Westside Nursing Home

Westside Care Home is a care home providing personal and nursing care to up to 26 people. At the time of our inspection there were 23 people using the service. The service has two floors with spacious communal areas.

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

The risks to people’s health were not always clearly documented, assessed or managed. People’s records were not always detailed or legible. This increased risk of people not being supported safely.

Some areas of the home, including bedrooms and bathrooms were not kept clean and hygienic. Some equipment used to support people was dirty. Staff did not always follow the infection prevention policy and current relevant national guidance. This meant people and staff were not consistently protected from infections.

The management of the service did not have effective measures in place to identify shortfalls in infection prevention control and care planning.

Staff knew how to raise concerns about people’s safety and there was a process in place to report any safeguarding issues. People's medicines were managed safely. Staff were recruited safely and had the training and experience they required to support people. Staff supported people to access health care professionals when required.

Staff worked closely with external professionals to ensure people received appropriate support with physical and mental health.

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 22 November 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received information of concern about infection prevention and control measures at this service.

We inspected and found there was a concern with infection prevention and control procedures and oversight at the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this 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 Westside Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Westside Care Nursing Home is a residential care home providing personal and nursing care to 19 people. The service can support up to 26 people. It is over two floors with spacious communal areas.

We found the following examples of good practice.

¿ The manager had informed families and health care professionals that the home was closed to visitors.

¿ The provider had installed a visitors pod in the lounge which meant that families could have a comfortable visit with minimal risk. This however was not taking place during the COVID-19 outbreak.

¿ The provider had adapted a bedroom for staff to use, in order to ensure staff had socially distanced breaks.

¿ Staff had received training in applying and removing personal protective equipment (PPE). We saw PPE was accessible throughout the home and staff used it in accordance with the most up to date guidance.

¿ Staff had received additional training in COVID-19 and infection control procedures which was provided in-house.

¿ A room had been allocated as a washing station since the outbreak of COVID-19, to provide space for health care professionals to sanitize hands and apply PPE upon entering the building.

¿ There were clear signs around the home reminding staff about correct PPE use and handwashing techniques to prevent infection.

¿ At the outbreak people who tested positive for Covid-19 were isolated in their bedrooms.

People who were discharged from hospital were also isolated to ensure there was less risk of cross contamination.

¿ Staff were cohorted to areas of the home to look after the people who were isolating to reduce the risk of infection.

¿ People in communal areas were supported to socially distance in accordance with national guidelines.

¿ While there were no visitors allowed in the home alternative ways for family members to keep in contact with those living at the service were used. Only essential healthcare professionals had entered the home during the outbreak.

¿ The home was clean, extra cleaning was carried out and frequent touch points were cleaned more regularly.

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

The provider did not always take sufficient action to comply with the requirements of the Mental Capacity Act 2005.

People were not always supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People did not always receive consistent support to manage their health needs.

Care plans did not always reflect the support people received. People did not always feel empowered to express their choice about their daily support.

People were safe when they received at Westside Care Home. Staff knew how to keep people safe from avoidable harm and abuse. Risks associated with people’s care had been assessed and regularly reviewed to reflect the support people needed to be safe. People’s medicines were managed safely.

Staff had the training and experience they required to support people. They supported people to meet their nutritional needs and access health care professionals when required.

Staff were kind and compassionate. They treated people with dignity and respect. They promoted people’s right to privacy.

The manager was easily accessible to staff and people for support and guidance. They were in the process of improving the service.

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 18 May 2017).

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.

Westside Care Home is registered to provide nursing and residential care for up to 26 older people, some living with dementia. At the time of our inspection there were 23 people using the service. The service is a converted residential property which provides accommodation on the ground and first floor. Access to the first floor is via a stairwell or passenger lift. The service is located within a residential area and has an accessible garden to the rear of the property.

The previous comprehensive inspection of 6 May 2015 found a breach of a legal requirement. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement. At this inspection, we found the service to be compliant with the regulation.

Westside Care Home had a registered manager in post. However they no longer had managerial responsibility for the service and confirmed they would be submitting an application to CQC to cancel their registration as manager. A manager had been appointed and had worked at the service for three months at the time of our inspection visit. The manager informed us of their intention so submit an application to CQC to be registered as the 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 and staff were trained in safeguarding (protecting people who use care services from abuse). Where people were at risk, assessments had been undertaken, however we found improvements were needed to ensure these fully documented the actions required by staff to promote and maintain people’s health and welfare.

People said there were enough staff on duty to meet their needs. Throughout the inspection we observed staff had the time they needed to support people safely. If people needed assistance this was provided promptly. Medicines were managed safely.

People were supported by staff that understood their needs and had received training. People using the service spoke positively about the attitude and approach of staff in involving them in the day to day decisions about their care. The manager was aware DoLS applications for some people needed to be made and plans were in place for their submission. The manager was liaising with health care professionals in the best interests of people, to ensure their needs could be met.

The support and care people required was outlined within their care plans and we found by speaking with staff they had a good understanding of people’s needs. However we found improvements to the quality of information about people’s individual care would assist staff in the provision of individualised, consistent quality care based on good practice. We found information within people’s care plans to be judgemental when referring to specific aspects of people’s care and showed a lack of understanding and empathy in recognising people’s health, care and support needs.

People we spoke with were complimentary about the meals provided at the service. Where people were at risk of poor nutrition, advice from healthcare professionals was sought and their recommendations followed. Individual dietary needs were catered for.

Our observations and comments from people we spoke with and their visitors told us they had good access to healthcare. Records showed people were referred to the appropriate healthcare professionals when necessary and that their advice was acted upon.

People spoke positively about the staff, referring to them as caring and kind and that they respected their privacy and dignity. People trusted staff and were at ease with them and happy in their company. People told us they were happy to raise concerns. We saw people relaxed within their environment, watching television, reading and taking part in a chair exercise session.

The provider had an open and inclusive approach towards people using the service and their relatives. Information was available to people about the services provided and people’s views and that of their relatives were regularly sought through questionnaires and meetings.

Reports undertaken by independent organisations, which included Healthwatch Derby, the local authority, and the CQC, were accessible along with a report produced by the provider which detailed the outcome of questionnaires completed by people and their relatives which sought their views about the service. The service had retained its award in ‘End of Life Care’, following a recent assessment by an independent organisation.

The provider had responded to our verbal feedback at the end of the inspection visit, by producing a plan which outlined their commitment to improving the service. This showed willingness by the provider to develop the service to improve the quality of care provided.

Below is a short summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service, and relatives and representatives of these people, told us that they felt they were well looked after at Westside Care Home and had confidence in the staff who supported them.

Risk assessments had been used to consider the possibility of any risks to each person's health or wellbeing, and plans then put in place to explain how any identified risks were to be managed.

The provider carried out checks on any new staff to ensure that they had the right skills, qualifications and were of good character.

Medicines were not being managed safely enough which meant people may not always receive their prescribed medicines when they should do.

Is the service effective?

Each person had an individual care plan to explain their specific needs and plans were in place to explain how their support was to be delivered. This included information about any specialist equipment which was needed to meet their needs.

Records were kept to confirm that people's care was delivered reliably and that people received the support they needed.

Is the service caring?

Staff were attentive and engaged in a positive way with the people they supported. It was evident from our observations that staff were familiar with the needs, interests and personalities of the people they supported.

There was information recorded in each person's care plan about their life histories and interests, which helped staff to get to know the people they supported.

Is the service responsive?

Social and recreational activities were arranged and people were supported to take part in these.

People told us that their views had been taken into account when their care plans had been put together.

There was information available to explain to people how they could complain about the service, should they need to do so. Visitors we spoke with told us that staff made them aware of any changes or concerns in relation to their relative's health or wellbeing

Is the service well led?

There were systems in place to help the provider check whether the service was operating well. Some of these were working reliably but those aimed at checking the reliability of medication arrangements had not been effective.

People's personal care records, and other records kept in the home, were accurate and kept safely.

People we spoke with told us they were happy with the care provided. Comments included: 'it's such a nice atmosphere', 'they have boosted my confidence' and 'it's alright'.

We found that one person out four we looked at did not have a care plan in place, not all risk assessments had been completed and that there was a lack of guidance for staff about what action to take following risk assessments.

Staff we spoke with felt that staffing levels were sufficient for them to meet people's needs.

We found that medication was not always being administered safely and that relevant protocols were not in place. Not all medication was being stored correctly.

The provider had quality assurance systems in place to help monitor the quality of the service. We found that not all of the audits carried out were effective.

We found that not all care records were accurately maintained.

Although the provider had made improvements in both outcomes we looked at, there were still some concerns.