Archived: West House

Updated 20 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 17, 19 and 20 July 2018 and was unannounced. The inspection team consisted of one inspector and an assistant inspector. On the 17 July 2018 the inspectors were accompanied by an expert by experience. An expert by experience is a person who has personal experience of caring for older people and people living with dementia.

We reviewed information that we held about the service such as safeguarding information and notifications. Notifications are the events happening in the service that the provider is required to tell us about. We used this information to plan what areas we were going to focus on during our inspection.

We used the Short Observational Framework for inspection [SOFI]. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 12 people using the service, three visiting relatives, three members of care staff, the person responsible for facilitating social activities, the deputy manager and two representatives from another organisation who had been requested by West House’s shareholders to support the deputy manager. We reviewed six people’s care files and four staff recruitment and support records. We also looked at a sample of the service’s quality assurance systems, the registered provider’s arrangements for managing medication, staff training records, staff duty rotas and complaint and compliment records.

Updated 20 September 2018

The inspection was completed on the 17, 19 and 20 July 2018 and was unannounced.

This is the second consecutive time the service has been rated 'Requires Improvement.'

West House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. West House provides accommodation and personal care for up to 26 older people. Some people also have dementia related needs. At the time of the inspection, there were 26 people living at West House.

Prior to the inspection the Care Quality Commission were notified of significant changes to the management team of West House. The registered provider and manager had notified us that they were no longer employed at West House. Following the inspection, the registered provider informed the Care Quality Commission they had applied to us to be formally de-registered as both the registered provider and manager of the service. An internal appointment was made in April 2018 whereby the team leader was successfully promoted to the post of deputy manager. At the time of this inspection the deputy manager was being supported by representatives from another organisation to manage the day-to-day running of the service. The representatives had been asked by West House’s shareholders to provide additional support at this time. Therefore, the service did not have a registered manager in post. 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.

The registered provider had not made adequate and necessary improvements to comply with regulatory requirements or to achieve a better-quality rating since our last inspection to the service in October 2017. The quality assurance arrangements had failed to identify the issues we found during this inspection to help drive and make all the necessary improvements. Although the deputy manager was now in day-to-day charge of the service, they had received no formal induction to their role and were finding some aspects of this challenging. This referred specifically to dealing with matters relating to staff, such as persistent staff absence or poor performance, safeguarding concerns and complaints management. The deputy manager confirmed these matters had primarily been dealt with by the previous registered provider. The shareholders representatives advised us that support was being provided to the deputy manager to enable them to undertake their role and to ensure the safety and wellbeing of people using the service.

The arrangements for the safekeeping of people’s monies did not protect or safeguard their monetary arrangements. Where incidents had occurred which suggested potential abuse, these were not robustly investigated. The deployment of staff was not always suitable to meet people’s needs and this impacted on the quality of care some people received. Improvements were required to ensure staff adopted good infection control practices and minor improvements were required in relation to staff recruitment practices.

Not all staff had received up-to-date mandatory and specialist training; and not all training attained was embedded in staff’s everyday practice. Where staff had been appointed to a senior role, they had not received an induction and not all staff had received regular supervision or an appraisal of their overall performance. Improvements were required to ensure people received a more positive dining experience. This referred to them receiving their meals in a timely manner, receiving support that treated them with respect and dignity; and which enabled people to make informed meal choices.

Though some people and those acting on their behalf told us they received a good level of support and were treated with care and kindness, interactions by staff and the way they communicated with people required considerable improvement. Many exchanges were centred primarily on tasks and routines, rather than it being person-led and person-centred. Staff did not always listen to people or respond to non-verbal cues and there was an over reliance on the use of the television. Although a new member of staff had been appointed since our last inspection to undertake social activities and there was an expectation that care staff would also facilitate these, people did not routinely receive opportunities to engage in social activities.

Improvements were required to ensure that people’s care plan documentation reflected all their care and support needs and how the care was to be delivered by staff. Compliments and complaints were recorded; however, improvements were needed to show how decisions and outcomes had been reached.

People living at the service confirmed they were kept safe and had no concerns about their safety and wellbeing. Medication arrangements at the service ensured people received their prescribed medication as they should. The service worked together with other organisations to ensure people received coordinated and ‘joined-up’ care and support. People’s healthcare needs were well managed and people had their healthcare needs met. Information available showed that each person who used the service had had their capacity to make decisions assessed. Where people were deprived of their liberty, the registered provider had made appropriate applications to the Local Authority for DoLS assessments to be considered for approval.

We have made recommendations about infection control arrangements, reviewing Mental Capacity Act principles to ensure staff work within these guidelines, end of life care and leisure and social activities.