Westlands

Westlands is a care home providing accommodation with personal care for up to 41 people. The home is purpose-built accommodation, providing care and support to people across three floors. At the time of our inspection visit there were 35 people living at the home.

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

There were enough staff to provide safe care to people, however, we received feedback from relatives and staff that people sometimes waited to receive personal care due to staffing levels. The provider had developed new systems to reduce the amount of agency staff usage and increase permanent staffing at Westlands. Relatives told us personal hygiene standards needed to be improved.

Communication between staff at Westlands and people’s relatives needed to be improved. Care records did not always show when people refused care and support.

Staff understood their role in safeguarding people. Risks to people’s health and wellbeing had been identified, assessed and managed. The provider’s checks helped ensure medicines management followed best practice.

People’s needs were assessed before they moved to the home to ensure staff had the appropriate skills to meet those needs. Staff received regular training to keep their knowledge and skills up to date. People’s healthcare needs were monitored, and they were referred to external healthcare professionals to maintain their health and wellbeing. People were encouraged to eat a healthy and balanced diet and their appetites and weight were monitored.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager was experienced and worked with the provider to develop and maintain systems and processes for reviewing the quality of the care provided. Any issues identified were pulled into a 'home improvement plan'. The provider worked with other organisations and healthcare professionals to improve outcomes for people.

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

Rating at last inspection and update

The last rating for this service was good (published February 2020). The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

The inspection was prompted in part due to concerns received from people about infection control and staffing concerns at the service. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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.

Follow up

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.

¿ A risk assessment was completed when visitors arrived at the home. The assessment explained the expectation of visitors in line with current guidance.

¿ A Perspex screen was used during some visits to maintain social distancing. This had reduced people's levels of anxiety as they were able to see and talk to their relatives clearly.

¿ The management team were proactively preparing for a possible second wave of the pandemic. A room was being prepared to facilitate future visits inside the home.

¿ People had creating signage which supported them understand the pandemic including the importance of effective handwashing.

¿ Wellbeing sessions had been held with staff. This included signposting staff to a confidential helpline for advice during the pandemic.

¿ The risks of staff using public transport had been explored to increase their safety. Staff had been provided with personal protective equipment to wear whilst travelling to and from work.

Further information is in the detailed findings below.

Westlands is a residential care home, providing personal care and accommodation for up to 41 older people, including people living with dementia. The home was divided into three separate floors or units which were being used as residential accommodation. There were 41 people living at Westlands when we inspected the service.

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

People’s relatives and staff gave us mixed feedback about whether there were enough staff available to always respond to people’s needs. However, we found staffing levels were determined by people’s support requirements and were being regularly reviewed by the provider. During our inspection visit we found there were sufficient staff to respond to people’s preferences and wishes.

People felt safe at Westlands. Staff were provided with guidance about how to keep people safe. Environmental risks were identified and mitigated against. Staff understood their responsibilities to protect people from the risk of abuse. The manager checked staff’s suitability for their role before they started working at the home. Medicines were stored, administered and managed safely following a full review of all medicine procedures at the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were cared for and supported by staff who had the skills and training to meet their needs. People were supported to eat and drink enough to maintain a balanced diet that met their individual dietary needs and preferences. People were referred to healthcare services when their health needs changed.

People received kind, responsive person-centred care from staff. Staff respected people’s privacy. Overall, people and their relatives were involved in planning their care and support. The staff team worked to promote people’s dignity and prevent people from becoming socially isolated within the home.

The provider employed lifestyle coaches, who were dedicated to supporting people to make the most of each day through physical and social activity. Group and one-to-one activity sessions were effective and the positive impact on people’s moods was visible. People knew how to raise concerns and provide feedback about the service. The provider ensured people received care at the end of their life, which met their wishes.

The service was led by an experienced registered manager who had been at the home since our previous inspection. The registered manager was supported by a care manager, daily duty manager, and care co-ordinators. The management team worked together to identify areas for improvement at the home.

The provider had implemented technological systems that ensured staff and management had access to the most up-to-date information about the support people received, at the press of a button which enabled relatives to be fully informed and involved in their relations’ care. People benefited from the technology because staff had more time to care for them. The provider listened and acted on people’s views to improve the service.

Rating at last inspection

The last comprehensive inspection report for Westlands (published August 2017) we gave a rating of good overall with a rating of outstanding in well led. At this inspection we found the service had maintained their overall good rating.

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

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

There were two registered managers for this service at the time of 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.

One registered manager had recently retired, but had not yet deregistered from the service. The new registered manager had been in post since April 2017 and had been registered as the manager at this home since May 2017. The new registered manager was already registered with us as a manager at another of the homes in the provider’s group, which had been rated Good under their leadership. The provider had notified us of these changes.

People were at the heart of the service. Staff and the management team shared and demonstrated the provider’s philosophy that, ‘every day should be a day well lived’. Staff received training in the provider’s values, which included, ‘play, make their day, be there and choose your attitude’. People were supported to maintain their purpose and pleasure in life independently or with the support of staff and volunteers.

People and their relatives were encouraged to share their opinions about the quality of the service, which ensured planned improvements were beneficial to the people who lived at the home. The provider continued to use external agencies and recognised methods to understand how people who lived with dementia experienced care, to drive improvements in the service. Changes to the premises had improved people’s enjoyment of their environment.

The provider was innovative and creative and strived to improve the quality of people’s lives. They had researched and reflected on how an internationally recognised provider of excellence in dementia care provided care. They had implemented an electronic care planning system that ensured staff and management had access to the most up-to-date information at the press of a button and enabled relatives to be fully informed and involved in their relations’ care.

The provider planned to implement an acoustic monitoring system at night, which was already in operation at some other homes in the group, where people had agreed they would like it. People will benefit from the technology because they will not be disturbed by regular night checks and staff will have more time to care for them.

People continued to have freedom of choice and were supported by staff who had the skills and training to meet their needs. People were supported with their dietary and health needs and were encouraged to maintain their independence by following their preferred and familiar routines and habits.

People were involved in planning their care with the support of their relatives and staff, to make sure their care plans met their individual needs, abilities and preferences. Staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.

People were protected from the risks of harm, because staff understood their responsibilities to protect people from harm. The registered manager checked staff’s suitability for their role before they started working at the home and made sure there were enough staff to support people safely.

Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. Medicines were stored, administered and managed safely and the registered manager regularly checked the premises and equipment were safe for people to use.

Further information is in the detailed findings below.

The provider assessed people's needs and abilities before they moved into the home. Everyone had a own care plan, which minimised risks and promoted their independence. In the five care plans we looked at, we saw that people or their relatives signed to say they agreed with the plan and consented to staff acting on their behalf for specific aspects of their care.

People were protected from the risks associated with medicines because staff followed the provider's policy, procedures and guidance. We saw that senior staff checked that accurate records were kept when medicines were obtained and administered.

Care staff we spoke with told us they were supported by the provider to deliver the care and support that people needed. We saw records of staff's individual meetings with the manager. A member of care staff told us, 'I love it here I love working here.'

The provider's quality assurance process included regular checks that people and their relatives were happy with the service they received. One person we spoke with told us, 'If I had any concerns, I would go to the manager.'