Westmead

Updated 5 January 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

The inspection was carried out by 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Westmead is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. 51 a Westmead is a care home without nursing care. 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 the Care Quality Commission 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.

What we did before the inspection

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

During the inspection

We visited the service over 2 days and visited out of hours. We spoke with 7 staff, including the registered manager, 3 people who used the service, 6 relatives and 2 professionals. We reviewed the care records of 4 people and 2 staff files. We reviewed a variety of records relating to the management of the service, including policies and procedures, audits and checks. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 5 January 2023

About the service

Westmead is a residential care home providing accommodation and personal care to up to 9 people. At the time of our inspection 9 people were living at the home. The service provides support to people with learning disabilities, autistic spectrum disorder, mental health concerns and people who display behaviours that challenge. Support was provided to people in their own individualised flats and bungalows.

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: Some people were actively involved in the community and some people’s activities were provided in a person-centred way. Support was provided to people in an individualised environment. However, not all people were provided with support to help them learn new skills and try new activities. Records were not detailed enough to evidence that people were offered enough meaningful activities.

Medicines were managed safely. Where medicines errors had occurred, appropriate action was taken to learn lessons from incidents. Innovative systems were used to support people to take their medicines.

Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Some people required high levels of support to keep them safe. Some improvements were required around how restrictions were reduced in a timely manner.

Right Care: People's care plans and risk assessments were detailed, and person centred. However, there were occasions when the guidance in place wasn't being followed to ensure people were kept safe. For example, cleaning products were not always stored in a way to prevent people causing themselves harm and window restrictors which were required to keep people safe were found to be broken. Staff knew people well and communicated with them in an individualised way to meet their communication needs.

Right Culture: Quality assurance systems required some improvements to gain people's and their relatives views about the service. We received mixed feedback from relatives regarding the leadership in the service. Staff were positive about the management team and said they were supported in their roles. Staff told us the registered manager was approachable and said they were able to raise concerns. There was an open and honest culture and incidents were reviewed, with lessons learned to reduce the likelihood of incidences occurring in the future.

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 14 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and unnecessary isolation of people. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Concerns raised around staffing and unnecessary isolation where unfounded. However, we have found evidence in other areas that the provider needs to make improvements. Please see the safe and well led sections of this full report

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.

You can see what action we have asked the provider to take at the end 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 based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westmead on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care, infection prevention and control and good governance 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.