Westley Court Care Home

Westley Court Care Home is a residential care home providing personal and nursing care to up to 33 people. At the time of our inspection there were 25 people using the service. The service provides support to people under and over 65 with varying needs, including some people living with dementia. The care home provides support to people over 2 floors, both of which have adapted facilities.

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

Risks to people’s health and well-being were not always managed safely and guidance and advice from professionals was not always followed. Risks identified during the inspection were discussed with the manager who addressed them immediately. Medicines were not always managed in a safe way. People and their relatives had mixed views on staffing levels. At the time of inspection the provider was recruiting to a number of vacancies.

People told us staff were kind and caring and people told us they felt safe. Staff respected people’s privacy.

Further improvements could be made to the environment to support people living with dementia. Some areas of the home were tired and in need of refurbishment. The manager advised a programme of refurbishment was planned to start in December 2023. Staff had received training relevant to people’s needs.

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 and their relatives told us they were happy with the care provided and spoke positively about staff.

Care records were detailed but sometimes contained conflicting and out of date information. Activities were limited due to vacancies in this area. However, we saw a group activity taking place and evidence of some one to one engagement for people who spent time in their rooms.

Management changes had recently occurred, the manager and regional manager had only been in post a few weeks at the time of our inspection. There were a variety of audits in place to provide the manager with oversight of the service, however these were not fully embedded and had not been consistently undertaken prior to the new manager starting. Audits which had been completed had not identified some of the shortfalls found at inspection.

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 22 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people's nursing care needs,

medicines management, and staffing. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 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.

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

Enforcement

We have identified breaches in relation to the safe care and treatment 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 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.

We found the following examples of good practice.

¿ On arrival visitors were screened for symptoms of COVID-19 and their temperatures recorded. The checks will help to ensure visits take place safely in line with current guidance. There are separate entrances for visitors to people living on the ground floor and visitors to people living on the first floor.

¿ Plastic computer key board covers had been purchased following a review of infection control working practices. This meant shared keyboards could be effectively cleaned with antiseptic wipes between use to mitigate cross infection.

¿ Computer tablets were being used to support people to keep in touch with their relatives and friends via video calls. Individual assessments had been completed for people requiring home visits, for example receiving end of life care.

¿ Staff taking breaks were limited to two at a time. Separate rest rooms had been set up in the home to ensure social distancing could be accommodated, avoided staff mixing between floors and reduced risk of cross infection.

¿ In addition to a weekly audit of infection prevention and control, the provider also had a supplementary daily audit completed.

¿ The home adhered to government guidance when disposing of clinical waste and the management of laundry.

Westley Court Care Home is a residential nursing home for 33 people, some of who live with dementia. At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not gone down since our last inspection.

A registered manager was 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.

People received care which was highly responsive to their individual needs. People were at the heart of the service. The provider's philosophy, vision and values were understood and shared across the staff team. People were supported to maintain their purpose and pleasure in life by staff who worked creatively to support their individual needs. The provider and staff team were passionate about providing high quality care tailored to people's individual needs and preferences. Staff invested time to understand the experiences of people who lived at the home. People told us they had formed excellent relationships with the provider, staff team and other people who lived at the home, built on trust and respect. Staff took time to understand people's life stories, so people received support in the ways and at the times they preferred. People, relatives and health professionals told us the care provided was responsive to people’s needs and because of this people experienced extremely positive outcomes. People and relatives told us staff were empathetic and gave compassionate care. Relatives and health professionals praised end of life care provision at the home.

People, relatives and staff agreed the service was extremely well managed and Westley Court was an exceptionally caring home. Everyone consistently praised the skills of the management team and emphasised they were motivated to provide an exceptional service. The provider ensured care was based upon good practice guidance. Exceptionally good governance was embedded into the provider and registered manager’s processes. This ensured people received people received a highly effective service which put them at the heart of their care.

Links within the local community were an important priority. Excellent links had forged with the local hospice which provided training and support to both staff and people who lived at the home. The home had a vibrant and welcoming atmosphere where visitors were welcomed and encouraged. There were processes to monitor the quality and safety of the service provided and actions were taken to drive continuous improvement for the benefit of the people who lived there.

Staff understood their responsibility to safeguard people from harm and had a good understanding reporting concerns both within and outside the home. Where risks associated with people's health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence. Staff had a good knowledge of how to support people at these times.

The provider and staff team were committed to ensure people were involved in decisions about their care and how they led their lives. Should people lack capacity to make their own decisions, staff understood the principles of the Mental Capacity Act (MCA) and their advocates or families and other health professionals were involved in making decisions in their best interests. Staff obtained people's consent before they provided care and support.

Staff with a range of skills were available at the times people wanted to receive support, in all aspects of their lives. Staff had received training so people's specific care and support needs were met, and we saw training was put into practice. Staff told us the provider proactively ensured they had many opportunities to further develop their skills and knowledge. Staff felt supported and valued by the provider and they prided themselves on providing high quality care.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink. The provider and staff team worked closely with external healthcare professionals to ensure people's health and wellbeing was promoted and maintained. Wherever possible staff supported people to retain responsibility for their own health. Medicines were managed so that people received their medicines as prescribed.

People were supported to maintain relationships with people important to them. Visitors were welcomed at the home and were encouraged to be actively involved in people's lives.

There was a registered manager in place at the time of our inspection. 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.

People lived in a safe environment as staff knew how to protect people from harm. We found that staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions.

There were sufficient staff on duty to meet people’s needs. People told us that staff helped them when they needed assistance. Regular reviews of people’s care and deployment of staff meant staffing levels were reviewed and reflected the needs of people who lived there. People’s medicines were administered and managed in a safe way.

The registered manager supported their staff by arranging training and up-skilling staff in order to provide care and support to people that was in-line with best practice. People and relatives told us of the positive benefits this had on the care and support received. Staff were equipped with the skills and knowledge to provide effective care and support for those who could not always verbalise their needs.

People received care and support that was in-line with their needs and preferences. Staff provided people’s care with their consent and agreement. Staff understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. We found that people had access to healthcare professionals, such as the dentist and their doctor when they required them and where supported to hospital appointments.

We saw that people were involved in the planning around their care. People’s views and decisions they had made about their care were listened and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected. Staff supported people with decisions around their end of life care and provided people with support from local hospices to further enhance their end of life care.

We found that people knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last 12 months and found that no complaints had been received.

The registered manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, which meant that people’s received care and support in-line with their needs and wishes.

We found that the checks the provider completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure that lessons were learnt and used to improve staff practice.

People living at Westley Court Care Home were being treated with dignity and respect.

We observed that people appeared relaxed and comfortable. They were being cared for in a way that they preferred. One person who lived there told us: 'I think it is lovely here'.

We found that the provider had held best interests meetings. This was to support decisions about care where people had been unable to consent, or where decisions needed to be made on their behalf.

We saw that the provider was monitoring the quality of the service that was being delivered.