About the service:

Westbrook House is a residential care home that accommodates up to 60 people. At the time of the inspection, not all the accommodation was being used. There were two units open for up to 30 people. One unit offered short stay enablement beds to support people to improve their skills and independence to return to their own homes, there were 10 people in the unit during the inspection. The second unit, provided support and assessment of needs for people living with dementia, there were four people in the unit during the inspection.

People’s experience of using this service:

People told us they felt safe and staff supported them in the way they preferred. However, potential risks to people’s health and welfare had not always been assessed and there was not always guidance for staff to reduce the risks. Medicines were not always managed safely. Audits had been completed but had not identified the shortfalls found at the inspection.

People were treated with kindness and respect, they were supported to be as independent as possible. People were actively supported to express their views about their present and future care needs. Staff monitored people’s health and referred them to health professionals when required. Health professionals such as physiotherapists were involved with people’s care to enable them to be as independent as possible and return to their homes. Professionals held regular meetings to discuss people’s needs and the support they would need in the future. People’s preferences about their future care were supported and put in place whenever possible and were reflected in their care plans.

People and visitors were asked their views about the service; the responses were analysed and the results displayed within the service. There was a complaints procedure available to people. People told us they had a choice of meals which they enjoyed. There were enough staff to meet people’s needs, who had been recruited safely and knew how to keep people safe from abuse.

There was an open culture within the service, any incidents were recorded and analysed to improve the care people received. Staff worked with other agencies to ensure people benefited from joined up care to enable them to live their life as fully as possible.

The service was purpose built and was adapted to support people to be as independent as possible. The service was clean and odour free.

Rating at last inspection:

Good (report published 17 September 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service no longer met the characteristics of Good in all areas. The domains of safe and well led are now rated Requires Improvement. The overall rating is now rated Requires Improvement overall.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

Westbrook House Integrated Care Centre provides nursing and personal care for up to 60 people some of whom may be living with dementia. The service is provided in four units: Victoria Red and Victoria Green are situated on the first floor and provide short term assessment and rehabilitation services to older people, Ogden on the ground floor provides nursing care and treatment to people with complex mental health and dementia needs, and Appleton on the ground floor which provides short term and respite care to people living with dementia. Staff were employed by either Kent County Council, Kent Community Health NHS Foundation Trust or Kent and Medway Partnership Trust. On the days of the inspection there were 43 people living at the service.

The service is run by a registered manager who was present during our inspection. 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 registered manager is supported by a deputy manager and unit managers.

People said they felt safe living at the service. Staff understood how to protect people from the risk of abuse and the action they needed to take to keep people safe. Staff were confident to whistle blow to the registered manager or organisations outside the service if they had any concerns and were confident that the appropriate action would be taken.

Risks to people’s safety were identified, assessed and managed. Assessments identified people’s specific needs, and showed how risks could be minimised.

Recruitment processes were in place to check that staff were of good character and safe to work with people. Information had been requested about staff’s employment history, including gaps in employment. There was a comprehensive training programme in place to make sure staff had the skills and knowledge to carry out their roles effectively. Refresher training was provided regularly. People were consistently supported by sufficient numbers of staff who knew them well. Contingency plans were in place to cover any emergency shortfalls of staff.

People received their medicines safely and people received their medicines when they needed them. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The registered manager and unit managers had submitted applications in line with guidance.

People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. People were able to make choices about how they lived their lives, including what time to get up, what time to go to bed and any preference of staff gender.

Staff had received training on the MCA and understood the key requirements of the MCA and how it impacted on the people they supported. They put these into practice effectively, and ensured that people’s human and legal rights were protected. Staff undertook lead roles on each unit as ‘MCA champion’.

Regular environmental and health and safety checks were completed to ensure that the environment was safe and that equipment was in good working order. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what t

Many of the people that use the service at Westbrook House have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with visitors to the service and other health professionals.

We spent some time with the people and observed interactions between the people and the staff. People were moving around the home at their own pace and were being supported by the staff to go where they wished.

We saw that people were responsive in the company of staff. They were able to let staff know what they wanted and we saw staff responded in a caring and positive way.

The staff we spoke to had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

A relative told us that they were satisfied with the care and treatment their relative was receiving on Ogden unit. They said they did not have any complaints but would not hesitate to contact the manager if they did have.

We carried out this review and brought forward the scheduled planned site visit because we had received anonymous information with regard to concerns about the safety and welfare of people who use services Westbrook House.

People told us staff had talked to them about the care and support they needed when they first came to Westbrook House. Most people spoken with did know about their care plan (a plan of care outlining how staff will support them), felt they had been involved in reviewing it and that they had signed it in agreement. Others did not due to the level of their mental impairment.

Several people spoken with said they were happy with the care given and had no concerns. One gentleman said on the intermediate care unit said “like gold dust coming in here” another said when referring to staff “I could not fault them”.

The service is provided in four units. Victoria Red and Victoria Green situated on the first floor which provide short term assessment and rehabilitation services to older people. Ogden on the ground floor provides nursing care and treatment to people with complex mental health and dementia needs. Appleton provides short term and respite care to people living with dementia.

We visited each of these units and spoke with the people using the service, family members and staff. Everyone we spoke with said they were happy with the service they received. One relative we spoke with told us. “I’m really happy with the service; my father has made a huge improvement since coming here. He has returned to the person he was before he was unwell.

Staff worked with other professionals to plan and provide a service which supported people to become independent again. A person told us, “I couldn’t walk when I came here and now I only need a stick”. Three relatives that we spoke with told us that staff had the skills to meet their relative’s needs and they had seen their relative improve in a few weeks.

Staff knew people well and treated them with dignity and respect. People looked comfortable and at ease with staff. We found that staff were supported to provide a safe service. Relatives told us, “The staff are really lovely and definitely caring” and “The staff don’t seem to be able to do enough to support people”.

People had been involved in planning of their care and were supported to make plans for their future care.

The provider had checks in place to ensure that the service was safe.