Westerley Residential Care Home for the Elderly - Woodhall Spa

Westerley Residential Care Home for the Elderly – Woodhall Spa is a residential care home which provides accommodation and personal care for up to 30 older people. Accommodation is provided over 3 floors, with a passenger lift available. At the time of the inspection 28 people were living at the home.

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

Risks to people's health and wellbeing were not being managed effectively and people did not always live in a clean, safe environment. Care documentation did not include up to date information about some people’s needs and risks to guide staff. There were inadequate systems in place to ensure there were sufficient staff available to meet people’s needs and monitor their safety. Medicines were not managed safely, in line with national guidance. Improvements were needed to staff recruitment processes, to ensure appropriate checks were completed before staff started working at the service.

People did not always receive support which reflected their assessed needs. Some people did not receive support when they needed it and people's safety was not always monitored effectively. Some staff had not received an appropriate induction or completed the training necessary to support people effectively. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Some people did not receive appropriate support with their dietary and healthcare needs and risks. The home environment needed to be improved to ensure it met the needs of people living with dementia.

People did not receive personalised, high-quality care which resulted in good outcomes for them. Many audits of quality and safety were not being completed regularly. When audits had been completed and shortfalls identified, the necessary improvements had not always been made. Many of the shortfalls we identified during the inspection had either not been identified by the manager or provider or had not been acted upon. This meant that appropriate standards of quality and safety were not being maintained at the home. There was limited evidence of engagement with people or relatives to gain their views about the care provided. There was a lack of appropriate oversight of the service by the provider; their visits and telephone calls to the service had failed to effectively monitor how the service was being run, the quality of care people were receiving and standards of quality and safety at the home.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 November 2022) and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 August and 1 September 2022. Breaches of legal requirements were found. We issued the provider with a warning notice.

We undertook this focused inspection to check the provider had complied with the warning notice and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westerley Residential Care Home for the Elderly – Woodhall Spa on our website at www.cqc.org.uk.

Enforcement and recommendations

At this inspection, we have identified breaches in relation to the management of risks to people’s health and welfare, medicines management, infection prevention and control, the safety of the premises, staffing levels, staff training, safeguarding people from abuse and improper treatment and the provider’s oversight of the service.

We have made recommendations in relation to staff recruitment and providing a dementia friendly environment.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We met with the provider shortly after our inspection to discuss our findings. We will continue to monitor information we receive about the service, which will help inform when we next inspect and will work with the local authority to monitor progress.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Westerley Residential Care Home for the Elderly is a residential care home providing accommodation and personal care to up to 30 people in one adapted building. The service provides support to older people. At the time of our inspection there were 28 people using the service.

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

The risks to people’s safety were not always fully identified and some assessment tools used were not regularly updated to ensure people’s current needs were reflected. Assessed measures to support people were not always in place and some environmental risks to people’s safety had not been robustly assessed.

Medicines were not always well managed, and some aspects of infection prevention and control did not reduce the risks of the spread of infection at the service. This included staff not wearing masks on the first day of our inspection

People did not always receive care from enough appropriately trained staff. There was a lack of adequately deployed ancillary staff to support care staff and allow them to manage people’s care needs in a timely way.

People’s nutritional needs were not always well managed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Quality monitoring processes were either not in place or had not highlighted the concerns we found at our inspection. People, relatives and staff did not always feel engaged and listened to.

There were safe staff recruitment processes in place.

Where any safeguarding concerns had been raised to the registered manager, they had worked with the local safeguarding team to investigate the concerns and act on the outcome of investigations. The provider worked in line with the duty of candour regulation.

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

Rating at last inspection

The last rating for this service was Good (8 February 2019).

Why we inspected

We received concerns in relation to staffing levels and people’s care and treatment. 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.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective 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.

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

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 safe care and treatment, staffing levels and training, safeguarding people’s rights and governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Westerley Residential Care Home for the Elderly provides accommodation, care and support for up to 30 people who experience physical disabilities and those who live with dementia.

There were 24 people living at the service at the time of this inspection.

People’s experience of using this service:

People received safe and effective care from staff who were recruited safely and were clear about how to recognise and report any issues of concern and potential abuse. Risk assessments were in place to manage risks within people’s day to day lives, whilst also promoting their independence. People received safe support with their medicines and the registered provider had systems in place to respond to any medicine errors.

Sufficient staffing levels were being maintained and at the time of our inspection, staffing support matched the level of assessed needs for the people who lived at the service.

Staff induction and on-going training was provided to ensure the staff team had the skills and knowledge needed to carry out the roles they were employed to do. Staff told us they were well supported by the registered manager and their management team.

Staff were caring and treated people with kindness, dignity and respect. People were able to have choice and control over their lives. Wherever possible, people's consent was gained before any care was provided and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People were involved in reviewing their care and in making any necessary changes to the way care was provided. People had access to a wide variety of food and drinks and care plan records reflected people’s likes, dislikes and overall preferences. People were also supported to access a range of activities and to maintain any individual interests they had.

A process was in place which ensured complaints could be raised. People and their relatives had access to this information so that if needed, they were clear about how to raise any concerns or more formal complaints.

Systems and processes were in place to support the registered persons in their monitoring of the quality of the services provided so that they could quickly take any improvement actions if shortfalls were identified.

There was an open and inclusive culture within the service which enabled people who lived there, and staff, to share ideas and work in partnership with each other. People, relatives and staff, expressed confidence in the registered persons and their approach to leadership.

Rating at last inspection:

Good (report published June 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated good overall.

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 was 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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered safely but medication administration sheets (MARS) were not completed fully.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the Dolls, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision. People were encouraged to enjoy a range of hobbies and social activities. They were supported to maintain relationships that were important to them. We saw that staff obtained people’s consent before providing care to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Audits were in place for areas such as falls and infection control. Accidents and incidents were recorded. The provider had informed us of notifications as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

All of the six people we spoke with gave us positive feedback about the service. One of them said, 'Nothing is too much trouble for the staff who are quite wonderful and kind. They'll go out of their way to help you.'

People's privacy, dignity and independence were respected. Staff were courteous and kind.

People said that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

There were reliable arrangements for managing medication so that people safely received the medicines they needed.

Records showed that security checks had been completed on staff to help ensure that only suitable and trustworthy people were employed in the service.

There were measures to check that people were reliably provided with the facilities and services they needed.

During our visit we spoke with nine people who lived at the home, two members of staff, a professional visitor and one other visitor. We looked at three people's care records in detail and reviewed several others in selected sections. We also spent time observing how people were supported and spoke with the deputy manger.

We saw people received individualised care and support, from staff who were knowledgeable about their needs, wishes and preferences. Staff were trained and supported to provide the care people needed. However, we made comments about how care records were completed.

People made comments such as, 'I couldn't ask for better care', 'I feel safe here, the staff make sure of that. It's safer than being at home' and 'The staff make time to listen to me and sort out anything I have a problem with.'

A professional visitor told us there was a 'good' feeling in the home and there was a good quality to the care provided.

Another visitor told us, 'It's a lovely place, very comfortable and clean and they keep me informed.'