CQC report explained · a nursing home
What the CQC found at Westbourne House Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, May 2022
Westbourne House Nursing Home was rated Good; inspectors found people were safe and the home was well managed, with some minor improvements needed to mealtimes and the environment.
This was an unannounced inspection on 26 April 2022. Two inspectors and a person with personal experience of care visited the home. They spoke with people, a relative, staff and health professionals, observed care, and checked records including medicines, risks, recruitment and quality checks.
The home was rated Good overall. Safe and Well-led were also rated Good. Inspectors found people felt safe, received their medicines as prescribed, and were supported by staff who understood their needs. The home was clean, infection control was effective, and the provider had systems to check and improve the service.
The overall rating included ratings from earlier inspections for the other key questions, because they were not assessed during this visit. The service had previously been Requires Improvement with two breaches in 2019, but inspectors said it had improved and met those breaches by 2020.
People felt safe
People said they felt safe and well cared for. Staff understood safeguarding procedures and knew how to report concerns.
“People told us they felt safe and well cared for at Westbourne House.” from the report
Safe care and medicines
Risks such as falls, moving and handling, and choking were assessed and managed. Inspectors observed safe medicines administration and found people received medicines as prescribed.
“Staff explained to people what medicines they were taking and asked if they needed any pain relief.” from the report
Enough suitable staff
Inspectors found enough staff to meet people's needs during the visit. Recruitment checks were completed before staff started work.
“There were enough staff to support people with their needs.” from the report
Good oversight
The management team used audits, checks and staff competency assessments to identify issues and support improvement. The home also worked with health and social care professionals.
“A number of audits and checks were completed to help ensure continuous learning and improvement.” from the report
Mealtimes could be improved
minorInspectors said the lunchtime setting was not very welcoming. Tables were not laid, and cutlery was handed to people rather than being set out.
“Tables were not laid for lunch and when meals were served, the cutlery was handed to the person.” from the report
Some areas looked tired
minorThe building was clean and safe overall, but some parts were described as tired and clinical. The home had an improvement plan for the environment.
“The building was clean but was a little tired and clinical in some parts.” from the report
- 01What changes have been made to the lunchtime setting since the inspection?
- 02Which parts of the building are included in the service improvement plan, and what is the timetable for the work?
- 03How will you make sure staffing levels remain enough when there are absences?
- 04How are families involved in care decisions and kept informed if something goes wrong?
- 05What are the current arrangements for booking visits, and how do they balance protection from infection with family contact?
This was an unannounced inspection of Safe and Well-led; the other key question ratings were not inspected during this visit and the overall rating used ratings from earlier inspections. This explanation was written from the published report of 25 May 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2020
Overall rating remained Requires Improvement; inspectors found improvements in medicines, staffing and infection control, but this was a targeted inspection and not a full re-rating.
Inspectors visited on 7 October 2020. They spoke with staff and residents, reviewed medicines and care records, and checked health and safety systems. They also looked at infection prevention and control.
They found enough staff, safe recruitment, clear risk assessments and safe medicine systems. The home was clean, personal protective equipment was available, and staff had infection control training. Minor improvements were still needed in some medicine records.
The management team carried out regular audits and staff said they felt supported. Inspectors found limited evidence of a clear plan to improve parts of the building that showed wear and tear.
This was a targeted inspection. It checked specific concerns and did not review every part of the service. The overall rating stayed Requires Improvement, and the Safe and Well-led ratings were not changed from Requires Improvement.
Staffing
Inspectors found there were enough staff to meet people's needs safely and in good time.
“There were enough staff deployed to ensure people's support needs were safely met.” from the report
Infection control
The home was clean, with protective equipment available and staff trained in infection control.
“The home was clean and effective measures were in place to prevent and control the spread of infection.” from the report
Risk management
Risks to people's health and safety had been assessed, and staff understood the guidance they needed to follow.
“Clear and detailed risk assessments were in place which were well understood by staff, giving us assurance they were followed.” from the report
Management checks
Inspectors found regular audits and quality checks covering the service. Staff said management was supportive.
“Checks were comprehensive and completed regularly by the management team to monitor the quality and safety of the service.” from the report
Medicine records
minorMedicine administration was safe overall, but records for topical creams and storage temperatures were not always complete.
“Minor improvements were needed to recording administration of topical creams and temperature checks to ensure medicines were consistently stored in optimal conditions.” from the report
Building improvement plan
needs fixingSome parts of the building showed wear and tear. Inspectors had limited assurance that these issues would be dealt with promptly because there was no clear improvement plan.
“The absence of clear improvement plan meant we had limited assurances these areas were being acted on in a timely way.” from the report
- 01How are you making sure records for topical creams and medicine storage temperatures are completed every time?
- 02What improvements are planned for the parts of the building showing wear and tear, and when will they be completed?
- 03Has the electronic care record system been fully introduced, and how is it checked for missing records?
- 04What were the findings of the most recent medicine and infection control audits?
- 05When is the next comprehensive inspection or full review of all five key questions expected?
This was a targeted inspection of specific concerns under Safe and Well-led, including infection control; all key questions will be assessed at the next comprehensive inspection and the other ratings were not changed. This explanation was written from the published report of 13 November 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Westbourne House Nursing Home
3 rated inspections over 6 years: the service has held its Good rating throughout.
- May 2022Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Westbourne House Nursing Home →
- November 2020Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
Read what inspectors found at Westbourne House Nursing Home →
- June 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 25 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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