Westerleigh

Westerleigh is a residential care home providing personal care for up to 55 people who are mainly aged 65 and over. At the time of the inspection the service were supporting 50 people. The service is arranged over three floors and supports people with a range of conditions including those living with dementia.

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

Since 2021 the service has had difficulties around ensuring medicine management was effective and safe. The senior management team were now proactively addressing the issues.

People felt safe. In conversation staff understood people's needs and how to manage any presenting risks. Many of the risk assessments on the electronic care records had not been completed. Those in place, needed to be accurate and more detailed, which the management team alongside staff were working to do.

Albeit the provider had a dependency tool in place, which determined how staff numbers were needed, factored in the layout of the building and minimum staffing levels this had not been used consistently. This had led to variations in staffing levels across shifts. The management team undertook to resolve this matter.

Due to the challenges of the pandemic and staffing crisis in social care there had been a high turnover of staff and increase in sickness levels, which was mitigated via the use of agency staff. The provider was actively seeking to fill vacancies and reduce their reliance on agency staff.

Staff had training on how to recognise and report abuse and they knew how to apply it. However, at times it was unclear from the records whether all incidents had been reported to appropriate authorities or if staff always recognised the need to record and report incidents. The management team were in the process of reviewing records and have discussions with staff to check whether alerts had been raised when needed.

The management team understood how closely monitored accidents and incidents to understand trends, then determine what action could be taken to reduce potential risks. This at present was impaired by the fact staff were not completing the electronic incident analysis and lesson learnt tools.

Staff did not feel confident when applying the Mental Capacity Act 2005 and associated code of practice to their practice. The management team were providing additional training.

Systems were in place to ensure checks were carried out on the environment and staff knew how to keep people safe. The management team were in the process of ensuring all staff completed simulated evacuations and undertook regular fire drills.

People and their relatives spoke positively about the care they received from the service and the staff. They told us the staff were extremely supportive and very caring. We observed staff to be very empathetic, caring and worked tirelessly to meet people’s needs.

We found recruitment practices were meeting requirements.

The provider had been very responsive when the recent concerns had been identified by the latest manager. They recognised the need to work with staff to develop their practices. The provider had deployed a full range of resources and were giving the team time to make the necessary changes. They were completing regular audits, which were robust and a honest reflection of the service. They had completed a development plan and were working diligently to ensure the goals were achievable and completed in a timely manner.

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 27 February 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westerleigh on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Westerleigh is a residential care home providing personal care to 55 people aged 65 and over. At the time of the inspection the service were supporting 51 people. The service is arranged over three floors and supports people with a range of conditions including those living with dementia.

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

Since our last inspection the service had made improvements to documenting people’s medicines and making sure checks on the service were more robust. People and their relatives spoke positively about the care they received from the registered manager and the staff. People told us they felt safe living in the home. Systems were in place to ensure checks were carried out on the environment and staff knew how to keep people safe.

Pre-employment checks were carried out on staff to make sure they were suitable. Once employed staff underwent an induction period and were supported through training and supervision. Staff knew what to do if anyone was at risk of abuse and were confident the registered manager would respond to any concerns.

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.

Staff provided people with a choice of meals. Kitchen staff knew people’s dietary requirements and were happy to provide people with food they liked to eat.

Staff worked with other healthcare professionals to promote people’s health and well-being.

People’s care plans were person-centred and provided guidance to staff on how to meet people’s care needs. These were regularly reviewed by staff and updated as required. An activities coordinator provided a weekly activities’ plan which was flexible to meet people’s preferred activities each day.

Staff protected people’s dignity and promoted their independence.

A system of audits and checks were in place to monitor the quality and safety of the service. The service had a home improvement plan.

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 requires improvement (published 31 January 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

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

People’s experience of using this service:

Since our last inspection the manager had made a successful application to CQC to become registered and a new deputy manager had been employed at the service. Improvements had been made and the service was no longer in breach of Regulation 11 – consent, Regulation 12 – safe care and treatment and Regulation 18 – staffing.

We found there was a continued breach of Regulation 17. This impact of poor governance has meant the rating remains requires improvement. Records to show people were given their medicines in a safe manner and ate and drank sufficient quantities required improvement. Audits carried out in the home showed mixed findings on these issues. Whilst some audits had identified areas for improvement, other audits had failed to pick up and address on going issues.

People and their relatives were complimentary about the registered manager and the staff. They spoke with us about feeling that issues they had raised with the staff team had been addressed.

The provider had introduced new arrangements to monitor the quality of the service and the quality team carried out audits. Actions to improve the service were listed on an improvement plan and signed off when completed by the regional manager who also carried out regular checks on the service.

People’s safety whilst living in the home was promoted using regular checks on the building and the environment. These were carried out by maintenance staff. Checks to reduce the risks of fire were carried out on a regular basis.

Staff had received support through training and supervision. This included safeguarding people and staff told us they felt confident in reporting any concerns to the manager.

The registered manager used a dependency tool to identify how many hours staff were required. There were consistent levels of staffing on each floor.

People were weighed on a regular basis and actions were taken to address people’s needs when they continued to lose weight. Advice from dieticians was incorporated into people’s care plans. Kitchen staff were informed of people’s dietary needs and understood how to prepare food to meet people’s individual needs.

People told us they experienced being cared for by staff who were kind and caring. Staff understood how to protect people’s privacy and dignity.

Arrangements were in place for on-going cleaning and for staff reduce the risks of cross infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were given choices and their decisions were respected.

The registered manager invited relatives to be a part of the service through residents and relative’s meetings.

Complaints and concerns had been addressed by the registered manager and practical solutions found to improve the delivery of care.

People’s care plans had improved since our last inspection. These were reviewed each month to check if they were accurate and up to date.

When we discussed activities with people in the home we received a mixed response. A new activities coordinator was putting together new activities plans. We found meaningful activities were carried out in the home and due to the timing of the inspection Christmas events were underway.

Staff felt there was good communication in the home and they worked as a team. Handover records between shifts were signed by staff to say they understood people’s up to date needs and wishes.

People were supported with their health needs by staff who had regular contact with other healthcare professionals to discuss people’s conditions.

Westerleigh is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Westerleigh is a purpose build care home and can accommodate up to 55 people across three floors. One of the floors specialised in providing care to people living with dementia. It is registered to provide accommodation for people who require personal care. Westerleigh does not provide nursing care. At the time of our inspection 45 people were using the service.

At the time of our inspection there was not a registered manager in post. 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.

Records throughout the home were incomplete and failed to document accurate and contemporaneous information about people’s care needs. This in turn meant people were put at risk of receiving care which was inappropriate.

We found there were gaps in people’s topical medicines records. People had a number of topical medicines on one document and we were unable to discern what topical medicines had been applied. Improvements were required to medicine records to guide staff on when to give people ‘as and when’ required medicines.

Although the home was generally clean and tidy we found some areas of the home needed improving to reduce risks of cross infection. This included bedding provided by the service which we found to be stained.

The risk of a fire in the home was reduced through regular checks. However we found consistent assessment of risk was not applied throughout the home. For example emergency pull cords in bathrooms and toilets were not accessible to people who may fall to the floor.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However we found care and treatment of people who used the service was not always provided with the consent of the relevant person. We saw staff understood the concept of making decisions in people’s best interest but failed to document the rationale for decisions.

Staff had not been supported through the regular use of supervision and appraisal as prescribed in the provider’s policy. The service had a training matrix in place. We saw staff had not been trained in end of life care and diabetes. The acting manager told us they had requested diabetes training from a training provider.

Audits had been carried out by the provider. However the regional manager and the acting manager were unable to provide us with audits the previous regional manager had carried out prior to December 2017. We saw an audit carried out by the provider’s quality improvement team. The audit had led to improvements in the service.

Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. We found we had not been notified of serious injuries to people. This regulatory breach is being dealt with outside of the inspection process.

We found there were sufficient staff on duty to meet people’s needs. However we recommended the provider reviews the deployment of staff during busy times to ensure people’s needs are met.

Staff confirmed to us they had received safeguarding training and were aware of their responsibilities to report any concerns.

People had the opportunity to give their views about the service and a complaints procedure was available in the service. Information on the complaints process was available in people’s bedrooms.

Staff who were employed in the service had undergone a number of checks to ensure they were appropriate to work with older people in a care home.

You can see what action we told the provider to take at the back of the full version of the report.

We previously inspected Westerleigh in January 2015, at which time the service was compliant with all regulatory standards and was rated Good. At this inspection the service remained Good.

Westerleigh is a residential home in Stanley, County Durham, providing accommodation and personal care for up to 55 older people, including people living with dementia. There were 53 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

There were sufficient numbers of staff on duty in order to keep people safe, meet their needs and ensure the premises were well maintained. All areas of the building were clean, with infection control risks well managed.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). The service had recently introduced an electronic medicines administration system and we found this to be working well, with no errors identified. Where people administered their own medicines, this was risk assessed.

Other risks people faced, such as trips and falls, were managed through risk assessments and associated care plans. These were reviewed regularly and incorporated advice from healthcare professionals to keep people safe.

Safeguarding principles were well embedded and staff displayed a good understanding of what to do should they have any concerns. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.

There were effective pre-employment checks in place to reduce the risk of employing an unsuitable member of staff.

There was prompt and regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Staff completed a range of training, such as safeguarding, health and safety, dementia awareness and moving and handling. Staff displayed a good knowledge of the subjects they had received training in and had a good knowledge of people’s likes, dislikes and life histories. Feedback regarding the face-to-face training provider was extremely positive.

Staff had built positive, trusting relationships with the people they cared for. Staff were supported through regular supervision and appraisal, as well as confirming the registered manger was willing to talk at any time.

People enjoyed the food they had and confirmed they had choices at each meal as well as being offered alternatives. We observed staff supporting people calmly and attentively to eat and drink, both at mealtimes and throughout the day.

The premises benefitted from some aspects of dementia-friendly design, although we found the registered manager was yet to fully incorporate person-centred care into the design of communal areas. Likewise, whilst care planning documentation was extensive, this had yet to be translated into easily accessible person-centred care documentation. Person-centred care means ensuring people's individual likes and preferences are considered and acted on when planning all aspects of care and people's environments.

Group activities were varied, well advertised and well attended. The activities co-ordinator required additional support to ensure the activities they planned were done so from a person-centred perspective.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The manager and staff displayed a good understanding of capacity and we found related assessments had been properly completed and the provider had followed the requirements in the Deprivation of Liberty Safeguards.

The atmosphere at the home was relaxed and welcoming. People who used the service, relatives and external stakeholders agreed that staff were caring and compassionate. We saw numerous instances of such interactions during our inspection.

The service had built and maintained some good community links, although there was scope to make further community links that would benefit the service and keep people involved in the communities they were a part of.

Staff, people who used the service, relatives and external professionals we spoke with were positive about the registered manager’s impact on the service. They confirmed the registered manager had improved staff morale and the continuity of care people received. We found the culture to be one where people received a good standard of care in a setting they found homely.

We returned to the home on 11 August 2014 for the purpose of looking at changes the home had been told to make.

We found the manager had made changes to the dementia unit of the home which included decorating and sensory boxes.

We saw care plans were being reviewed and changes had been made to take into account people's needs

We found people were not protected against the risks associated with the use and management of medicines.

Whilst we saw some improvements since our last visit, there were still some issues which meant that people did not receive their medicines at the times they needed them and in a safe way. Medicines were not obtained, administered and recorded properly.

We found that the provider continued to breach the regulation relating to safe handling of medicines and we are taking action away from this process to address this.

Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and 'in good hands'. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application for Deprivation of Liberty should be made, and how to submit one. There were systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach. However we did find that people the service had not reviewd people's care appropriately and where people had complex conditions they were not always cared for safely and effectively.

The service was not clean and hygienic. Appropriate guidance, equipment and facilities were not in place for staff so people were not safe and protected from the risks associated with cross infection. We have told the provider improvements are necessary.

Is the service effective?

People's health and welfare was not always protected and promoted although we do recognise the service had sought expertise and support from other health and social care services that people required, in order to meet their needs effectively.

People did not always receive appropriate care and support because there were not effective systems in place to assess, plan, implement, monitor and evaluate people's needs.

Is the service caring?

Staff did not have a good awareness of individuals' needs and people were not treated in a warm and respectful manner. We saw people did not receive care and support in a sensitive way and staff were not always able to manage behaviours that were complex or challenging.

People were positive about their experiences. Comments included "They are all lovely and very kind", "It's not like being at home but it will do" and "The home is wonderful, I am very well looked after' and "It's like home from home". Not all people we spoke with were positive, some people expressed concerns that they did not always receive a bath when they wished or were able to use the toilet when they needed to.

Is the service responsive?

Systems were in place to ensure where people required healthcare support they received it. However we found staff often lacked the skills to understand when it was necessary to obtain advice and guidance from health professionals which meant people did not always receive the care they required.

Is the service well-led?

The manager had been in post for 18 months when we inspected. We found improvements which had been required following our previous inspection on 9 September 2013 had not been addressed adequately. It was evident the manger was committed to ensuring people received care which was safe and effective but we did find shortfalls in auditing, care planning and staff attitude which meant people's needs were not always met in a safe and effective way. We told the manager and provider improvements were necessary.

People who were able to share their experiences, and relatives we spoke with, told us that their wishes were taken into account by staff. One person said, 'The staff are very good. They are always checking that I'm happy. I feel that they listen to me.'

However, other evidence did not support this. We found the provider had not always acted in accordance with people's wishes and legal requirements.

People told us they were happy with the care which was provided. One person said, "It's a wonderful place, I wouldn't want to go anywhere else." A relative said, "It's champion here. The staff are very good with my mum. I have no complaints at all. Her health has been much better since she's been here. She needed 24/7 care and they can really look after her well here.'

Appropriate arrangements were not in place to protect people against the risks associated with medicines.

We saw processes were in place to ensure staff were of good character and qualified to work within the service.

There was an effective system to regularly assess and monitor the quality of service people received.