Westmead Care Home Physical Disabilities

Westmead is a residential care home providing personal care and support to 16 people aged 18 and over at the time of the inspection. The service can support up to 19 people in one adapted building.

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

Most people said they felt safe, well cared for and enjoyed living at Westmead. Two people were less positive about their life at Westmead, but for both individuals the service was working with commissioners to find more appropriate placements.

Not all medicines were safely managed. We did not find people had come to any harm and the management team have already addressed issues of concern to ensure medicines were administered and recorded more safely and accurately.

Staff were knowledgeable about people’s needs and wishes and had strong relationships with them. The culture was caring and supportive but not always forward thinking in terms of ensuring people had enriched lives outside of the service. We are mindful that the pandemic had stopped some activities but there were options to enable people to go out and about which had not been fully explored until we gave this feedback. The registered manager believed there had been a reluctance for staff to think about assisting people to access the local community for fear of their vulnerable status. They said with some support they were now thinking of ways they could offer trips and outings that were low risk.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible within the service and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture (RSRCRC).

Right support:

• Model of care and setting maximises people’s choice, control and independence. The building was large, and staff were seen to use only some sections of communal areas meaning lots of people were in one area. They did not make use of other spaces to ensure people had quiet times, a change of scenery or just space away from noise and lots of people.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. Staff did work in a person-centred way to ensure individuals had personalised care and support. Due to the large number of people living in one building this was not always done in an individualised way. For example, most people ate at the same time in one dining area.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. This model of care had not been considered or included within the service’ statement of purpose or service user guide. There were no current plans to consider how Westmead might be adapted in line with RSRCRC principles and staff were not aware of this guidance.

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 the service under the previous provider was good, published on 24 July 2018.

Why we inspected

This was a planned five key question inspection as the service has been registered under a new provider for 12 months.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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. Following feedback, the registered manager and provider has taken action to mitigate the risks we identified so people were not at risk of any harm.

Enforcement 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.

We have identified breaches in relation to safe management of medicines and good governance at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The provider had adapted one spare bedroom as a visiting pod to enable people to still have visits with their family in a safe and protected way. The room was accessed via an external door which meant visiting friends and family did not enter into the main building of the home. There was also a full length screen. There was a full cleaning process between visits.

All visits were only via prior arrangement. There was clear signage at the entrance with a supply of personal protective equipment for visitors to use. Visitors were asked to ensure they were well and had their temperature checked before entering the home.

Safe procedures have been followed by staff to minimise the risk of transmitting Covid-19. They had good stocks of all personal protective equipment (PPE). There were supplies of PPE available around the home. Staff were seen using appropriate PPE. Staff have received training on donning and doffing and on the coronavirus pandemic from various sources including local health and social care professionals, e-learning, and from in-house training sessions. People confirmed staff were diligent in using the correct PPE at all times.

Measures were in place to ensure staff and people living at the service had regular testing. Where a person tested positive for Covid 19, they immediately isolated for the required number of days as set by government guidance. There had been no new admissions since the latest lockdown, but guidance was in place to ensure if new people were being considered, they would be tested prior to being admitted and also have a period of self isolation in their room. Most people and staff had received the coronavirus vaccination.

The home was clean and hygienic. Detailed cleaning schedules were in place for all areas of the home. All touch points were cleaned frequently including high touch points. Deep cleaning of all areas was carried out at least monthly.