Westhill Care Home

Westhill Care Home is a residential care home providing accommodation for up to nine people requiring personal care. The service provides support to people with a learning disability and autism across two residential properties. At the time of our inspection, there were eight people using the service.

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

We were somewhat assured the service were following safe infection prevention and control procedures to keep people safe. We identified that the provider did not have systems in place to ensure all relevant visiting professionals were checked for their COVID-19 vaccination status prior to entering the service. When we highlighted this, the provider took immediate action to address this and implemented appropriate systems.

People who used the service and their relatives told us they felt safe with staff and that they were kind and caring towards them. Staff were aware of risks associated with people’s care and how to reduce these. We observed sufficient staff being deployed and people did not have to wait for support.

People’s medicines were stored and administered safely. The provider regularly reviewed the use of ‘as required’ medicines to ensure these were used as a last option. We saw from records that healthcare professionals had been involved in people’s care. People had risk assessments in place to reduce known risks and included instructions for staff to follow.

Staff had received supervisions and told us they felt valued and supported by the provider. Staff understood their role and responsibilities and knew who to approach for support if they needed to.

There was a positive culture in the service and relatives told us this gave them a peace of mind. People, their relatives and staff spoke highly of the management of the service and told us they felt confident approaching the provider if they had suggestions on how to improve the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions Safe and Well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and Independence

People were supported by staff to make their own choices in relation to their care and people were encouraged to have control in their daily lives. Staff used a variety of methods to communicate with people to ensure they were able to express their views.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights

The service was situated in a residential area and there were no outward signs to differentiate it from other houses in the street. Local shops and amenities were within close proximity of the service. Staff knew people well and ensured they were supported appropriately with their care needs and relatives told us people lived dignified lives that respected their human rights.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The culture of the service was inclusive and encouraged individuals to express their views. People who used the service, their relatives and staff spoke highly of the leadership and culture in the service. Relatives told us they felt people were supported to lead confident and empowered lives.

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 9 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 not changed following this focused inspection and remains good. This is based on the findings at this inspection.

Follow up

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

Westhill Care Home is a residential care home providing support for up to 9 people with a learning disability or autism. At the time of our inspection there were 9 people at the home. People had varying communication needs, one person was able to provide verbal feedback and we observed the care and interactions for other people living at the home.

At our last inspection we found breaches of regulation. At this inspection we found actions had been taken to ensure the regulations had been met and the service had improved.

There was 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.

People were kept safe by robust risk assessments that identified any risks they faced and measures to keep them safe. Plans were developed to promote people’s independence whilst ensuring their safety. Staff understood the importance of promoting people’s independence and this was completed in line with people’s care plans. Where incidents had occurred, staff took appropriate actions to prevent them from reoccurring. Checks were in place to reduce the risk of environmental hazards and plans had been drawn up to keep people safe in the event of an emergency.

People’s care plans were person-centred and reflected the things that were important to them. People had access to a wide variety of activities that reflected their interests. Staff involved people in their care and encouraged them to make choices. Staff understood how people communicated and used these methods to encourage choices in areas such as activities and food.

People were served food in line with their preferences. Meals were tailored to people’s choices and people were involved in shopping for food and preparing meals. Where people had specific healthcare needs, these were met. Staff supported people to attend healthcare appointments and worked alongside healthcare professionals where appropriate. Staff were trained to administer people’s medicines and the provider followed best practice in the storage and management of people’s prescribed medicines.

Staff were trained to carry out their roles. Staff training was specific to the needs of the people that they supported, as well as covering mandatory areas such as fire, health and safety and safeguarding. Staff had a good understanding of how to safeguard people from abuse. Staff also understood the principals of the Mental Capacity Act (2005).

People’s care was delivered in line with the Mental Capacity Act (2005) and staff ensured that people’s consent was sought before care was provided. Staff respected people’s privacy and dignity and involved people in their care. People were supported by staff that knew them well.

There were sufficient numbers of trained staff to meet people’s needs. The provider carried out checks to ensure staff were suitable for their roles. We did identify two instances where work histories were incomplete. We recommended that the provider reviews their recruitment procedures to ensure full work histories are obtained for new staff.

Systems were in place to measure the quality of the care that people received. The provider carried out regular audits to ensure the quality of people’s care. Surveys were conducted to gather the feedback of people and relatives. People had access to regular meeting sot be involved in the running of the home and staff were also encouraged to contribute their ideas. Staff told us that they felt well supported by management.

This was an unannounced inspection which took place on 20 September 2016.

During our inspection the registered manager, who is also the provider was 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 and associated Regulations about how the service is run.

There was a lack of structured quality assurance systems and processes. Breaches of regulations had not been identified by the provider. The views of people were not being sought on a regular basis or being used to drive improvements at the home. You can see what action we told the provider to take at the back of the full version of the report.

Assessments and best interest decisions, when people did not have the mental capacity to make particular decisions, did not feature in the provider’s care planning systems. As a result, people’s legal rights to consent were not always upheld. You can see what action we told the provider to take at the back of the full version of the report.

The provider was not proactive in looking at ways to formally support people to make decisions about their own care and welfare. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were managed safely and staff training in this area included observations of staff practice to ensure medicines were given appropriately. Guidance about medicines that did not need to be taken on a regular basis was not always available. We have made a recommendation about this in the main body of our report.

Checks on the environment and equipment had been completed to ensure it was safe for people to use. People were involved in fire drills so that they were aware of what to do if a fire occurred. Personal evacuation plans were not in place and we have made a recommendation about this in the main body of our report.

People appeared very happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse. People were supported to take control of their lives in a safe way. Risks were identified and managed that supported this.

Staff were available for people when they needed support in the home and in the community. Staff told us that they had enough time to support people in a safe and timely way. Staff recruitment records contained information that demonstrated that the provider took the necessary steps to ensure they employed people who were suitable to work at the home. Staff were sufficiently skilled and experienced to care and support people to have a good quality of life. Training was provided during induction and then on an on-going basis.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People were supported to access healthcare services, to maintain good health and to eat and drink healthily.

Positive, caring relationships had been developed with people. We observed people choosing to spend time with staff who always gave people time and attention. Staff knew what people could do for themselves and areas where support was needed. Staff appeared dedicated and committed.

People received personalised care that was responsive to their needs. During our inspection we observed that staff supported people promptly. Activities were offered both within and outside of the home which supported people to increase their independent living skills. People were also supported to maintain contact with people who were important to them.

Staff understood the importance of supporting people to raise concerns who could not verbalise their concerns. People spoke highly of the registered manager. Staff were motivated and told us that management at Westhill Care Home was good.

At the time of our inspection the service provided care and support to nine people. As part of our inspection we spoke with four people who used the service and people's relatives about the care they received. We also spoke with staff about their role and responsibilities.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We saw that people who used the service and their families had been involved in the planning of their care and their choices and wishes were respected. For example, we saw that people had chosen the daily activities they wished to participate in.

We reviewed a sample of care plans and found that risk assessments were in place to provide information to staff to help minimise any identified risks. One relative that we spoke with told us "I have no concerns about the safety of my relative".

Recruitment practice was safe and thorough and ensured that only staff suitable to work with vulnerable people were employed by the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place and staff gave us an example of what actions had been taken where concerns had been identified in relation to an individual. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We saw that information regarding people's care and support had been provided in a format to help with their understanding.

People were involved in writing their plan of care and support. We saw that people's care plans had been regularly reviewed to ensure they remained up to date in order to reflect their needs.

Staff we spoke with demonstrated they had a good understanding of people's needs and this mirrored the information included in their care plans.

The people who used the service and their relatives told us that they were "Happy" with the care and support provided. One relative said "Just couldn't fault it, we are very happy with the support the service provides".

Is the service caring?

We spoke with staff who told us they "Enjoyed" their role and "Cared" about the people they supported. They told us that the team worked well together to ensure people received the care and support they needed.

We saw that staff supported people around the home in a way that promoted their independence. People we spoke with told us that they "Liked" the staff.

A relative said, 'I feel very welcome when I visit my relative" and "The staff are very good and make everyone feel safe and comfortable".

Is the service responsive?

We saw that people's plan of care had been reviewed regularly and updated when their care and support needs had changed.

Staff were attentive and supported people quickly when they needed assistance.

Is the service well-led?

Staff we spoke with were clear about their roles and responsibilities. They told us they felt "Supported" by the service and felt confident that they could raise any concerns in order for the appropriate action to be taken. This helped to ensure that people received a good quality of service at all times.

The service completed an annual customer service satisfaction questionnaire with people and their relatives in order to gain people's views about the care and support they received.

Regular checks had been completed in the home. These included health and safety, maintenance, electrical and legionella checks, to ensure the environment that people lived in was safe and appropriately maintained.

Some of the people who used the service had more complex needs which meant that they were not able to tell us about their experiences of using the service; we therefore used our observations to help inform our judgements. We observed staff interacting with people who used the service in a respectful manner, calling people by their first names and promoting their dignity and privacy.

People who used the service appeared relaxed, content and at ease in their surroundings. We found the property to be in a good state of repair. Following our inspection the provider took action to address the fact they were not routinely screening their water system for the presence of legionella bacteria.

Records demonstrated that staff had been well trained, knew how to meet the individual needs of people and provided care which was consistent with people's care plans.

The provider also demonstrated robust procedures for effectively monitoring the quality of the service to ensure that people received safe and appropriate care and support.