Westgate House Care Centre

We found the following examples of good practice.

The provider had robust systems in place to ensure visitors were entering the building safely to reduce the risk of spreading the infection. For example, Relatives and friends received awareness sessions in how to test and put on and take off personal protective equipment (PPE) safely.

People were admitted safely when moving to the home. People and relatives were informed of the process of being admitted and the need to isolate upon arrival. In each unit there had been consideration when cohorting people where they had COVID-19 or where they had recently been admitted and were in the isolation period.

The management team had quality assurance systems in place to check staff competency and check the environment was safe. This was through infection prevention control audits, unannounced spot checks and competency assessments for staff. In addition, the management team had formulated a checklist inline with the current government guidance to ensure they were up to date with the correct practice.

We found the following examples of good practice.

All visitors to the service had their temperature checked, undertook a rapid COVID-19 test, completed a health questionnaire and were provided with personal protective equipment (PPE).

Visits were being re-introduced by appointment only, with times allocated to avoid potential infection transmission with other visitors and to allow for the visiting area to be thoroughly cleaned between visits. They were also undertaking training in how to test for COVID -19, handwashing, and putting on and taking off of PPE.

The provider had developed policies and procedures in response to the COVID-19 pandemic.

Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed. PPE was placed throughout the service, with ample supplies available. Staff were seen to be adhering to the PPE guidance and protective measures in place.

The service was clean and hygienic. Robust cleaning schedules were in place. People's rooms and areas frequently touched by people and staff such as door handles were cleaned regularly.

Westgate House Care Centre is a purpose-built residential care home providing personal and nursing care to 94 people aged 65 and over at the time of the inspection. The service can support up to 109 people.

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

People who used the service, their relatives and the staff team all told us the service was exceptionally well-led. Relatives praised the staff and management for the care provided and the positive impact it had for people and peace of mind for relatives. We saw many examples where the management ethos and leadership enhanced people’s feeling of safety and wellbeing. The management team had excellent oversight of the way the home operated and nurtured the staff team to take ownership and have pride in the care they delivered.

The management team demonstrated an open and candid approach when improvements were identified. Staff felt listened to, their opinions were valued, and they felt truly supported both as staff members and as individuals. The provider’s robust quality assurance systems promoted high quality care and helped to ensure that people received a safe and effective service that was caring and met all their needs with a holistic approach. The registered manager maintained a strong influence on people receiving excellent care and support by ensuring reflective practice opportunities were provided for staff. These were very effective in putting actions in place and learning into daily practice.

People felt safe living at Westgate House Care Centre and were protected from the risk of abuse. Staff were trained in recognising and reporting any concerns. The provider operated a robust recruitment procedure to help ensure staff were suitable to work at the home. There were enough skilled and competent staff on duty to meet the needs of the people using the service. Risks to people’s health and wellbeing were assessed and their care was planned to remove or reduce the level of risk. People received their medicines from staff who were skilled, and competency assessed to safely administer medicines. The environment was pleasant and bright creating a clean and fresh place for people to live.

People's needs were assessed so that they could receive the care and support they needed. Staff received training needed to support people's differing needs. People were supported to eat and drink a balanced diet which met their needs and individual preferences. People were supported to maintain good health and prompt referrals were made to external professionals when health needs changed, or people became unwell. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with compassion, kindness and respect. People’s relatives complimented staff for their empathy and support, both for the person and for their families when people reached end of life. The registered manager consulted with people and staff about decisions made in the home, it was clear that any changes made were centred around, and driven by, people’s wishes, health and wellbeing.

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 this service was good (published 07 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Westgate House Care Centre is a purpose built care home providing nursing or personal care for older people. The home has a purpose built unit for people living with dementia and also provides nursing, intermediate and rehabilitation care. The home is registered to provide care for up to 109 older people and there were 94 people living at the home when we inspected.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection of this service in July 2015 the service was rated Good. At this inspection the overall rating remained as Good however, there were some aspects of the service where people would benefit from some improvements being made.

People received the support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed. However, the meal time experience on one unit needed further development to help ensure people had a positive experience and the system in place to monitor people’s fluid intake was not robust. We noted some examples where staff used terms that did not promote people’s dignity and where staff did not always seek people’s consent. For example, moving people in their wheelchairs without explaining what was going to happen.

People felt safe living at Westgate House Care Centre. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We revisited Westgate House Care Centre on 19 August 2014 to assess compliance in this area and found that some improvements had been made.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

What people told us and what we found

At our inspection on 03 and 04 March 2014 we found that the service was required to make improvements in relation to treating people with dignity and respect, their consent arrangements, the care and welfare of people who used the service, recruitment methods and the accuracy of people's records. The provider submitted an action plan on 17 April 2014 which told us they would be compliant with the regulations by 15 May 2014.

We inspected Westgate House Care Centre on 11 and 12 June 2014 and found the provider had made some of the improvements, we had requested by 15 May 2014. At this inspection we were supported by three inspectors and one expert by experience. We looked at 12 people's care records. We also spoke to the provider, manager, the unit managers for the three floors of the home, and 15 members of care staff on duty. We have served warning notices on the provider and manager requiring them to be compliant with the Health and Social Care Act 2008 by 18 July 2014. We will follow up this warning notice to ensure compliance has been reached.

We set out to answer five questions. These were whether the service is caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We found that care was not consistently planned and delivered in a way that was intended to ensure people's safety and welfare.

We found on two floors that pressure mattress settings were consistent with the weights of people who used the service. However on one floor we found that all pressure settings were set to firm, regardless of the weight of people.

Is the service effective?

We saw that most of the risk assessments and support plans had been reviewed and updated following our last inspection. We looked at the care notes for people whose plans we had viewed and saw that in most cases care was recorded as being delivered in accordance with the plans. However these had not been completed for all people who used the service.

Overall people's daily care records were up to date and reflected the care provided to people. However we found examples where the care plan had not been followed, reviewed or updated.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Where applications had needed to be submitted at our previous inspection, proper policies and procedures had been followed. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service caring?

We observed staff interaction with people who used the service and noted that interactions were positive. Staff were attentive and kind and appeared to know the people well. However we also found that for two people who used the service, staff were unaware of their particular needs. These two people presented with particularly high and complex needs.

During our previous inspection we found that all the bedroom doors for people were left open, this did not promote people's dignity and privacy. At this inspection we found that staff had reviewed this with people and their relatives and people's doors were only open where they had requested this.

We found that staff were in the process of reviewing all people's care records and were involving people who used the service and their relatives. This meant that they were able to seek the views of those people who best understood the needs of the person.

Is the service responsive?

The views of people who used the service were sought, encouraged and recorded in their care plan. However these views and preferences were not always carried out. We noted that preferences in relation to activities and bathing had not been provided for example.

The service listened to people's experiences, concerns and complaints to improve the quality of care they received. We saw that recently the manager and staff had held meetings with residents and relatives to seek their views and opinions. However it was too early to determine how the manager had reviewed the responses and learned lessons from these views.

Is the service well led?

The service did not always promote a positive management culture that was positive, and open. We were provided with one record which we determined had been doctored during our inspection to provide us with a false impression of recruitment procedures. We confirmed the false entry made on the record with staff working on duty who had made the entry.

We found that recruitment processes for employing new care staff had been reviewed. We saw from records we looked at that staff employed at Westgate House Care Centre had been thoroughly vetted to ensure they were of good character and experienced to work with vulnerable adults.

During our inspection on 03 and 04 March 2014 we found that people's dignity was not maintained. We noted that people's bedroom doors had been left open and people were visible from the corridors in various states of undress. We also found that the needs, wishes, preferences and decisions of people who used the service were not at the centre of the assessment, planning and delivery of their care, treatment and support.

We found that the provider had not sought the required consent from people who acted on behalf of those who had complex needs and lacked the mental capacity to make or understand decisions themselves. Where the provider had not acted in accordance with relevant guidance and legislation people may have been unlawfully restricted because their preferences and views had not been sought.

We spoke with people who used the service and their relatives. Some of the people we spoke with were positive about the care they received. One person told us, '[Carer] is fantastic, so gentle and kind and knows just what I need, in fact most of the staff are very caring.' However people did not always feel involved in the planning of their care. One person who used the service told us, 'I don't know what's in my care plan, I would like to see it but the staff don't have the time to show me, I trust that they know what's best.'

We found that people were not always cared for by suitably qualified, skilled or experienced staff. This was because the provider had not sought to ensure that staff were suitably skilled or qualified prior to commencing employment. One staff member we spoke with told us, 'I didn't have an assessment [of my skills] by the unit manager, and I haven't spoken to them about how I am getting on. They just take my word that I am doing okay.'

We found that people's care records were not stored securely, nor were they always accurate and appropriate.

We found that the provider had taken steps to improve the environment that people lived in. During our inspection on 26 June 2013 we found the home was clean, welcoming and free from odours. The provider had recruited further domestic staff, and had reviewed their use of detergents. One person who used the service told us that, 'It is much nicer here now, I am happier to have friends and family visit me.'

We previously found during our inspection on 23 April 2013 that people's records were not stored securely. We also found that records relating to resuscitation of a person were not completed sufficiently. During our inspection on 26 June 2013 we found that the provider had taken action to remedy these issues. People's records were stored securely and documentation had been completed appropriately.

We found that care records were comprehensive and contained individual goals for people to achieve. One member of staff told us, "If any care worker comes here to work, we make sure the records are clear and up to date. That way anybody can read how to care for that person."

People we spoke with told us that the food they received was good. One relative said, 'They do get a good meal here.' One person who used the service said that the food was 'very nice'.

We found that the home had an infection control policy in place and staff had received training in how to manage and reduce the risk of infection. We saw that the home had achieved a five star food agency rating for cleanliness, meaning that people received food that had been stored, prepared and cooked in a very hygienic environment. During our inspection we also found that the home had a bad odour for the majority of our visit. People who used the service told us, 'Sometimes the bedroom was cleaned but not the bathroom."

We found that staff had received appropriate training for their role and medicines were only administered by trained nurses. We saw that medicines were given to people appropriately and when they required them.

Records were comprehensive and fit for purpose, however we found that people's care records were not stored securely.