Westbury Lodge

Updated 9 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors and an assistant inspector carried out the inspection.

Service and service type

Westbury Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. The first visit of the inspection was completed out of office hours, in the evening.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We communicated with 8 people who used the service and 2 relatives about their experience of the care provided.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with 1 person to tell us their experience.

We spoke with 11 members of staff including the registered manager, regional director and 9 support workers.

We reviewed a range of records. This included 4 people’s care records and 4 medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We received feedback from 3 relatives and 7 health and social care professionals who regularly visit the service.

Updated 9 June 2023

About the service

Westbury Lodge is a residential care home providing personal care to 8 people at the time of the inspection. The service can support up to 8 people with a learning disability or support needs relating to their mental health. The service is located in a residential area of Westbury, with access to local services and train station.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Medicines were not managed safely, and staff did not keep accurate records relating medicines. This meant the provider could not be sure whether people were supported to take their prescribed medicines.

The service did not make sure people received support in a safe and hygienic environment. The home was not clean. Cleaning schedules were in place, but staff had not completed them. This increased the risk that people would be harmed as a result of poor infection control practices.

There were enough staff to meet people’s needs. The provider had taken action to address staff shortages through use of temporary agency staff. The agency staff had been working at the service on a long-term basis and provided consistent support for people.

Most staff demonstrated a good understanding of the risk management plans and the actions they needed to take to keep people safe. We identified one member of staff who was unclear of the support a person needed to manage the risk of choking. The staff member was provided with additional guidance from senior staff on the day of the inspection and further training was planned.

Feedback from health and social care professionals highlighted staff having a good understanding of people’s needs and actions to keep people safe.

Right Care

We used the ‘Talking Mats’ communication system with 1 person, who indicated they were happy living at Westbury Lodge. Another person told us they felt safe at Westbury Lodge and staff treated them well. The person said they knew how to raise concerns with the registered manager and were confident concerns would be addressed.

We observed people interacting with staff in a confident and comfortable way. People appeared at ease in the presence of staff.

People were supported to maintain contact with their family and friends. Relatives reported they could visit without restrictions, and staff supported people to keep in contact with them through phone calls.

Right culture

The provider had systems to assess and monitor the quality of the service being provided. However, where shortfalls were identified, actions to improve the service were not always maintained and embedded in practice.

We observed staff working in ways that responded to what people were communicating to them.

Health and social care professionals who had contact with the service told us the service promoted a person-centred culture, and worked with them to meet people’s needs.

Staff told us they felt listened to and valued by the registered manager.

People were supported to be active members of their community and participate in local activities.

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 1 May 2021).

Why we inspected

We received concerns in relation to the way people were treated and the culture of the staff team. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches of regulations in relation to safe care and treatment and premises and equipment 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.