Westgreen House

Westgreen House is a residential care home providing nursing or personal care to up to 45 people. The service predominantly provides support to older people, of whom some live with dementia. At the time of inspection there were 32 people using the service.

People were accommodated in one adapted building across two floors. Part of the building was closed due to building work in progress. The care home was operating as three units, one of which provided support to people who required additional support to live with dementia.

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

Risks to people had not always been sufficiently assessed, planned and managed. Staff had not received sufficient or appropriate training, in line with best practice guidance, to safely support people with distressed behaviours. We made a recommendation to support the deployment of staff.

People did not always receive the care and support they required to meet their individual needs and preferences. People’s care plans did not always reflect their needs.

The provider had systems in place to protect people from the risk of abuse, however, one incident was not promptly notified to CQC to ensure all relevant agencies could monitor people’s safety. We made a recommendation to support external incident reporting.

The provider’s quality monitoring processes had not been effective in identifying shortfalls found during this inspection.

We made a recommendation about records relating to concerns and complaints.

We were not fully assured that people were supported to have maximum choice and control of their lives. Although staff were aiming to support people in the least restrictive way possible, practices and records showed that this had not always been the case and the principles of the MCA were not always followed. Decisions made on behalf of people and in their best interests were not always clearly recorded.

People and relatives told us the staff were caring, kind, friendly and welcoming. People had access to healthcare professionals when required.

Infection, prevention and control arrangements were in place to help prevent the spread of infection. There were no restrictions in relation to visiting.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The service was newly registered with us under the current provider on 10 October 2020 and this is the first rated inspection of the service.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care provided, staff training, infection control practices, medication practices, management of service user behaviours, restrictive practices and the management of the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service is requires improvement based on the findings of this inspection.

During this inspection action was taken to reduce risks associated with distressed behaviours.

Enforcement and Recommendations

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.

We have identified breaches in relation to the safe care and treatment of people, personalised care delivery and the provider’s quality monitoring processes at this inspection.

We have made recommendations regarding staff deployment, external incident reporting and recording of concerns received.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice

¿ The service was clean and free of malodour. There was a cleaning schedule in place to ensure that all areas of the service were cleaned.

¿ The service had implemented personal protective equipment (PPE) stations which were situated near the main entrance and throughout the home.

¿ Visitors were supported by staff to ensure they followed safe infection control, PPE guidance and to check whether they had any symptoms of coronavirus before entering the home. This included taking the visitor's temperature.

¿ The service had a designated indoor area for visitors that was used for relatives to visit their loved ones. This area had its own entrance and PPE station.

¿ People were supported to receive regular testing for Covid-19.

¿ All people being admitted to the service were tested for coronavirus by the care staff on admission.

¿ Staff were compliant with weekly testing requirements and the registered manager ensured test results were followed up when not received. When unclear results had been received, the registered manager and provider sought and followed advice from PHE.

¿ Staff were required to change into their uniform in a designated area when they first came on shift. This also included having specific footwear which was only worn in the home whilst staff were on shift. Staff were required to change out of their uniform after each shift. This was then washed to minimise the risk of the spread of infection.

¿ Individual risk assessments had been conducted on staff which identified any vulnerabilities they may have in relation to coronavirus and any mitigating action that the provider needed to implement.

¿ The service had developed a COVID-19 secure wing to accommodate anyone who may test positive for coronavirus. The provider told us this would minimise the risk of infection spreading to others.

¿ The service had appropriate infection control policies and procedures in place. These had been developed in line with current government guidance. There was signage around the home for staff and visitors on what measures were being taken to minimise the risk of spread of infection. These messages were also being communicated through easy read formats, email and on the provider's website.