Westwood

We found the following examples of good practice.

¿ The provider had installed a visiting pod to facilitate visiting, this included a screened off area to ensure social distancing. Due to a recent outbreak of COVID-19 visiting had been suspended to reduce the risk of further transmission of COVID-19. Essential visitors were asked to complete a health screening questionnaire and had their temperature checked.

¿ People and staff who were clinically vulnerable had a risk assessment in place to manage the risks associated with COVID-19. The service followed current guidance for care home testing.

¿ A recent outbreak of COVID-19 at the service had been managed well. People who tested positive for COVID-19 were asked to self-isolate where it was possible and in people’s best interest. People who were unable to self-isolate were closely monitored by staff to ensure they were not coming in to close contact with others. People were supported to keep in touch with their relatives via telephone calls or video links.

¿ The service was clean with no odours. The housekeeping team used a cleaning programme, including regular cleaning of high use touch points throughout the day. Dedicated changing rooms were available for staff to use at the start and end of their shift to prevent cross contamination. The service had obtained a fogging machine to allow effective disinfection of furniture items.

¿ There were enough personal protective equipment [PPE] supplies in place to ensure safe infection prevention and control practices were undertaken. PPE stations were situated throughout the service. Staff had access to PPE and were observed wearing this in line with national guidance.

¿ Infection control policies had been updated to reflect current national guidance.

Further information is in the detailed findings below.

People’s experience of using this service:

• The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2017. More information about this is in the full report.

• The risks to people’s health and safety were fully reflected in the care they received. People were protected by staff who understood how to protect them from avoidable harm. There were enough staff in place to keep people safe.

People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection. The registered manager and the provider worked in partnership to learn from mistakes. This included the detailed analysis of accidents and incidents.

• Staff training was up to date; action had been taken to address some gaps in the frequency of staff supervisions. People were provided with care and support which protected them from discrimination. People received the support they needed to maintain a healthy diet. People had access to other health and social care agencies where needed. People were supported to make decisions about their care, the provider ensured these were made in accordance with appropriate legislation.

• People liked the staff and found them to be kind and caring. People were treated with dignity and respect. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

• People had their needs assessed prior to coming to live at the home to ensure they could be cared for safely and effectively. People’s personal preferences were considered when care was planned. People had access to information in a format they could understand. Complaints were handled appropriately and line with the provider’s complaints policy. People did not currently receive end of life care but people had discussed their wishes with staff if they had any personal preferences.

• Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (23 and 24 August 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor this service and will return within the next 30 months if we are satisfied that there are no serious risks at the service during this time.

The service had a registered manager in place at the time of our inspection but they were unavailable during our inspection visit. 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 our last inspection on 30 and 31 August 2016 we found the provider was in breach of one Regulation of the Health and Social Care Act 2008. This was in relation to the staffing levels and the staff skill mix and experience. The provider sent us an action plan detailing what action they would take to become compliant with this regulation. At this inspection we found the provider

had taken action and this breach in regulation had been met. Whilst we concluded staffing levels on the day of our inspection was appropriate and improvements had been made, we asked the provider’s operations director to further review the deployment of staff to ensure this was fully effective.

Some people told us they felt unsafe at night due to other people entering their room uninvited. Staff had received safeguarding training and had information available about the action required to respond to any safeguarding incidents or concerns.

Risk assessments associated with people’s needs were either missing or lacked detail in places. The health and safety of the environment had been assessed. Whilst people had personal evacuation plans used to inform staff of their support needs, these lacked specific detail that staff would require to support people safely and effectively.

Medicines were found to be managed and stored appropriately, but records used to inform staff of people’s needs associated with their prescribed medicines lacked detail in places. The action required when people received their medicines covertly in food, had not been fully followed.

Not all people felt staff understood their needs, and an example of this was observed during the inspection.

Staff received an induction and ongoing training and development. Some staff felt they would benefit from further training in how to effectively support people at periods of heightened anxiety that affected their mood and behaviour.

Staff gained people’s consent before providing care and support. The principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were understood and applied. Where people communicated their anxieties and needs through behaviour that was challenging at times, staff had limited instruction and guidance to support them.

People’s nutritional needs had been assessed and planned for and people received a choice of meals. Some concerns were raised by people who used the service about the availability of suppertime snacks. Positive feedback was received from external healthcare professionals about how people’s health needs were monitored and managed. However, a relative raised a concern about how health needs were met. During the second day of the inspection concerns were identified about the lack of action initially taken by a member of staff in response to a person experiencing pain and discomfort.

Staff were kind and caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy and independence. Information about an independent advocacy service was available for people should this support have been required.

People and or their representatives where appropriate, were involved in the assessment and review of their needs. Care plans informed staff how to support people and were on the whole personalised to people’s needs, routines and preferences. Activity staff provided a range of one to one and social activities and opportunities, to support people with any interest’s hobbies and pastimes. People and staff knew how to raise concerns and these were dealt with appropriately.

People who used the service and relatives or representatives, were given opportunities to share their experience of the service. Quality assurance systems were in place to regularly review the quality and safety of the service provided.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.

People were not always supported by sufficient numbers of staff. There were times when the number of staff the provider had identified were required to meet the needs of the people who used the service were not met. As a result people received care that was either rushed or they had to wait for long periods of time before staff could assist them. This meant the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (regulated activities) regulations 2014. We have asked the provider to report on actions they plan to take to meet this regulation.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager had shared information with the local authority when needed. Appropriate risk assessments were in place for both individuals and the environment. People received their medicines as prescribed and the management of medicines was safe.

People were supported by staff who had received training and supervision to ensure they could perform their roles and responsibilities effectively.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. The service had acted in accordance with the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed and people’s health needs were well managed.

People, who used the service, or their representatives, were encouraged to contribute to the planning of their care. They were treated in a caring and respectful manner and were encouraged to take part in a range of social activities both in and outside the service.

People, who used the service, or their representatives, were encouraged to be involved in the running of the service and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

We saw evidence that people were consulted before receiving care. One of the people who used the service told us, 'I can tell them if I need something, staff will always ask if it's ok to help me.'

People told us they thought the care provided met their needs and they were safe. A relative of a person who used the service told us, 'I find that they are safe there. The staff are very caring, I can't fault them at all.'

People were protected from the risk of infection and the home was clean and tidy. A relative we spoke with told us, 'I feel the care given here is excellent and the standard of cleaning is very good.'

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person who used the service told us, 'Yes they (staff) are knowledgeable, I am supported."

The provider had an effective system in place to monitor the quality of the service that people received and to learn from incidents when they have occurred.