Westmead

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.

People’s experience of using this service:

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways. Each person had their own individual flat including living space and kitchen which had been adapted to their individual needs and preferences. There was a strong focus on promoting choice, control and independence. People’s support focused on taking positive risks to ensure they had as many opportunities as possible for them to gain new skills and become independent.

• People received good care and support which met their individual needs. One health professional said, “I have found the Bridge to be one of the most effective and supportive environments I have ever worked in.”

• People, relatives and health professionals praised the home and the way in which care was provided.

• People were supported in a safe environment. Risks to people’s health and safety were assessed and mitigated. The service learnt lessons and improved the safety of the service following incidents.

• Restrictive interventions were only used as a last resort and in people’s best interests and there was a strong focus on reducing these interventions over time.

• There were enough staff deployed to ensure people received their required care and support. Staff were kind and caring and treated people well. Staff knew people well and had developed good, caring relationships with them.

• Staff had received bespoke training to enable them to care for the individuals living within the home.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• The service was well managed. The management team were well respected and had good oversight of the service. They were looking to continuously improve and develop the service.

Rating at last inspection:

This was the first inspection of the service since it registered in April 2018.

Why we inspected:

Whilst a routine inspection was planned, the inspection was brought forward due to a notification received from the provider where a person had the potential to suffer harm. This inspection examined those risks.