Westerleigh

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

People were safeguarded from harm and where concerns arose, investigations took place and action taken to mitigate the circumstances and learn lessons for the future. There were a number of medicines errors, by both agency and permanent staff. Checks and audits highlighted these, and action was taken to try and address the shortfalls, although numbers remained high. The provider was introducing a new electronic medicines system to look to improve the situation.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had in place a range of systems to monitor and review safety at the home. The registered manager oversaw accidents and incidents and regularly evaluated the nature and potential cause of falls. A range of other checks were in place relating to helping to maintain people’s weight and monitoring any errors with medicines. Professionals remained concerned about the number of medicine errors, but the provider was looking to address this. Where potentially avoidable accidents had occurred, the registered manager had reviewed the circumstance and written to the person, or their family, with an explanation and description of any remedial action taken, complying with the Duty of Candour regulations.

Relatives and professionals told us the registered manager was responsive to any concerns they raised and moved quickly to address them. Comments included, “I noticed my relative's mat, which is used to set off an alarm when they step on it. It was under their bed and not next to them in their armchair. I raised this with the senior carer on the Sunday morning and she took on board my concern and apologised for this and said she'd check what had gone wrong. Whilst I was visiting my relative a carer came into their room and apologised for her oversight. I was impressed how the matter was addressed promptly, and my concern had been noted and addressed.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety, health and well-being was effectively managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was regular input from outside professionals and District Nurses visited the home on a daily basis to support people’s health needs. Prior to people coming to live at the home the service carried out an assessment to ensure they could meet people’s needs.

Care plans broadly reflected the health care need of people, although some areas required some additional detail, to ensure all aspects were covered. However, this had not impacted on people’s care or wellbeing. Staff had a good understanding of people’s health care needs and were responsive to concerning situations or deteriorating conditions.

Relatives were happy with how the service responded to any ongoing care needs. They told us, “Staff are attentive and very nice and polite. They are just there for you. It doesn’t take them long to respond to any needs. Their catheter came out, but it was quickly put back in place.”

Professionals said the service worked collaboratively and proactively in managing health issues. One professional stated, “Staff are very good at encouraging people to have breakfast in relation to their diabetic management. They are aware of the needs of diabetic residents. If concerned they will contact the District Nurse or the GP. Often when I go in, they have already contacted 111 because they have had some concerns.” One professional felt that communication could be improved, and not all staff were fully up to date with people’s progress.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and relatives felt the home was a safe place and they had not been subject to any instances of discrimination or bullying. Comments from people and relatives included, “Overall I think the staff are kind, caring and treat my relative with dignity” and “The care staff act in a prompt, professional and caring attitude with residents. Staff treat the residents with dignity.”

The staff had a good understanding of safeguarding and had undertaken training related to this matter. They had a clear view of potential safeguarding concerns and how and where to report such concerns.

The provider had a comprehensive whistleblowing and safeguarding adults policy for staff to follow. The registered manager reported any potential safeguarding concerns to the appropriate authorities and, where necessary, carried out a review to ensure appropriate remedial action was taken and lessons learned for the future.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care plans contained assessments of risk related to the care people were receiving, and any health conditions that may increase potential risks. Reviews of risk were undertaken on a regular basis, although the content of these reviews was sometimes limited. Some care records had not always been fully updated. This had not directly affected people’s care and staff were aware of people’s most up to date needs. The registered manager took steps to address these discrepancies during the period of the assessment.

People and relatives told us staff involved them in decisions and kept them up to date should any concerns arise. Relatives told us, “I am kept regularly up to date with issues or concerns. The staff contact me when needed but also update me when I visit”

Where people had equipment in place that potentially limited their freedom, such as bed rails and sensor mats to monitor movement there was evidence that people, relatives and professionals had been involved in making these decisions, as appropriate.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider had in place appropriate systems to ensure the environment of the home was safe and secure. The home had in place appropriate checks for electricity safety, gas safety and a legionella assessment in relation to water safety. Regular checks were undertaken on fire equipment, bedrails, and small electrical appliances. Lifting and hoisting equipment was subject to LOLER (Lifting Operations and Lifting Equipment Regulations) checks, to ensure they were well maintained and safe to use.

People were supported to be safe within the environment of the home. Where people did not have capacity to understand risks then appropriate restrictions were in place, such as keypad locks and window safety catches. Where people’s freedom was restricted, applications had been made under the Deprivation of Liberty Safeguards (DoLS).

Relatives told us they felt their relations were safe at the home and that all staff members took responsibility for ensuring people were protected. One relative told us, “I've watched how the cleaners, kitchen staff, the manager and administrator all keep an eye out for the residents and will chat with them.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had a thorough recruitment process in place that had been followed. New staff were subject to a probationary period.

The registered manager regularly reviewed people’s needs to ensure staffing numbers were sufficient to meet needs. The service made use of agency staff to fill any shortfalls in staffing. Agency staff were subject to review prior to working at the service and received an appropriate induction at the start of a shift. Where there were concerns about the appropriateness of agency staff, the registered manager took action to ensure people were safe and alerted agencies and other homes to concerns.

Staff received regular supervisions and appraisals to ensure they were able to work effectively. They had also undertaken a range of training and development. Staff told us there were sufficient staff in the home to deliver care and keep people safe. Comments included, “I think there are enough staff. I just work days. There are 11 staff on during the day including 3 seniors – 1 on each floor”

People and relatives told us overall they felt staffing was appropriate, although did suggest weekends and night shifts could be better staffed. Comments included, “The regular caring staff / nurses are, on the whole, very pleasant and capable in equal measure. It can appear at certain times that there aren't enough of them. Saturdays and Sundays certainly appear to be understaffed as a general rule”; “Staff are marvellous with her – can’t fault them at all” and “I think there are enough staff around – if you can ever have enough staff. There was an issue a while ago when I thought there were less on at the weekends, but that seems to have improved recently.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had in place a comprehensive infection control policy. Regular infection prevention and control audits and checks were undertaken. Staff had received training in relation to effective infection control. Personal protective equipment (PPE) was available around the building and staff used this appropriately. Areas such as toilets, showers and sluices were well maintained and free from any dirt.

We looked around the home and found it to be clean and tidy, with no malodours evident on any of the floors. Some areas of the home were in need of redecoration or cosmetically updating.

Professionals and relatives found the home clean and tidy when they visited. Comments included, “The service seems clean, tidy and well organised “ and “The food / dining appears to be of a reasonably high standard along with the laundry / cleaning etc. Nothing I have noticed has made me think otherwise.”

During the first day of our assessment, the home was visited by the local authority environmental health officer, who carried out a routine inspection of the kitchen areas. The home received the highest possible rating of 5 from this inspection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

The provider had in place a medicines policy to ensure practices within the home were safe. Staff who administered medicines had received additional training and competency checks.

The registered manager reviewed medicines records to identify any errors. There had been a number of errors over the previous 6 months. Professionals told us despite input from various agencies the rate of errors remained persistent. The range of issues included, missed doses, incorrect doses and medicine given on the wrong day. Professionals felt permanent and agency staff struggled at times. Where errors concerned permanent staff additional training was provided.

The provider was aware of issues around effective medicines management and were introducing an electronic medicines management system to monitor and administer medicines. Professionals were hopeful that this would improve the situation.

Medicines were given in line with directions and there were a limited number of missing signatures on medicine administration charts (MAR). Some errors had occurred during the second day of the assessment, when an agency staff member had been on duty. The registered manager took immediate steps to address the situation. Medicine counts were maintained, and we could reconcile medicines given with remaining stock.

Controlled medicines were stored effectively and any doses given were double signed by staff. Regular weekly checks were not always undertaken, but we found recorded quantities to be accurate. Rooms where medicines were stored were clean and tidy and temperatures monitored. We observed staff dealing with medicines appropriately and people felt supported with their medicines. People said, “I’m on 13 tablets per day – I always get these on time” and “They deal with my medicines – I get them all on time."