This inspection took place on 15 and 21 January 2016, the first day was unannounced. We arranged to come back on the second date to ensure that the registered manager and owner were present. 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 last inspected Westwards House Residential Care Home on 30 July 2014 and the service was judged to be fully compliant with the previous regulatory standards.
Westwards house residential care home is registered to provide personal care for up to 19 people. Accommodation is on two floors with a stair lift for access between the floors. There are two lounges and a large dining room and a large garden for people to use. The home is situated close to shops, buses and the local facilities of Garstang.
There were 17 people at the home on the two days the inspection took place of which four people had been transferred from the organisations sister home in Lostock Hall, near Preston, due to the boiler breaking down. The registered manager was registered for both homes therefore knew the four people well and we saw that all the necessary care documentation was present at Westwards House for them. Due to the issues at the home in Lostock Hall the registered manager and owner were not present during the first day of the inspection. Both were present on the second day of the inspection. The newly appointed Deputy Manager was present on both days of the inspection.
The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Staff members spoken with said they would not hesitate to report any concerns they had about care practices. However we saw some incidents had occurs that should have been notified as safeguarding issues to the local authority.
Body maps detailing people’s injuries were not completed with any frequency and those we did find were in different locations, some being in people’s care plans and some in a separate file in the office. Body maps we did find did not inform changes to care plans.
Risk assessments that were in place that we reviewed did not have sufficient information within them to be effective.
People told us they felt safe at the home and with the staff who supported them.
We spoke with the deputy manager of the home regarding staffing levels. They were confident that staffing levels were in place at all times to meet the needs of the people in the home. This was observed to be the case during the inspection and the feedback we received from people, their relatives and staff also confirmed staffing levels to be sufficient to meet people’s assessed needs.
We looked at how medicines were ordered, stored, administered and recorded. We spoke with the deputy manager who had responsibility for administering medication on the both days of the inspection and observed medication being given to people on the morning of the second day of our inspection.
We observed a number of recording issues whilst reviewing the controlled drugs records, this was mainly around missed signatures.
We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We reviewed care plans and associated documentation for people who used the service. We found no records of people’s consent to care and treatment, nor any assessment of people’s capacity to make a decision around consent.
We talked with people who used the service about the quality and variety of food provided. The responses we received were positive and people were seen to enjoy the food on offer. We observed lunch being served in a relaxed manner. Tables were set appropriately and people were offered a choice of hot and cold drinks.
People who lived at the home were very complimentary about the approach of the staff team and the care they received.
People told us that staff respected their privacy and treated them with dignity. We observed staff interactions with people during our inspection and found them to be warm and compassionate.
Staff we spoke with were knowledgeable and passionate about end of life care. Some staff had attended specialist training via the ‘Six Steps’ course in end of life care. This involved demonstrating that the service met a number of specific standards including enhanced training for care staff.
We examined the care files of five people, who lived at Westwards Residential Care Home. We found documentary evidence to show that people had their care needs assessed both externally by healthcare professionals prior to moving to the home, and by staff at the home.
A bath rota was in place at the home. The rota was assigned to room numbers as opposed to people. This was institutional in approach as when a new person came into the home they would be assigned a particular day to have a bath or shower instead of being able to choose themselves.
People we spoke with told us they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be listened to and addressed.
The service had not submitted some statutory notifications, as required, with regard to significant events at the service, including death notifications and accidents and incidents which affected people who used the service.
We saw that audits took place at the service which highlighted some issues. However it was not always clear how audits feedback into making improvements for people at the home.
We spoke with people who lived at Westwards House Residential Care Home about the culture of the home. The responses we received were positive.
We found several breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. These related to; Person centred care, Need for consent, Safe care and treatment, Safeguarding service users from abuse and improper treatment and Staffing. There was also one breach of the Registration Regulations 2009 relating to Notifications of other incidents.
You can see what action we told the provider to take at the back of the full version of this report.