41 West Hill

Inspectors were assured that infection prevention arrangements, including visitors, protective equipment and the home's infection control policy, were suitable.

“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report

The home made health referrals promptly when people were unwell, including contacting a GP when needed.

“The provider had made health referrals in a timely manner.” from the report

Inspectors found that recruitment procedures were safe.

“The provider operated safe recruitment processes.” from the report

Staff did not always recognise or report bruising, marks and other possible safeguarding incidents. This meant possible causes were not investigated and people could remain at risk of harm.

“Staff failed to recognise and report safeguarding incidents.” from the report

Records did not show clearly that restraint was necessary, proportionate or used for the shortest time. The home did not consistently review restraint afterwards or look for ways to prevent it.

“People were at risk of harm by restrictive practice.” from the report

Fire alarm testing was not completed as required and fire doors were wedged open. Water temperatures exceeded safe levels without staff taking action.

“Fire doors had been wedged open.” from the report

People were not consistently supported to make choices, communicate, maintain privacy or follow hobbies and activities. Care was described as staff-led and task-focused rather than centred on each person.

“We found the service was staff and task-led, rather than person-centred” from the report

The provider's checks did not identify or fix repeated problems. Important incidents were not always reported, and relatives said information was not always open or shared properly.

“The provider failed to have an effective quality monitoring system to inform them of areas of the service that required improvement.” from the report