.

People and their relatives knew how to make a complaint about the care people received. We reviewed records of written complaints received at the service and saw that the manager put measures in place to address the issues that were raised.

During our inspection, we found that there were two significant incidents that the provider had not notified the Care Quality Commission of as required in law. People were not always confident that the service was well managed. They told us that they were getting used to having a new manager and hoped that they would make improvements to the service. Staff felt supported by the manager and deputy manager to fulfil their role. The provider had systems in place to monitor the quality of the service. However their audits did not identify the issues we found during our inspection.

We found breaches of the Health & Social Care Act 2008 Regulated Activities Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.