Westminster House Residential Care Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Care and treatment was planned and delivered in a way which was intended to ensure people's safety and welfare. Improvements had been made to support people to have their medicines safely. There was a learning culture and staff had been supported to complete training and develop the skills they needed to support people safely. There were enough staff to meet people’s needs. Staff were employed after the appropriate recruitment checks were completed.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were supported by staff who undertook training to give them the skills they needed to support people safely.

Senior staff told us learning from accident/incidents and safeguarding were shared with the staff team through a number of forums, including meetings and supervision. The provider had developed a more open and transparent culture with better communication.

Processes had been put in place to learn from accident/incidence and safeguarding at the service. This included completing investigations and reflecting on practice to see what had worked well and what needed changing.

There was a plan in place to support people who moved into the service. A relative told us, “Initially the move here was going to be temporary however, [person name] settled really well and moving again would have been disruptive.”

The home manager told us before people moved to the service an assessment was completed by senior staff to ensure their needs could be met.

The service liaised with other healthcare professionals and families to complete a full assessment of people’s needs before they moved to the service. This meant that staff and people could be assured everything would be in place to support them.

People were protected from the risk of abuse. One person said, “I feel safe living here.” A relative told us, “I know [person name] is okay and safe. It is a relief they are here.”

Staff told us they had completed training on how to safeguard people. One member of staff said, “I would report any concerns to my manager first, if they were not dealt with I could report on-line to the CQC and ‘whistle blow’.”

We observed people to be happy in the company of staff and others. Staff were kind and supportive to people during all interactions.

Senior staff at the service had worked with the local authority to raise and investigate any safeguarding concerns. Staff told us they felt they were now more transparent at the service and any feedback was shared with staff and learning implemented.

People were involved in planning their care and supported to manage risks safely.

Staff knew people well and how they wished to be supported whilst promoting their independence. Care plans and risk assessments provided staff with the information they needed to support people safely.

We observed people were able to complete activities of their choosing safely. For example, one person chose to walk with purpose, they were supported to do this safely with a walking aid. We saw people accessing the garden independently and had community trips facilitated by staff safely.

People were supported to be as independent as possible. Risk assessments helped to mitigate the risks to people by providing guidance to staff on how to provide safe support. Where needed risk assessments supported moving and handling, pressure area care, risk of falls and risk of choking. There were detailed personal evacuation plans in place for people and staff had received fire evacuation training.

People were happy and comfortable; rooms were personalised and people chose where they wished to spend their time.

Staff told us the environment had been improved and we saw this was more dementia friendly.

We observed communal areas had been repainted and new flooring had been laid in the corridors. Signage was in place to help people navigate around and there were more sensory items available to provide stimulation.

The provider had a maintenance person for day-to-day repairs and when staff highlighted issues these were addressed. Some areas of the service still needed updating which the provider is aware of. Certificates were in place for the checking of gas and electrical appliances and fire equipment. Water monitoring had also been completed to check the service remained free from legionella. The local authority had completed a food safety check in August 2023 and given the service a 5 star rating.

Each person had a key worker to help with their specific needs. People were happy with the level of staff support, a relative told us, “You could not get any better.”

Staff told us they felt staffing at the service had improved and there was enough of them to provide good care to people. Staff told us improvements had been made since the addition of a cook/domestic which meant care staff had more time to support people. Staff told us that since the last inspection they had been involved in a number of different training courses which had given them confidence and equipped them with the skills they needed to support people. The provider had worked with other organisations to source relevant training for staff, including working with the local mental health and district nurse team. Staff had been supported to achieve nationally recognised training certificates in social care to enhance their skills.

We observed staff were available and engaged with people doing activities and providing support both physical and emotional.

The provider had reviewed staffing at the service and had a consistent staff team. There had been a new home manager appointed and team leader since the last inspection who together had been driving improvements. Recruitment processes had improved with a more consistent approach taken to recruitment paperwork under the home manager. Prior to this we found some references had not been fully verified. Appropriate checks were in place including full work histories, references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had been supported to complete further training on moving and handling and supporting people with mental health issues along with other training to help them fulfil their roles more effectively. Staff were supported with supervisions to discuss their training needs and had regular meetings to discuss people’s care needs.

People were supported from the risk of infections.

There was personal protection equipment (PPE) supplied in stations around the service and we observed staff using these when needed. The service appeared clean without any malodours.

Staff had undergone training on infection prevention and control (IPC). There was an infection prevention and control lead who had undergone additional training to provide support to the service. The IPC lead carried out a number of audits to ensure the service remained clean and infection free. They also observed staff practice for example with hand washing and how staff supported personal care. Any issues identified could then be addressed with staff.

There had been improvements since the last inspection however, further improvements were still needed. People were receiving their medicines safely and as prescribed. People were only receiving when required [PRN] medicines as a last resort. Staff used psychological intervention techniques to support people if they became distressed or agitated. People’s medicines had been reviewed and stopped where appropriate by healthcare professionals. However, people’s care plans did not always contain all the information needed to support people. Staff knew people well but information about physical health needs and behaviour support was not always documented.

Staff had received regular medicines training and training from a mental health specialist to support them with looking after people with mental health illness. Staff completed competency assessments yearly and when needed. Where errors occurred, these were recorded however, investigations and lessons learned were not always recorded.

There had been improvements since the last inspection however, there were still areas that needed further improvements. Processes were in place for the safe management of medicines. Person centred PRN protocols were in place however, where people were prescribed medicines with a variable dose, there was no information to support staff to know when to give the higher or lower dose. Staff were not always recording when people had become distressed or anxious in daily records when people did not require PRN medicines. Risk assessments were in place for people who were taking blood thinning medicines however, these were generic and were not in line with NICE guidance. There were regular audit in place which had identified errors.