Westhome Care Services Limited achieved an overall Good rating at this November 2018 inspection, having remediated previous breaches in safe care, person-centred care and governance. Well-led was rated Requires Improvement due to an incompletely embedded governance framework and two statutory notifications that had not been submitted to CQC.
Concerns (3)
moderate
Governance
: “Not all audits had been fully completed but we were assured the new framework was being followed to monitor and review the quality of the service.”
moderateIncident learning: “We found two incidents which had not been notified to the CQC which related to injuries. The registered manager and nominated individual were unware that this type of incident had to be notified.”
minorGovernance: “Accidents and incidents were to be analysed for trends and themes but at the time of inspection this aspect of the governance framework had not been fully completed.”
Strengths
· People and relatives consistently reported feeling safe with care provided by staff.
· Medicines were managed safely with regular MAR checks and staff competency assessments.
· Staff received face-to-face training delivered by the registered manager, with a dedicated training room and online resources.
· Person-centred care plans were detailed, regularly reviewed, and reflective of individual needs and preferences.
· Complaints were investigated fully with outcomes shared with people, relatives and staff.
Quality-Statement breakdown (18)
safe: Safeguarding procedures and trainingGood
safe: Risk assessment and managementGood
safe: Staffing levelsGood
safe: Medicines managementGood
safe: Infection controlGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Mental Capacity Act compliance and consentGood
effective: Multi-agency working and care planningGood
Westhome Care Services Limited received an overall rating of Requires Improvement following a March–April 2016 inspection, with concerns primarily around unsafe medication administration systems, inadequate post-safeguarding risk controls, and care plans that lacked personalisation and MCA compliance. The service was rated Good for caring, reflecting positive relationships, continuity of staff, and strong feedback from people and relatives.
Concerns (7)
criticalMedication management: “Staff were not provided with the appropriate information or systems to enable them to safely administer medication within a community setting.”
criticalSafeguarding: “Remedial actions were not always risk assessed and adequate controls were not always put in place to effectively protect people from the risk associated with potential abuse or neglect reoccurring.”
moderateConsent / capacity: “The service did not explore the conditions attached to lasting power of attorneys to ensure that they acted in accordance with decisions made lawfully, and in the best interests of people.”
moderateCare planning: “Care plans were not always person focused and personalised to ensure that people received care that was responsive to their needs. They did not always contain the preferences of people.”
moderateGovernance: “At the time of the inspection we could not assess the effectiveness of these audits in driving sustainable improvements due to the short period of time that they had been implemented.”
moderateRecord keeping: “Another person's MAR had some blank spaces where nothing had been recorded... There was no coding in place to explain this.”
minorStaff competency: “A quality assurance officer had been recruited since the last inspection. We found that this person had no previous experience of quality assessment.”
Strengths
· Effective recruitment process in place including DBS checks, references, and induction for 100% of care staff
· Training requirements and completion had much improved since the last inspection, including condition-specific training
· Staff received regular supervision and an annual appraisal to support and develop them in their role
· Stable staff team with mostly permanent rotas, promoting continuity of care and positive relationships
· Complaints procedure developed and implemented with defined roles, timescales, and six complaints all investigated and responded to appropriately
Westhome Care Services Limited was rated Requires Improvement overall following an unannounced inspection in July–September 2017, with three regulatory breaches identified relating to safe care and treatment (infection control), person-centred care, and good governance. Key failures included widespread late and missed visits due to poor roster planning, inadequate infection control practices, incomplete care plans, and ineffective quality auditing systems that failed to identify these issues.
Concerns (8)
criticalMissed or late visits: “67% of the respondents replied, 'My care workers don't arrive on time' and 47% of people responded, 'Staff don't stay the agreed length of time.'”
criticalStaffing levels: “Staffing rosters showed people's visits were back to back and travelling time was not calculated. Rosters showed some support staff were rostered to be at one house at the same time as starting a call at another.”
criticalInfection control: “100% of respondents disagreed that, 'The care and support workers do all they can to prevent and control infection (for example, by using hand gloves, gel and aprons).'”
criticalCare planning: “Care plans did not give instructions for frequency of interventions and what staff needed to do to deliver care in the way the person wanted.”
criticalRecord keeping: “Records did not always reflect the care provided by staff to ensure people received care and support in the way they wanted and needed.”
criticalGovernance: “Audits were not all effective as they had not identified issues found at inspection. Robust systems were not in place to monitor the quality of care provided.”
moderatePerson-centred care: “Staff were not provided with the required information before they began to work with people to ensure they delivered the correct support.”
moderateCommunication with families: “Staff reported if they telephoned the office to say they were running late, the person was not always contacted to inform them the care worker would be late.”
Strengths
· Staff received safeguarding training and understood reporting procedures; all staff were aware of the whistleblowing policy.
· Medicines management had improved since the last inspection, with accurate records and competency assessments for staff.
· Staff received regular supervision (every two to three months) and an annual appraisal.
· Broad training programme in place including specialist topics such as PEG care, dysphagia, epilepsy, dementia awareness and end of life care; 37 staff held a Level 2 diploma.
· Risk assessments were in place and accurately identified current risks to people in their own homes.
Quality-Statement breakdown (22)
safe: Safe care and treatment (infection control)Requires improvement
safe: Staffing deployment and reliability of visitsRequires improvement
Westhome Care Services Limited was rated Inadequate overall following a September 2015 inspection, with multiple regulatory breaches across safe care, safeguarding, recruitment, staffing governance, complaints handling, and person-centred care. The service was placed in Special Measures, with critical failures including absent safeguarding policy, widespread gaps in medicines records, staff starting before DBS checks were completed, and 46 staff receiving no supervision or appraisal in 2015.
Concerns (15)
criticalMedication management: “Some sheets contained blank entries which meant it was not possible to see whether medicines had been administered at specified times. Two people's sheets had blank entries on 17 different days over a three month period.”
criticalSafeguarding: “The service did not have a safeguarding policy and investigations of incidents were not always fully recorded. Staff had not reported alleged abuse of a person.”
criticalCare planning: “Three care plans we looked at showed that people received support from the service before their needs were assessed... staff were caring for the person with no care plan or assessment to follow for at least one week.”
criticalRecord keeping: “Care plans recorded whether a person was taking medicines but did not document what those medicines were.”
criticalGovernance: “37 care plan audits were overdue, one since January 2015. The registered manager did not always understand their responsibilities to make notifications to the CQC.”
criticalSupervision / appraisal: “46 members of staff had received no supervision or appraisal in 2015, despite them being scheduled.”
criticalStaff training: “One member of staff had not undertaken medicines training since 2006 or safeguarding training since 2009. Two members of staff had never received mandatory training.”
moderateComplaints handling: “The service had a complaints policy, but this only related to written complaints. There were no records to show that investigations of complaints occurred or remedial action taken.”
moderateMissed or late visits: “Three people and two relatives told us that appointments were often missed without them being given notice, or that staff attended late.”
moderatePerson-centred care: “Care plans were not always written in a person-centred way. It was not always clear from care plans what level of support people needed or had requested.”
moderateConsent / capacity: “We saw no evidence of the assessment of capacity or any formal record of decisions being made in people's best interest.”
moderateCommunication with families: “People said that when appointments were missed or staff were running late communication from the service was poor.”
moderateStaff competency: “We saw no evidence of an assessment of competency on any of these questionnaires. Staff were providing support without having relevant training or their competency assessed in specialist areas.”
moderateIncident learning: “Safeguarding incidents were investigated and action plans were created but it was not always clear that remedial action had been taken.”
moderateLeadership: “The registered manager did not always understand their responsibilities to make notifications to the CQC. We saw that we had not been told about some relevant matters.”
Strengths
· There were enough staff employed to support people safely.
· Staff were trained in safeguarding and had a good working knowledge of possible types of abuse and how to respond.
· When staff did attend, people were treated with dignity and respect.
· Staff were positive about the culture and values of the service.
· Some people reported consistently good, caring relationships with regular carers.
Quality-Statement breakdown (17)
safe: Safe care and treatment (Regulation 12) – risk assessment and medicines managementInadequate
safe: Safeguarding service users from abuse and improper treatment (Regulation 13)Inadequate
safe: Fit and proper persons employed (Regulation 19) – recruitment checksInadequate
safe: Staffing levelsGood
effective: Staffing – supervisions and appraisals (Regulation 18)Inadequate
effective: Staff training – mandatory and specialistRequires improvement