The inspection took place on 20 and 22 October 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.
We previously inspected West House Care Home on 13 January 2014, at which time the service was compliant with all regulatory standards.
West House Care Home is a residential home in Chester-le-Street providing accommodation for up to 30 older people who require nursing and personal care. There were 26 people using the service at the time of our inspection.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found that there were sufficient numbers of staff on duty in order to meet people’ needs. All people and relatives agreed that staff were attentive and there were sufficient staff on duty each day. We saw that call bells were responded to promptly.
All staff were trained, or had training courses booked, in core areas such as safeguarding, health and safety, moving and handling, infection control, as well as additional training intended to ready staff for potential future needs, for example epilepsy training. The service had a training matrix in place to track which staff had attended training courses and when; the registered manager used this to plan when refresher training courses were due. Understanding and support of mental health needs was an area that could be further developed. The service used a keyworker system and we found that staff had a comprehensive knowledge of people’s preferences, needs, likes and dislikes.
We found that the management, administration, storage and disposal of medicines was generally safe and adhered to National Institute for Health and Care Excellence [NICE] guidelines. Where we found isolated errors and areas for improvement the service responded promptly.
We observed dignified and patient interactions during our inspection. Relatives and external stakeholders told us that people were treated well and unanimously agreed that the service was welcoming and effective in their management of people’s healthcare needs.
There were effective pre-employment checks of staff in place and effective staff supervision and appraisal processes.
The service was clean. We saw that a recent visit by an infection control team had identified areas to improve immediately. We checked a sample of these issues and saw improvements had been made. Some areas of the service were in need of or in the process of refurbishment and we saw that there had been improvements since the last CQC inspection on 13 January 2014, notably the installation of the ground floor wet room.
People told us they enjoyed the food and we saw that menus were varied and people had choices at each meal as well as being offered alternatives if they did not want the planned options. We saw that the service had successfully implemented a tool to manage the risk of malnutrition and people requiring specialised diets were supported. This was augmented by an additional tool the registered manager had devised to look at wider weight loss trends.
Person-centred care plans had recently been established in all care files and the provider had sought consent from people for the care provided. Regular reviews ensured those who knew people best were consulted and involved in ensuring people’s medical, personal and nutritional needs were met. Where we suggested areas of improvements to practice the service was responsive. We also found people were protected from the risk of social isolation through regular encouraging interactions by staff and the service had an activities co-ordinator in place. We saw that relatives supported the activities programme by bringing in arts and crafts projects.
Not all people who used the service had their preferences considered or acted on however and we found the service did not proactively plan activities with people’s preferences in mind.
The service had individualised risk assessments in place, quality assurance and auditing processes and policies and procedures to deal with a range of eventualities. Emergency evacuation plans and maintenance of the premises were up to date.
People who used the service, relatives and external professionals were complimentary about the approachability and levels of communication afforded by the registered manager.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The registered manager was knowledgeable on the subject of DoLS and we saw that appropriate documentation had been submitted to the local authority.
During our inspection we found the provider was in breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.