This unannounced inspection took place on 14 & 15 June 2018. Westlands Retirement Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Westlands Retirement Home is registered to provide personal care and support for up to 20 older people some of whom may be living with dementia or physical frailty. The home does not provide nursing care; people living there would receive nursing care through the local community health teams.
On the afternoon of 14 June 2018, the provider informed us they had admitted another person for planned respite care. The person was admitted to a vacant room, which had previously been registered. We explained to the provider that they were in breach of a condition of their registration and asked them to send the required notification, which they did. This meant there were 21 people living at the home and the provider was in breach of a condition of their registration. The home is now registered to provide accommodation and support for up to 21 people.
The home did not have a registered manager at the time of the inspection as the registered manager had recently retired. A new manager had been appointed; they had applied to become registered with the Care Quality Commission and were available throughout this inspection. They are referred to as the manager throughout this report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
We looked at the home’s quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality and safety of the services provided. Although some systems were working, others had not been effective, as they had not identified the concerns we found during this inspection.
People were not always protected from the risk of avoidable harm. We found risks such as those associated with people's complex care needs, medicines, recruitment and the environment had not always been assessed or managed safely. Where risks had been identified, guidance had not been provided to staff to mitigate these risks. Although systems were in place to identify and record accidents incidents, there was no consistent system in place for analysing and identifying patterns to prevent a reoccurrence.
Whilst some premises checks had been completed we noted others had not, we found a number of bedroom windows were not risk assessed so the provider could not judge if they were properly restricted, and safe. There was no evidence the provider had carried out any form of risk assessment in relation to needs of people currently living at the home and the risks posed by having unrestricted windows that were accessible.
People were not always supported by staff that had the necessary skills and knowledge to meet their needs. Records showed that staff inductions, supervisions, and annual appraisals were poorly documented. There was not an effective system in place to ensure staff were provided with the necessary training and support to meet the needs of the people they supported.
People’s needs were assessed prior to coming to live at the home. This formed the basis of a care plan, which was further developed after the person moved in and staff had gotten to know the person better. We found people were at risk of receiving care that did not meet their needs as some people’s care plans contained outdated or misleading information. None of the care records we saw were being regularly reviewed or updated in line with homes expectations.
People received their prescribed medicines on time and in a safe way. However, we found medicines were not always stored safely, as the home did not have a robust system to ensure that people or unauthorised staff could not access medicines.
People told us there were enough staff to meet their needs. One person said, "They [staff] are here when I need them." However, staff told us there were not always enough staff to meet people's needs especially during the evening and at night. We discussed staffing levels with the provider and manager who told us there were enough staff on duty to meet people's needs but they did not have a system for deciding how many staff were needed in relation to the number of people who lived in the home and their level of dependency.
We have recommended that the provider uses a suitable tool to ensure staffing levels are sufficient to meet people’s assessed needs.
We checked whether the home was working within the principles of The Mental Capacity Act 2005 (MCA). We saw staff obtaining people’s consent. However, where a person’s capacity to make complex choices or decisions was in doubt records did not show staff had assessed the person’s capacity. Where decisions had been made in a person’s best interests, these were not being recorded properly and it was not clear these were the least restrictive.
Westlands Retirement Home is set over four floors, which meant in many ways it was not an ideal environment for the needs of the older people living there, although there was a lift to the upper and ground floors. The environment was not adapted to meet the needs of people who may be living with dementia or a sensory impairment. There was very little signage throughout the home and bedroom and bathroom doors were hard to distinguish.
We have made a recommendation in relation to the suitability of the environment.
People told us they were happy living at the home and liked the staff that supported them. Relatives told us they did not have any concerns about people’s safety. People were protected from the risk of abuse. People were encouraged to share their views and could speak to the provider and manager whenever they needed to. People were aware of how to make a complaint and felt able to raise concerns.
We have made a recommendation in relation to the management of complaints.
People were encouraged and supported to engage with a range of healthcare services and staff supported people to attend appointments. A visiting healthcare professional told us they did not have any concerns about the care and support people received, staff made referrals quickly when people's needs changed and followed professional advice.
Most people told us they enjoyed the food provided by the home. Comments included, “The food is very good,” “It’s very nice I can’t complain,” and “There is always at least two choices each day.” We spoke with the chef who had a good understanding of people's likes and dislikes. Details of people's food allergies or special dietary requirements were available in the kitchen and regularly reviewed
We received mixed views about the level of activities the home provided. Some people told us there was plenty to do and they enjoyed spending time with each other, taking part in quizzes, playing board games or going on trips to places of local interest. One person said, "There is always something going on.” While other people told us, they were board and felt the level of activities provided by the home were limited. The home produced a monthly activities programme and we saw people had different opportunities to socialise and take part in activities if they wished to do so.
The registered provider had not always notified the Care Quality Commission of significant events, which had occurred in line with their legal responsibilities.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.