Westmead

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well Led- this means we looked for evidence that service, leadership, management and governance assured high quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. Following this assessment, we have rated well-led as inadequate. We looked at 4 quality statements and found a breach of regulation concerning management oversight of this home. Leaders were not carrying out robust quality checks of the service, action had not been taken to remedy the issues the provider identified prior to this inspection. Leaders did not encourage an open and candid approach throughout this inspection.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We found leaders were unable to demonstrate they were operating a service which provided safe, effective and compassionate care. Leaders were unable to demonstrate how they monitored the quality of interactions between staff and residents, why the number of hours people were supported for had been amended, and why only a small number of people were supported to access vehicles and therefore their wider community.

The management team told us the values of the organisation, but we found these were not always adhered to in practice. For example, the values stated ‘we take an evidence based approach to why behaviour occurs and how to respond appropriately’ yet inspectors found significant delays in analysis of incidents where behaviour presented challenges, and delays and incomplete reviews of restraint. There was a conflict between a senior support worker’s analysis of an incident in April 2024 and the manager’s analysis. The senior support worker wrote, ‘Alarm should have been raised as [person] hit their head’ yet a member of the management team noted, ‘The incident has been dealt with well and staff have been responsive to [person’s] needs.’ In addition, we found a further 6 incidents in April 2024 for the same person where the manager’s analysis had not been completed. Leaders were aware they had a shortage of drivers available in their staff team, but failed to consider other opportunities such as arranging private transport.

The management team did not fully support the inspection process by enabling and encouraging staff to be open and transparent with inspectors. Despite our considerable efforts, we struggled to speak with staff as they did not respond to our contacts. Some staff we subsequently spoke with on day 3 of our inspection told us they were not aware the inspection was taking place. Prior to our inspection, the provider issued staff with an internal satisfaction survey, but we were told the human resources manager personally collected completed survey responses, meaning staff felt unable to report their concerns.

Inspectors saw records that showed in December 2023 a relative raised a complaint. Whilst some action was taken, the concerns were not logged by the service as a formal complaint. Some response was evident although the provider had not followed its own complaints policy and fully recorded details of their complaint and subsequent response. In January 2024, another relative raised multiple concerns. Subsequent concerns were raised at the end of January 2024. This was not recorded as a formal complaint and had not been fully responded to. Shortly before our inspection, a closed cultures questionnaire had been given out to 15 staff following concerns raised by relatives. However, this was not extended to the whole staff team of 84 to help the management team understand where risk factors may need increased monitoring. The results were analysed and summarised in a way that did not fully reflect the comments made by staff. Inspectors reviewed the completed surveys and saw that whilst there were some positive comments in some of the surveys, this was not reflective of negative feedback provided and therefore did not demonstrate the management team had acted on this feedback. Inspectors reviewed the surveys completed by 6 people who used the service, all of whom had staff support to complete. There were no actions taken to explore any of the responses or comments made by people. For example, one person said they did not like their menu but there was no evidence of anything being done to discuss or address this.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

There was no evidence of any quality checks of staff interaction with people. The registered manager told us they did not routinely check this, as it was the senior support workers’ responsibility to make sure all staff worked in line with people’s needs. Senior support workers told inspectors they had a long list of tasks to complete each day and they relied on information from support staff to know what was happening in each person’s home. This meant they did not always observe the daily quality of interaction or staff practice to be assured person centred care was provided. This was a concern because many of the people using the service had limited verbal communication ability to express their experiences and were highly dependent on staff to meet their needs properly. Information provided by the management team did not reflect what we found in practice. Managers talked about robust quality and compliance checks, yet inspectors found these were not always in place or thorough enough to demonstrate the service was operating to a high standard. Managers told inspectors there were reviews of staff rotas to ensure staff did not work excessive hours. However, inspectors reviewed a sample of records which showed some staff worked excessive hours. Inspectors reviewed a sample of staff rotas for April 2024 and saw several examples of staff working an unsafe number of hours. Inspectors spoke with the management team, who said the rotas were completed off site and staff usually had rest periods. However, there was a lack of oversight to ensure staff worked safe hours and had regular breaks.

There was no timely analysis of accidents and incidents, or depth of analysis to establish why issues had arisen. Some patterns and trends were identified, such as time of day or days of the week. However, there was no analysis made between the staff on duty and the person being supported, or whether pain was being expressed, to establish if there were any causal factors. Some debriefs were scheduled for 5 to 6 months after the incident occurred, which meant staff may not have recalled details of what happened, with missed opportunities to identify or act on concerns much sooner. The closed cultures risk assessment referred to a robust complaints system and regular supervision. Inspectors found the complaints system was not thoroughly implemented and regular supervision had not taken place. The quality assurance manager told us supervisions would be approximately every 8 weeks with staff, but few staff supervisions had taken place in 2023, which managers told us was due to high management turnover in the service. There was a significant backlog of accidents, incidents and debriefs, and the management team were working to address these, but the delay to this meant some safeguarding incidents were not reported or mitigated, and lessons learned were not identified in a timely way, putting people at risk of harm. Processes did not ensure people using the service were involved in any of the debriefs to help them understand their behaviour and manage their responses to incidents.

Before our inspection of Westmead, individuals including relatives, whistle blowers and professionals shared information of concern about the provider not working well with partners. During the inspection, feedback we received from partners was mixed, with one reference to positive feedback about a complex service and the difference it had made to this person. Other feedback raised concerns about how Westmead did not support people well.

It was unclear from discussions with the management team how the decision to serve notice to 2 people living at the service was arrived at. There was a lack of meetings records to show a systematic process had been followed. Some partnership working with families was not effective.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.