The inspection took place on 3, 5 and 6 April 2018 and was unannounced, which meant the provider did not know we would be visiting.At the last inspection in January 2017 the provider had not ensured that people were protected against the risks associated with unsafe and unsuitable premises. They did not ensure that robust systems were in place to assess, monitor and improve the quality and safety of the service or to mitigate the risks relating to the health, safety and welfare of people using the service. Records were also not accurate or completed fully. These issues were breaches of regulation 15 (premises and equipment) and regulation 17 (Good governance). Following the inspection, the provider sent us a detailed action plan to explain how they would address these concerns.
At this inspection the provider had made some improvements but we found other issues needed to be addressed. Following the inspection we wrote and invited the provider to attend a meeting with us to discuss the concerns we had found. We will report on this at the next inspection.
The overall rating for this service is now inadequate and the service has been placed in special measures.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they
do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
Westwood Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Westwood Lodge Care Home provides accommodation for up to 44 people with residential and nursing care needs. People had a range of health care needs, including those with mental health, alcohol misuse related conditions and those living with dementia. At the time of the inspection, there were 31 people living at the service.
The service had a registered manager who had worked at the service for over 10 years, the last two as manager. 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. The provider was currently seeking to appoint a deputy manager to support the registered manager in their role.
Although people told us they felt safe living at the service, we found some areas of concern which needed to be improved.
The Registered manager had not maintained clean and hygienic facilities for people living at the service. Staff did not always follow correct procedures to maintain hygiene, including the lack of proper use of aprons and gloves. The provider had not monitored this area which led to poor infection control procedures being followed. After the inspection, the registered manager told us they had addressed some of the concerns we had raised and later sent us an action plan on how they would address this.
Medicines were not always managed appropriately. We found a number of areas which needed to be improved, including giving medicines before food as prescribed, thickeners being stored in unlocked cabinets within one of the dining room areas and ensuring that correct records were kept to support staff.
People’s needs had been assessed and individualised care plans and risk assessments developed. Some care records had detailed information for care staff to follow. Other care records lacked specific detail about how to support people, including missing risk assessments and care plans not in place. Reviews of care plans were not always timely, detailed or appropriately recorded.
People said food and refreshments at the service needed to improve and was not always hot. Meals were not always delivered in an appetising way, for example people with pureed meals. We found this not person centred.
We have made a recommendation to the provider in connection with ensuring they follow best practice with the input from dietician teams when necessary.
Quality monitoring systems were not always in place at the service, including for example, those in connection with infection control. We found checks had not always uncovered what we had during the inspection. We deemed that the registered manager and the provider did not have full oversight of the service because of this.
The provider had completed equipment and premises checks at the service, including gas, electric and fire safety. We have made a recommendation to the provider in this area to update their fire risk assessment in light of our findings.
People said staff were kind and caring. Although we found some staff practices were not respectful and less dignified than they should have been. For example, food being left on people’s faces after being supported to eat and appropriate bedding not being in place for one person.
Activities took place within the service, but we deemed these were limited and have made a recommendation to the provider to review these and the deployment of staff.
Staff told us they felt supported and had received induction, training, supervision and yearly appraisal. The registered manager knew they were behind in some support sessions and were working through this.
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
People felt that the staff at the service kept them up to date with information and enabled them to be involved with planning and review of their care needs.
The service had responded to the changing needs of people and supported people if the intention was to move on to different living accommodation by helping them with skills they needed to either retain or build upon, for example, completing laundry tasks, shopping or cooking.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person centred care, dignity and respect and good governance.
You can see what action we told the provider to take at the back of the full version of the report.