Westlands is a service which provides accommodation for up to 30 people who require nursing or personal care. The home supports older people some of who live with dementia and physical disabilities. At the time of the inspection there were 19 people using the service.Following our previous comprehensive inspection in June 2016, we gave this location an overall rating of 'Requires Improvement’.
At that inspection we found that people’s risk assessments were not robust enough and the staffing levels were not sufficient to ensure people's needs were safely met. We also found the service was not always safe because people's medicines were not managed effectively. In addition to this we found some of the areas of the home and furniture were dirty and this exposed people to the risk of acquired infections. People were also exposed to hazards because cupboards with cleaning detergents were not always locked.
The service offered to people who lived at the home was not always effective because the requirements of the Mental Capacity Act 2005 were not met. We also found people were not always involved in decision making around their meals and meal times. From our observations, we found that care plans lacked involvement from the people who received care and did not take into account their wants, needs and were not person centred. People were bored and spent much of the time just sitting throughout the day which was punctuated by mealtimes or tasks delivering their personal care. People also told us they were not able to take part activities and hobbies that were of interest to them because there wasn't enough staff.
We found there was an area of concern whereby the lift had broken down, but this was not reported to the Care Quality Commission (CQC) as an event that stopped the service from operating as normal. You can read the report from this comprehensive inspection by selecting the 'all reports' link for Westlands on our website at www.cqc.org.uk.
The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have them met by. At the last inspection in June 2016 we asked the provider to take action to make improvements to the above issues and during this unannounced comprehensive inspection on 14 June 2017, we found that these actions had been completed
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 about how the service is run.
There was not strong leadership in the service and we found that people were unsure who the registered manager was. Quality monitoring systems were however in place. A variety of audits were carried out and used to drive improvement.
People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.
People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent. There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed. Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.
The service was clean and there were no malodours. Cleaning products were locked away.
Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported with regular supervisions. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.
People were supported to access a variety of health professional when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.
Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was maintained at all times.
People were supported to follow their interests and join in activities if they chose to. People knew how to complain. There was a complaints procedure was in place and accessible to all. Complaint had been responded to appropriately.