The Westbourne Care Home

The Westbourne is a care home providing personal and nursing care to 45 people at the time of the inspection. The service can support up to 50 people across two separate floors, each of which has separate adapted facilities.

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

The management of risk to people was not always sufficiently robust. Where risks had been assessed, staff had not always followed the identified guidance to manage the risk safely. Aspects of training and induction was not sufficiently effective to support staff knowledge and understanding. Systems and processes to maintain oversight of the quality and safety of care were not always effective.

Staff worked within the principles of the MCA. Appropriate Deprivation of Liberty Safeguards (DoLS) authorisations were in place where required. However, the service had not ensured all conditions attached to 1 person’s DoLS authorisation were being met. We have made a recommendation about this.

New staff had been recruited, which meant the home was fully staffed. Overall, staff had been safely recruited, the provider and was in the process of reviewing current policy and procedures. The current registered manager had focused upon supporting and building an effective staff team. People told us they felt safe living at The Westbourne and staff understood their role in safeguarding people.

Overall medicines were managed safely. On the first day of the inspection aspects of the building needed cleaning, this was addressed along with some redecoration during the inspection. A planned refurbishment programme was due to commence at the home. There were no visiting restrictions in place, and we saw various visitors in the home.

Care plans were developed from assessments. However, the level of detail varied and some contained contradictory information, including some around nutritional needs. They did not always contain enough person-centred information about people’s individual needs and requirements to guide staff. Managers had already identified this was an area for improvement and actions were underway to amend aspects of the electronic care planning system and to improve regular communication with relatives.

Feedback indicated that due to recent recruitment, overall staffing was more consistent, which was helping to ensure staff knew people well and understood any changes to their needs . Staff worked in partnership with health and social care professionals.

The provider had a lifestyle manager who was supporting the team to review and develop activities, especially for people who were living with dementia. The provider had a feedback policy in place, overall feedback indicated the registered manager was responsive and acted to address any issues or concerns raised.

Records were not always complete and/or up to date with person centred information and some were contradictory.

The registered manager understood their role and responsibility under the duty of candour. They were open and honest about shortfalls found during the inspection and acknowledged there was ongoing work to build on learning and improvements which had already been made. Staff told us they were well supported and there were some positive examples and compliments about the care provided.

The provider’s quality team were supporting the service and were responsive to feedback for ongoing improvement.

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 26 May 2021).

Why we inspected

This inspection was prompted by a complaint about the service.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to risk management, staff training and good governance. We have also made recommendations in relation to The Deprivation of Liberty Safeguards (DoLS)

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Westbourne is a residential care home providing personal and nursing care to 47 people aged 65 and over at the time of the inspection. The service can support up to 50 people across two separate floors, each of which has separate adapted facilities. Each bedroom had its own en-suite bathroom.

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

At this inspection we found improvements had been made and the provider was no longer in breach of regulations, however further assurances were needed to ensure governance systems which demonstrated these improvements were sustained and embedded into everyday working practice.

There was a new manager employed at The Westbourne. Relatives knew who the new manager was and how to raise concerns or make a formal complaint. We received consistent feedback about the positive impact the new manager had on people’s quality of care as well as contributing to staffing stability and motivation. However, the provider still needed to appoint a new deputy manager and ensure the new manager was registered with the Care Quality Commission.

Care plans were person centred and risks to people’s health and wellbeing were safely monitored and reviewed. This included where people needed support with prescribed medicines or had diagnosed health conditions requiring specific plans of care. Where possible people had been involved in developing and reviewing their care plans. Further plans to improve this were in place with the easing of visiting restrictions caused by the COVID-19 pandemic.

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.

Support around mealtimes had improved and people had access to a range of activities within the home.

People were able to personalise their bedrooms. A number of environmental improvements had been made. These included improvements designed to assist people living with dementia. Further improvements were planned within the home and to the outdoor areas.

The home was visibly clean and well maintained. We were assured systems and practices were in place to manage any risks relating to the COVID-19 pandemic.

Recruitment of permanent staff had improved; plans were in place to reduce dependency on temporary (agency workers). Checks were in place to ensure the safe recruitment of all workers at The Westbourne.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 19 December 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 05 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contained those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Westbourne on our website at www.cqc.org.uk.

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.

The Westbourne is a residential care home providing personal and nursing care to 40 people at the time of the inspection. many of the current residents were living with dementia. The service can support up to 50 people across two separate floors, each of which has separate adapted facilities and each bedroom had its own en-suite.

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

There had been a significant change in the management of The Westbourne in July 2019. There had also been a large staff turnover and the new manager was working to recruit new permanent staff. We found this had, in part, impacted on the consistency of the care currently being provided and we found a number of improvements were required.

Some aspects of the management of the risks to people were not always safe. Improvements were needed to ensure people’s diabetes and pressure care needs were being met. Improvements were also needed to systems and processes to ensure the new manager had sufficient oversight of the risks to people and the records being maintained. This has resulted in a breach of regulations.

We have also made a number of recommendations. We have recommended a review of the use of homely remedies, and the experience of people during mealtimes at The Westbourne.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This was because we found that an authorised DoLs had expired and not been reapplied for. This was addressed during our inspection.

Care plans were in the process of being re-written for every person at the time of this inspection and the manager was receiving support from the provider to do this. New care plans were detailed and person centred however not all of these clearly demonstrated that people had been involved in their development. We have also made a recommendation around this.

There was an activity coordinator in place and there was a programme of activities which we observed was enjoyed by people who participated. The activities however were limited to weekdays and we have made a recommendation that this is also reviewed.

Some environmental improvements had recently been made at The Westbourne and further improvements were planned.

Staff and relatives spoke positively about the new manager and people living in the home were complimentary about the staff support they receive. Opinions were sought through meetings and surveys about the quality of the service and complaints were responded to appropriately.

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 08 September 2017).

Why we inspected

The inspection was prompted in part due to concerns the CQC received about the quality of care and an increase in the number of incidents being reported to the local authority. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needed to make improvements. Please see the safe, effective, 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.

The provider and manager had identified a number of the issues we raised through their own governance systems prior to our inspection and additional support was in place from the providers quality team who were supporting the manager at the time of our inspection. Immediate steps were taken by the manager to reduce the risks relating to pressure care at the Westbourne.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Westbourne on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of risks relating to people’s physical health and also the oversight of these risks 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.

The last inspection took place on 18 and 24 November 2015. At that inspection we identified three breaches of the relevant regulations in respect of staffing, safe care and treatment and person centred care. At this inspection, we found that improvements had been made and the provider was no longer in breach of any of the regulations.

The Westbourne Care Home is registered to provide accommodation with nursing and personal care for up to 50 older people who may be living with dementia. The home is purpose built and is divided into two units, one on the ground and one on the first floor. The kitchen and laundry areas are on the second floor of the building together with a large room which is used as a base for staff training. There is an enclosed garden area and parking to the front of the building. On the day of our inspection there were 43 people living in the home.

The home has a registered manager who had been registered since April 2016. 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.

We found that the arrangements for the administration, storage and disposal of medication were safe, however we saw that there were some shortfalls in the recording of when topical creams had been applied. These had been picked up by the provider’s quality assurance system and a new system was being put in place.

We observed that there were sufficient numbers of suitably qualified, competent, skilled and experienced staff deployed within the service to meet the needs of the people living there.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke with confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

There was a flexible menu in place which provided a good variety of food to the people using the service. People were provided with specialist diets but the presentation of soft food diets could be improved.

Peoples’ weights were now being consistently monitored and managed and advice taken appropriately where significant changes were noted.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year.

We observed caring relationships between staff members and the people living in the home.

Personal information about people was now stored securely.

We found that that there had been improvements in the care plans and these were being updated regularly and were clear. Staff were now consistently keeping contemporaneous records where additional monitoring was required.

The provider had a quality assurance system in place and regular audits were being completed, and issues identified were addressed in a timely manner. The registered manager continually sought feedback from people living in the service, relatives and staff in order to improve the service.

Staff members and relatives we spoke with were very positive about how the home was being managed. Everyone spoke of the improvements observed since the current registered manager had been in post.

We spoke to two people who used the service and one relative and they all said that they were very happy with the support that they received. One person said; "The staff are really nice here."

We looked at the care plans and risk assessments for four people and saw that they had been regularly reviewed and updated using a new system that had recently been implemented.

We looked at the procedures in place for keeping people safe from harm and we saw that they were clear and the staff understood how to recognise the signs of abuse and use the systems in place.

We spoke to the registered manager and three members of staff who all said that they enjoyed working at the service and that they thought that the service offered quality support to the people who lived there.

We looked at the systems in place for recruiting new staff and saw that all the appropriate checks were carried out prior to staff commencing work at the service.

We looked at the procedures in place to protect people from harm. We had some concerns that the home did not follow it's own procedures in relation to an incident that had occurred and had not contacted the appropriate authorities to enable them to investigate.

We looked at the staffing levels in the home and we saw that there were adequate staff on each shift to meet the needs of the people in the home.

We looked at the care records and we had concerns regarding the detail on the records and the frequency of when they were updated.

We used the Short Observational Framework for Inspection (SOFI) during the course of the inspection. SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. We observed positive interactions and engagement between staff and people who used the service. We also observed staff assist people to maintain their independence with their mobility whilst still offering them the support they needed.

We spoke to four people who used the service who told us they were happy with the care and treatment they received. We met and spoke with seven visitors to home and we spoke with three staff members, the area manager and the homes new manager.

However, we observed during the course of the inspection that there were insufficient staff deployed to one floor of the home, which meant that there was a risk of people not receiving care in a timely manner.