This unannounced inspection was carried out on 23 and 24 August 2017. Westwood Care Home is run and managed by Runwood Homes Ltd. The service provides accommodation and personal care for up to 78 older people including people living with dementia. On the day of our inspection 67 people were using the service, which is split into four units over two floors.The service had a registered manager in place at the time of our inspection but they were unavailable during our inspection visit. 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.
At our last inspection on 30 and 31 August 2016 we found the provider was in breach of one Regulation of the Health and Social Care Act 2008. This was in relation to the staffing levels and the staff skill mix and experience. The provider sent us an action plan detailing what action they would take to become compliant with this regulation. At this inspection we found the provider
had taken action and this breach in regulation had been met. Whilst we concluded staffing levels on the day of our inspection was appropriate and improvements had been made, we asked the provider’s operations director to further review the deployment of staff to ensure this was fully effective.
Some people told us they felt unsafe at night due to other people entering their room uninvited. Staff had received safeguarding training and had information available about the action required to respond to any safeguarding incidents or concerns.
Risk assessments associated with people’s needs were either missing or lacked detail in places. The health and safety of the environment had been assessed. Whilst people had personal evacuation plans used to inform staff of their support needs, these lacked specific detail that staff would require to support people safely and effectively.
Medicines were found to be managed and stored appropriately, but records used to inform staff of people’s needs associated with their prescribed medicines lacked detail in places. The action required when people received their medicines covertly in food, had not been fully followed.
Not all people felt staff understood their needs, and an example of this was observed during the inspection.
Staff received an induction and ongoing training and development. Some staff felt they would benefit from further training in how to effectively support people at periods of heightened anxiety that affected their mood and behaviour.
Staff gained people’s consent before providing care and support. The principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were understood and applied. Where people communicated their anxieties and needs through behaviour that was challenging at times, staff had limited instruction and guidance to support them.
People’s nutritional needs had been assessed and planned for and people received a choice of meals. Some concerns were raised by people who used the service about the availability of suppertime snacks. Positive feedback was received from external healthcare professionals about how people’s health needs were monitored and managed. However, a relative raised a concern about how health needs were met. During the second day of the inspection concerns were identified about the lack of action initially taken by a member of staff in response to a person experiencing pain and discomfort.
Staff were kind and caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy and independence. Information about an independent advocacy service was available for people should this support have been required.
People and or their representatives where appropriate, were involved in the assessment and review of their needs. Care plans informed staff how to support people and were on the whole personalised to people’s needs, routines and preferences. Activity staff provided a range of one to one and social activities and opportunities, to support people with any interest’s hobbies and pastimes. People and staff knew how to raise concerns and these were dealt with appropriately.
People who used the service and relatives or representatives, were given opportunities to share their experience of the service. Quality assurance systems were in place to regularly review the quality and safety of the service provided.