Westbank Care Home provides accommodation along with nursing and personal care for up to 40 older people. One wing of the service was closed for refurbishment at the time of the inspection. This inspection was carried out on 29 January and 1 February 2016. It was an unannounced inspection. There were 24 people using the service. We had received information of concern about the service from a number of sources prior to the inspection.
There was not a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. A manager had been appointed to the service in December 2015, but they had not yet applied to CQC to be registered.
At the last inspection on 24 March 2015, we asked the provider to take action to make improvements in respect of dignity, consent, governance, records and staffing. An action plan was not sent to us by the date we required when we published the final report. An action plan was submitted in July 2015 when we requested this again. The final date the registered provider had set for compliance with the breached regulations was 30 September 2015.
At this inspection we found that the registered provider had failed to make or sustain the required improvements they had outlined in their action plan.
People had not always been safeguarded from abuse or harm whilst using the service. Systems in place to reduce the risk of harm had not been effective. The risks to the welfare of people and the safety of staff had not been appropriately managed or reduced. People were at risk of developing pressure wounds and dehydration due to a lack of effective systems for reducing these risks. One person was at risk of choking and guidance to minimise this risk had not been followed.
There were insufficient numbers of suitably skilled and experienced staff deployed in the service to meet people’s needs. This meant that people waited unreasonable lengths of time for care and for their meals. Staffing numbers on occasions during December 2015 were seriously below the number required to keep people safe in the service.
Staff did not receive adequate induction or training to ensure they were competent in providing safe and effective care to people. The registered provider had not ensured that systems for the regular supervision of staff were effective to ensure they were meeting people’s needs.
Whilst we saw some examples of caring and compassionate staff we found that people were not always treated with respect or their dignity and privacy maintained. Staff were unclear how to respond appropriately to people who were confused or had memory loss.
People did not always receive a personalised service that reflected their needs and preferences. People were not supported to get up at a time they wanted. A lack of directive care planning meant that people’s needs were not always met.
There was a lack of effective leadership of the service. Audits and quality monitoring systems had not identified shortfalls in the provision of safe and effective care and plans to make improvements, following our last inspection, had not been successful.
People did not consistently have their nutrition and hydration needs met. People did not always have their health needs met in a timely way. People did not have care plans in place to enable them to improve their mobility and independence. We have made a recommendation about this.
Recruitment procedures were robust to ensure that people were suitable to work in the service.
People were provided with information about the service provided and were signposted to other services available to them.
People’s medicines were managed safely. A policy for the management of medicines was not available. We have made a recommendation about this.
People lived in a clean environment and systems were in place to reduce the risk of the spread of infection. The premises was under refurbishment to modernise the service taking into account the needs of the people who used the service, including those living with dementia.
People were supported to make decisions about their care and treatment and had their rights under the Mental Capacity Act 2005 met. People were only deprived of their liberty in line with the law.
People knew how to make a complaint. People’s views were sought through residents and relatives meetings and an annual survey, but the registered provider had not considered alternative and creative methods to seek the views of people with limited verbal communication. We have made a recommendation about this.
You can see what action we have told the registered provider to take at the back of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Following the inspection of this service we continue to liaise with the local authority who is working closely with the service to ensure people’s safety.