About the service:

Westbury Court is a care home, which provides personal or nursing care and accommodation, to a maximum of 42 people. At the time of the inspection 39 people were receiving care. People who received this care were predominantly aged 65 and over; some people lived with dementia, or with a learning disability or a specific physical disability.

People’s experience of using this service:

Following our last inspection in October 2016 the service had gone through several management changes. This meant the quality assurance systems were not always effective and consistently implemented and monitored and the service had not sustained their previous ‘Good’ rating. A new management team had been in post for three months. Prior to our inspection the provider had completed a comprehensive quality audit and identified shortfalls. A new management team had been in post for three months. Actions for improvement taken by this team and had already made significant improvements to people’s experiences and their quality of life.

Time was needed for further improvements to be fully completed, embedded and sustained. For example, personalisation of care and social activities, areas of staff communication and for care plan content to always remain updated and fully reflective of people’s care needs and preferences. Therefore, at this inspection we rated the service ‘Requires Improvement’ overall.

Everyone we spoke with told us they felt safe. People’s health needs were managed appropriately. Improved working relationships with other health care professionals meant people received their medicines as prescribed and they had access to timely health support. People received support to maintain their nutritional well-being and risks to people were assessed and managed effectively.

Some people and staff had moved to Westbury Court from another care home, which had closed. Therefore, people and staff were still developing new relationships with those they had not previously known or worked with. The management team were aware of the challenges merging of the services would present and had a clear action plan in place to manage this effectively.

People’s right to make their own decisions was supported. People were supported to make decisions for themselves. People who were assessed as lacking mental capacity to make safe decisions were protected from care or decisions which were not in their best interests.

The provider’s quality monitoring processes were in place to monitor the service provided to people. The provider was supporting the registered manager’s program of change and improvement. The registered manager had a clear vision of the standard of care they wanted delivered. They were supported by skilled and experienced senior staff who were also committed to the success of the improvement program. These staff were providing team building support and the leadership staff needed to work as one whole team for benefit of those who lived in the home.

Rating at last inspection:

The service’s rating at the last inspection in July 2016 was Good.

Why we inspected:

Our inspection on 3, 4 and 7 January 2019 was a scheduled inspection based on the previous rating.

Follow up:

We will monitor all intelligence received about the service to inform us of the service’s progress and of any risks, and to help us plan the next inspection accordingly.

The inspection took place on 20 and 21 July 2016 and was unannounced. The service was last inspected on 17 and 18 August 2015 when several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These had included, insufficient systems and processes in place to manage people’s risks, inadequate training and support for staff, people’s consent had not been sought for the care and treatment they received, the principles of the Mental Capacity Act 2005 had not been followed, there had been a lack of personalised care, people’s care plans were not followed and there had been poor records kept of the care that had been delivered. Overall there had been a lack of effective management and a lack of effective quality monitoring of the service’s performance. The provider wrote to us and told us how they would address these breaches. They told us these would be fully met by the end of April 2016. During this inspection we found all of these breaches had been met and improvements to the care and services provided had been sustained.

Westbury Court provides care predominantly to older people. A maximum of 42 people can be accommodated but at the inspection 34 people were living in the care home. Accommodation was provided on two floors and a passenger lift gave access to the second level. Each person had their own bedroom with washing facilities and some had private toilet facilities. There were plenty of additional communal bathrooms and toilets. People were provided with areas to sit and a separate dining area. Communal areas were comfortable and varied in size with televisions and music systems. One communal room had been fitted with memorabilia and furniture from past years. This room was used as a quiet area to sit and for people who found the objects familiar and reassuring. A sheltered and safe garden provided outside space which could be enjoyed during the good weather. The care home provided the equipment people needed to be safely looked after and to promote independence.

The current registered manager had been in position since September 2015. They had started just after our last inspection had been completed. A registered manager is a person who has registered with the Care Quality Commission 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.

Risks to people’s health and welfare were identified and managed. There were arrangements in place to help prevent people experiencing harm or abuse. There were enough suitable staff to meet people’s needs. Staff had received training and support to be able to meet people’s needs safely and effectively. People’s medical needs were met and their medicines reviewed and administered safely. People received help to eat and drink and any nutritional risks were managed well. People were supported to make decisions and their choices and preferences were met by the staff whenever this was practicable to do. People who found this difficult to do, because of a lack of mental capacity, were supported and protected under the appropriate legislation. Any decision making carried out on behalf of a person was done in the person’s best interests.

People and their representatives were involved with the planning of their care and had opportunities to review plans of care with the staff. People’s recorded care plans were followed by the staff and records of care were accurately maintained. There were arrangements in place for people to join in social activities, either on a one to one basis or in small groups. Regular outside entertainment was booked for people to enjoy. People’s family and friends were able to visit at any time and their involvement encouraged and valued. People and visitors to the care home were able to raise a complaint or dissatisfacti

During our visit, we spoke to three people who used the service. We spoke to staff and looked at documents held by the provider. We looked at the care files for six people who used the service. During our visit we noted that people who used the service were offered choice for everything that they did. People’s privacy and dignity were maintained.

The care files we looked at all contained the life story for each person who used the service. This gave staff valuable information about the person's life experiences. We saw that care plans were in place and these had been reviewed on a regular basis. The care plans were person centred meaning they reflected people’s individual needs. The provider had systems in place to monitor the nutritional status of people who used the service to prevent risks of malnutrition. Systems were also in place for the safe administration of medicines.

We spoke to three people who used the service. All three people were very complimentary about the home, staff and the care they received. The comments we received included “I am well looked after, everyone takes great care of me”.

We spoke to three people who used the service and looked at their care files. The care files were all up to date and fit for purpose. They were individual to each person and person centred. During our visit, we observed excellent communication and interaction between staff and people using the service. This communication was very friendly and respectful. The staff seemed to know people very well and responded appropriately to their needs.

One person told us “its really nice here, friendly environment and staff”. Another person told us “they look after me very well here, I’m very happy”.

Both staff and people who used the service reported a lack of staffing. However, we found this was being addressed by the manager and we saw no evidence that showed people's care was being adversely effected whilst further recruitment had taken place.

We spoke to people using the service. They told us who they would speak to if they had any concerns about how people were being treated. They were confident that the correct measures would be taken as a result. They also told us that the staff treated them with respect.

The inspection took place on 17 and 18 August 2015 and was unannounced.

The service predominantly cares for older people who have physical needs and those who live with dementia. It can accommodate up to 42 people and at the time of the inspection 40 people were living at Westbury Court.

The home had a registered manager registered with the Care Quality Commission however, they had recently resigned following a period of absence. A registered manager is a person who has registered with the Care Quality Commission 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. The care home was being supported by one of the provider’s peripatetic managers. A new manager had been employed and was due to start on 1 September 2015.

Prior to the inspection we had received information of concern which related to how people’s care was delivered. This was looked at during this inspection and our findings are included in the full version of the report.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to: ensuring risks to people were sufficiently managed, adequate staff training and support, the process for obtaining people’s consent and ensuring they were protected under current legislation. You can see what action we told the provider to take at the back of the full version of the report.

We also recommended that: the service seeks support and training for the management team about motivation and team building and the service seeks advice and guidance from a reputable source about the development of more robust quality assurance processes.

People were cared for by staff who were kind but did not always have time to be compassionate. There were enough staff to meet people’s needs but not to deliver personalised care. Although some staff wanted to personalise people’s care, others were resistive to this approach. As a result, people did not always receive care when they wanted it and their preferences were not always listened to or considered by the staff.

Whilst consent was sought appropriately for significant treatment decisions, this did not always happen for day to day care decisions. People’s care plans were detailed but did not support a personalised approach to care. It was not evident that people or their representatives had been involved in planning care or reviewing it. Some staff worked hard to ensure people had activities to take part in but this was not supported by the whole staff team. People were particularly positive about the quality of the meals provided.

Staff received training but had not always received training in subjects they needed to be aware of to ensure people needs were appropriately met. For example, in dementia care, personalisation of care and the Mental Capacity Act 2005. Staff had not received regular supervision/support to ensure their training needs were adequately identified and they could develop their skills and awareness.

Whilst some risks that people faced were addressed, others, such as pressure ulcer management and keeping people safe from others who may be distressed, were not. This put people and staff at risk or harm. People lived in a service which had not been well-led for a period of time. Staff lacked leadership and guidance on what was expected of them. The provider’s audits for monitoring the service provided had continued, but it was not clear if the resulting actions had been completed. There were opportunities for people to express their concerns or make a complaint and these had been investigated and addressed by the registered manager.