Following an inspection on the 10 and 13 February 2015 to Westholme Clinic Limited, breaches of legal requirements were found in six areas and we took enforcement action with regard to three of them. Warning Notices were issued in respect of care and welfare of people, management of medicines and assessing and monitoring the quality of service provision, which were to be met by 4 April 2015. A responsive inspection was carried out on 13 May 2015 to follow up on the warning notices. At that visit we found that improvements had been made and the Warning Notices had been met.
We undertook an unannounced comprehensive inspection of Westholme Clinic on 6 January 2016. This inspection was carried out to confirm that improvements had been sustained and to check that the service now met legal requirements in the breaches of the regulations we found in February 2015. At this inspection we found that improvements had been made and the service was no longer “inadequate.” However we have identified some areas for further improvement.
Westholme Clinic Limited provides personal and nursing care for older people living with dementia and other mental health conditions. It is registered to accommodate up to 55 people and at the time of our visit 50 people were living at the home.
The service had not had a registered manager in post since April 2015. The person currently managing the home had not yet been registered with the Care Quality Commission (CQC). We have referred to this person as ‘The manager’ throughout the report. 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’s medicines were not always managed safely. There were some medicines that were used as stock medicine for a number of different people. We found inconsistencies and poor practice in relation to medicines records, including transcribing of medicines and accuracy in recording medicines given. Staff were not fully aware of best practice guidance in relation to managing and recording medicines.
Before anyone moved into the home a needs assessment was carried out. However due to their needs, people did not always understand a care plan had been prepared for them. Only one relative said they were included in the development of their relative’s care plan. People’s care plans provided information for staff on how people should be supported. However care plans were task orientated and not person centred. There was little evidence that people were consulted and involved in the planning of their care so people were not always involved. This meant that care may not always be delivered in the way they preferred.
The manager used a needs dependency tool to assess the required staffing levels to meet people’s needs. People told us there were enough staff on duty. Relatives considered there were enough staff to meet people’s needs and we observed that there were sufficient staff on duty at the time of our visit.
People told us they felt safe. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm. Appropriate recruitment checks were carried out to check staff were suitable to work with people.
Care records contained risk assessments to protect people from any identified risks and helped to keep them safe. Although these gave information for staff on the identified risk there was not always clear guidance on reduction measures contained in the risk assessment. There were also risk assessments for the building and contingency plans were in place to help keep people safe in the event of an unforeseen emergency such as fire or flood. We have made a recommendation regarding risk assessments.
Staff received training in a variety of subjects and the manager told us 80% of care staff had a national qualification in care such as a National Vocational Qualification (NVQ). Since the last inspection additional training has been provided for staff in areas such as caring for people living with dementia. The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Newly appointed staff received an induction to prepare them for work and staff received regular supervision.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager and staff understood the basic principles of DoLS and acted in people’s best interests if they did not have capacity to consent to their care and support. However greater understanding of the Mental Capacity Act 2005 (MCA) and DoLS is needed. We have made a recommendation regarding MCA and DoLS.
People were satisfied with the food provided and said there was always enough to eat. People had a choice at meal times and were able to have drinks and snacks throughout the day and night. Specialist diets were catered for such softened food textures and consideration was given to certain conditions such as diabetes. The advice of specialist services such as the Speech and Language Therapist were sought so people could be supported to eat and drink safely and according to their needs.
Staff supported people to ensure their healthcare needs were met. People were registered with a GP of their choice and the manager and staff arranged regular health checks with GPs, specialist healthcare professionals, dentists and opticians. A visiting GP told us people’s health care needs were met and appropriate referrals were made when medical assessment or treatment was needed. Appropriate records were kept of any appointments with health care professionals
People told us the staff were kind and caring. Relatives had no concerns and said they were happy with the care and support their relatives received. Staff respected people’s privacy and dignity and staff had a caring attitude towards people.
People told us the manager and staff were approachable. Relatives said they could speak with the manager or staff at any time. The manager operated an open door policy and welcomed feedback on any aspect of the service. Regular meetings took place with staff, people and relatives.
The provider had a policy and procedure for quality assurance. The manager and senior staff carried out weekly and monthly checks to help to monitor the quality of the service provided. Quality assurance surveys were sent out to people and relatives at six monthly intervals to seek their views on the service provided by Westholme Clinic.
It was evident the manager and provider had invested time and effort into improving the service following the previous inspection. We noted improvements in all the areas identified during our previous inspections. Staff told us that the manager had made improvements to the service. They reported that the manager and provider had involved staff in discussions and decision making regarding improvements the service needed to make.
We two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.