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Inspection on 11/12/09 for West Eaton House Nursing & Residential Home

Also see our care home review for West Eaton House Nursing & Residential Home for more information

This is the latest available inspection report for this service, carried out on 11th December 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

West Eaton House is a friendly and welcoming place and has a nice atmosphere. It is set in pleasant surroundings and has a large garden with countryside views from most windows. The staff are polite and have a respectful and caring attitude towards the people who live in the home. People have their health and personal care needs attended to and medication is managed safely with further improvements planned. An activities organiser is employed and provides a range of things for people to do, this includes group activities and also one to one activities like writing letters for people or just having a chat. The house is kept clean and warm and people are encouraged to have personal space and belongings around them to help make them feel they have familiar surroundings. The new manager is working hard to bring stability to the home after a period of change due to the previous manager leaving.

What has improved since the last inspection?

Work has been done to recruit more staff and to reduce the amount the home relies on agency staff. This is a good way to improve the standard and consistency of care. A new manager has been appointed following a period since the last inspection without a manager. The new manager and the owners have looked at how the service does things and have identified a number of things they need to improve rather than continuing to accept things how they were.

What the care home could do better:

The owners need to decide whether the home will focus on caring for people with physical care needs (and not for people with dementia related needs) and amend the statement of purpose accordingly. Whilst care provision is generally good, some improvements are needed to make sure significant information is always acted on quickly and correctly. Charts in rooms need to be completed more reliably so that staff have good records to refer to about when care and attention have been provided each day. Some additional developments in the way medication is managed will help to make the systems in place more robust. More information is needed in the kitchen about individual`s dietary needs so that catering staff are more involved in making sure people have their nutritional needs met. Recent safeguarding training for senior staff should be consolidated and safeguarding training for all staff needs to be updated. The physical environment needs to be updated to make it more attractive and more helpful to people in finding their way about the home. The planned training needs analysis should be done as soon as possible and adequate resources made available to address the slippage in staff training during the last year. In order to ensure the home fully complies with fire safety legislation the fire risk assessment for the home needs to be updated.

Key inspection report Care homes for older people Name: Address: West Eaton House Nursing & Residential Home Worcester Road Leominster Herefordshire HR6 8QJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Denise Reynolds     Date: 1 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: West Eaton House Nursing & Residential Home Worcester Road Leominster Herefordshire HR6 8QJ 01568610395 01568614407 graeme@frontsouth.co.uk Heritagemanor.co.uk Heritage Manor Limited care home 33 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 33 Dementia (DE) 33 Old age, not falling within any other category (OP) 33 Date of last inspection Brief description of the care home West Eaton House is situated in a rural setting close to the town of Leominster. The two-storey building is suitable for its purpose and is in attractive grounds. The providers, Heritage Manor Limited, also own homes in other areas of the country. The home has thirty-three beds and provides care for older people who either require Care Homes for Older People Page 4 of 30 Over 65 0 33 0 33 0 33 2 4 1 1 2 0 0 8 Brief description of the care home nursing care or personal care. Residents who have additional physical disabilities or dementia can also be accommodated. None of the single rooms are twelve square meters so an assessment of equipment and space requirements for those residents with physical disabilities is essential prior to admission. Readers wishing to know the weekly fee arrangements should contact the home directly. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: One inspector spent a day and a half at the service for this inspection. During our inspection we spent time observing day to day life, speaking to people who live there, a visitor and some staff. We also looked at a range of essential records needed to support the care of people and the overall safety and management of the service. The focus of our inspection was to look at the outcomes for people who live at West Eaton House and to find out what they think about their care. To help us with this we looked in detail at the care of two people. This included observing some aspects of their care, talking to staff about the care they need, looking at care records and where possible, speaking with them. Some months previously the service had sent us their Annual Quality Assurance Assessment (AQAA). This is a self assessment tool which services use to describe what they do well, what they need to do better and what their plans are for improvement in Care Homes for Older People Page 6 of 30 the coming year. At this time we also sent surveys to people using the service, their relatives, staff and some professionals. We used all of this information to help us build a picture of the quality of the service people at West Eaton House are receiving. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The owners need to decide whether the home will focus on caring for people with physical care needs (and not for people with dementia related needs) and amend the statement of purpose accordingly. Whilst care provision is generally good, some improvements are needed to make sure significant information is always acted on quickly and correctly. Charts in rooms need to be completed more reliably so that staff have good records to refer to about when care and attention have been provided each day. Some additional developments in the way medication is managed will help to make the systems in place more robust. More information is needed in the kitchen about individuals dietary needs so that catering staff are more involved in making sure people have their nutritional needs met. Recent safeguarding training for senior staff should be consolidated and safeguarding training for all staff needs to be updated. Care Homes for Older People Page 8 of 30 The physical environment needs to be updated to make it more attractive and more helpful to people in finding their way about the home. The planned training needs analysis should be done as soon as possible and adequate resources made available to address the slippage in staff training during the last year. In order to ensure the home fully complies with fire safety legislation the fire risk assessment for the home needs to be updated. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of using either service have their needs discussed with them first by staff to make sure the service can provide the right care for them. Consideration is being given to whether the home will focus on caring for people with physical or dementia related care needs so that a stronger service can be developed. Evidence: The AQAA told us that there are some aspects of the admission process that the home know they could improve. For example they told us they know they need to get better at giving people the information they need to help them decide if West Eaton House is somewhere they would like to live. They also identified that they need to get more information from families and social workers so they can be sure that the home is able to meet any care needs a person has. The AQAA showed us that the owners and managers of the service know how important it is to have good information about a persons needs before they arrive. Care Homes for Older People Page 11 of 30 Evidence: This is so that staff will know what care a person needs and so that the manager can make sure staff have the right skills to meet any specialist needs. During this inspection we looked at the admission information for a person who had gone to the home for a week. The information in the persons assessment was sufficient to guide staff during the first day or two and a nurse told us that they would be adding to the information as they got to know the person better. The person told us that they had been made very welcome by staff and that people had been kind to them. We noted that the person had a specific care need which staff at the home had not had training about. This was something that had not recently given the person problems but is an example of the need to consider staff skills when arranging for someone new to move in. We had a discussion with the manager about the type of person she considers West Eaton House is best suited for ie, people who need nursing due to their physical care needs or because they have difficulties due to dementia (the home is presently registered to enable West Eaton to offer places to both groups). The managers view was that the home is generally better suited for people with physical nursing needs. She recognises that care needs to be taken so that distress is not caused to others when people with advanced dementia become restless. This something she wishes to discuss with the owners so that the purpose and aims of the home can be made clearer. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at West Eaton House receive care which is planned to meet their individual needs. Medication is managed safely. Staff treat people as individuals and with respect for their privacy and dignity. Evidence: In the AQAA we were told about a range of things the service plans to develop and improve. These included having written information about care which is more individual and person centred and having better systems for checking essential things like nutrition, weight and pressure area care. During our inspection we found that some of these things had already begun, for example, we saw good records to show that pressure area care was being provided. During our inspection we observed that people had been helped to look their best by staff, for example, people had clean clothes and their hair and nails were well looked after. We heard staff speak to people in a caring and respectful way and saw that they knocked on doors before going into peoples rooms. Care Homes for Older People Page 13 of 30 Evidence: The surveys we had sent back to us gave a mixed picture of peoples views about the quality of the service. In general people were pleased with their care but mentioned things like there not always being enough staff and that this affected the help people get. For example two people commented on delays in being helped to the toilet. Some people (including a health professional) mentioned that sometimes, there is a breakdown in communication, possibly due to some staff needing to improve their English language skills. During our inspection we were able to discuss these things with the manager and we say more about this in the staffing section of the report. The written records we saw provided a lot of information about the care people need and showed that health concerns had been followed up. People we spoke to said that they feel well looked after. One person had recently developed a large bruise; this concerned the persons relative who spoke to us at the home. We checked and found out that the home had asked for a GP visit but been given verbal guidance by phone. However, when the manager learned of this issue she followed this up by insisting on a visit by a doctor. She also made a referral under local safeguarding arrangements because the cause of the bruise was unexplained. We were told that significant changes have been made in the way that people in the home who have limited mobility are moved. The manager and deputy told us that a lot of work has been done to reduce the risk. This has been done by having better moving and handling assessments and using hoists where this is assessed as the safest way for a person to be moved. During the inspection we saw staff using hoists for transferring a number of people from their wheelchairs into armchairs and saw that they took a lot of care with this. We noted the care being given to one person who was very frail and having all their care in bed. We saw that the person was comfortable and that staff attended to her during the day and that her nightdress and bedding were changed when this was needed. We saw that records kept in the room for staff to record when the person had drinks, food and was turned were not filled in as well on some shifts as others. We drew this to the managers attention so staff could be reminded that this is an important way to help them make sure the right care is being given at all times. Medication is securely stored and we found that the records were up to date and accurate. A monitored dosage system is being introduced shortly to help the home monitor medication administration. We checked a number of items of medication and found that the balances held in stock were accurate. We saw records of audits of medication done by the manager; these were thorough and covered all the expected aspects of practice to ensure the homes medication is managed in line with Care Homes for Older People Page 14 of 30 Evidence: legislation. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at West Eaton House are given opportunities to do enjoyable things and to have time spent with them one to one if they prefer not to take part in communal activities. The meals at the home are nutritious and mealtimes are relaxed with good staff support to help people with their meals. Evidence: During both days we were at the home the atmosphere was friendly and welcoming. Visitors are made welcome and encouraged to stay in touch with their family member, for example, one person has their main meal of the day at the home with his wife. An activity organiser is employed full time and arranges a variety of things for people to do. This includes communal activities such as musical entertainment and board games but also one to one things such as helping people write letters and birthday cards to relatives or just having a chat. The activity organiser also does shopping for people and does things like manicures and other personal grooming tasks. This inspection was just before Christmas and we saw that a lot of work had gone into making the home look festive and in having seasonal activities such as carol singers coming to the home. Care Homes for Older People Page 16 of 30 Evidence: We saw that mealtimes were relaxed and that most people are helped to sit at the table to join other people to eat. We also saw that the staff assist during mealtimes to make sure that people who need help have someone at hand to do this. In some cases staff sat with people needing most help throughout the meal. We spoke to the cook who was enthusiastic and knowledgeable about catering and committed to providing nutritious and enjoyable meals. She was planning to re-do the menus shortly to freshen them up. We suggested using this as an opportunity to get people living in the home more involved with choosing what they have to eat. The cook told us that there is already a regular guest spot on the menu where someone has the chance to choose the main meal that day. A choice of meal is provided at each meal time with two main options offered at lunchtime. Information was available in the kitchen regarding some people with specific dietary needs such as diabetes. We highlighted the need for information to also be available about people at nutritional risk due to things such as weight loss and pressure area damage to make sure kitchen staff know who would benefit from fortified diets. This is an area already identified in the homes AQAA as needing attention and could be supported by the purchase of specialist cookery books aimed at older peoples nutritional needs. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that staff will take notice if they have concerns and do what they can to put things right. Staff know they have a duty to protect people from the risk of abuse or neglect. Evidence: The organisation used this part of the AQAA to tell us that they recognise that there are things they can do better in respect of complaints and protecting people. They told us that they are working to make sure that people who live at West Eaton, their families and staff are all aware of what to do if something isnt right. The answers we got in the surveys showed that this is working as most people said they know what to do if they, or someone else, has a concern. There is a copy of the complaints procedure in the service user guide and in the AQAA the service told us they will be making sure the process is explained to people (or their family) when they first move in. Since the last inspection the service has made some referrals to the local multi-agency safeguarding process following a number of concerns. These related to poor moving and handling practice and people at the home being told not to use their call bell by a carer. The service took the right action by suspending the staff concerned and reporting the issues to the safeguarding process. Subsequently a carer was dismissed and reported to the Independent Safeguarding Authority for potential inclusion on the list of people barred from carer work. During this inspection another matter arose Care Homes for Older People Page 18 of 30 Evidence: involving an unexplained bruise which the manager was in the midst of reporting to the local authority as a safeguarding alert. She had identified some shortfalls in practice in the home in that she had not been informed of the bruise when it was first noted and that other staff had not identified that it should be dealt with as a safeguarding matter. We had a conversation with the relative of this person who was concerned that the bruise had happened and that no-one knew how it occurred but was reassured that the manager had reported it for outside investigation. Since the bruise had first been noted, two senior staff had attended a safeguarding training course for managers of services run by the local council. The manager felt that this would help senior staff deal with any future issue more promptly as a safeguarding matter if necessary. The manager also told us that plans were in hand to update all safeguarding training for all staff. Staff we spoke to were clear with us that if they believed someone was being treated badly they would report this to a manager of the service or, if they felt it was not being dealt with, to us or social services. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. West Eaton House provides a welcoming and safe place for people to live and people are encouraged to make their rooms personal to them and have their own space and belongings around them in the communal rooms. Parts of the home need refurbishment and more done to make it easier for people to find their way around the home. Evidence: West Eaton House is in a rural setting but within a short drive of Leominster and about half an hour from Hereford city centre. The building has large, pleasant grounds and lovely views over surrounding countryside. It is a two storey building with lift access to the first floor. On both days of our inspection the building was clean and warm. The communal rooms were looking festive with Christmas trees and cards for people to enjoy. The manager told us that when she started work at the home she reorganised the layout of the communal rooms to make a more private and attractive dining area. The arrangement seemed to be working well and people said they liked the space they now had in the dining room. We saw that in the communal rooms people had space around their armchairs to create an area that is theirs, for example, lots of people had a side table next to Care Homes for Older People Page 20 of 30 Evidence: them, some had bags of knitting, some had books and newspapers, others had plants or flowers and one person had the use of an alcove with space for a coffee table and small tv. This is good practice and helps to create a homely, personal atmosphere. Similarly, people are encouraged to make their bedrooms personalised by having belongings in their rooms that are important to them. One person we spoke to said that their room is kept clean and tidy for them and that staff respect that it is their room and knock when they come in. The bedrooms are below 12 square metres, the minimum size for any new rooms provided and as a result have some limitations for the use of equipment. This needs to be taken into account when allocating bedrooms. Some areas of the home looked in need of redecoration as the paint and wallpaper looked tired in places. The manager said that she would like to have the 1970s style dark wood doors painted white to help make the environment look fresher and to lighten the dark corridor areas. The manager also agreed that more needed to be done to help people identify their bedrooms eg by having more attractive and prominent numbers and, if people wished, names, photographs or other means to identify one room from another. She hoped that all of this work would be timetabled and started in the near future and understood that the owners have plans to invest in this work. The laundry was clean, tidy and well organised and we saw evidence of good infection control arrangements including the use of disposable gloves and aprons. The manager told us that bins in bathrooms and toilets had recently been replaced with foot operated models as a further way to reduce the risk of cross infection. There is a small team of domestic staff who do the cleaning in the home and a full time maintenance man who deals with all routine repairs and safety checks in the building. We saw comprehensive records showing that this is done conscientiously and that problems are dealt with promptly. Essential fire safety checks were particularly well recorded but the homes fire risk assessment had not been reviewed or updated and this should be arranged promptly. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training needs to be re-established in a planned and organised way to make sure staff can develop their knowledge and skills. Staffing levels need stability so people will always have enough staff to support them. Evidence: In the AQAA the service confirmed that they have recognised that some aspects of staffing at the home need to be improved. The things that are planned include more staff meetings and staff training and supervision. The service has also identified a need to reduce the amount of staff turnover and to recruit more care staff who have done NVQ training. During our inspection we checked the records of how recent staff were recruited and found that a good process was followed and all the required pre-employment checks were done to help ensure the staff employed were suitable. The manager told us that she is in discussion with head office about ways to make the process more streamlined. Checks to make sure references have been verified as being genuine could be more detailed to provide a better audit trail. In discussion with the manager it became clear that training at the home had fallen behind over the last year and that work was needed to establish where the gaps are and to arrange the training needed. The manager was planning to speak with a local Care Homes for Older People Page 22 of 30 Evidence: training company to arrange for a full training needs analysis to be done to help her with this. Following the inspection the manager sent us a copy of the homes training matrix showing the current training situation. This confirms that up to date training in some crucial topics (both health and safety and care practice related) is needed by a number of nurses and care staff. The staff we met during our inspection impressed us with their attitude towards the people living in the home and in their desire to improve the quality of care the home provides. People we spoke to told us that staff are polite and kind. In one survey a person wrote They are friendly staff. When we did the surveys some people commented on there being too many staff who needed to improve their English language skills. For example a member of staff commented They could employ staff that are able to converse with the residents in their own language and who are more caring. We are having to have more bank nurses due to staff shortages who are not interested in the care, here today gone tomorrow attitude. Maybe if they raised the wages we would get better staff. and a professional wrote Occasional communication problems due to poor English language skills of staff. The manager told us that when she started work at the home there were four vacancies for care staff and that in spite of warnings that it would be hard to recruit, all the posts had been filled. Partly as a result of this, the homes use of agency staff has been reduced to almost nothing and the manager felt this was helping to improve consistency and team work. An experienced member of the care team had just been appointed to a new role involving supporting the care staff team and liaising with the trained nurses about peoples care needs. The manager confirmed that at present the home does not have named liaison nurses for specialist areas such as diabetes, tissue viability and infection control but hopes to get this established in the next few months. When we did the inspection we found a good ratio of overseas and British staff and those from overseas whom we spoke to were able to converse readily in English. This may reflect the recent reduction in the use of agency staff and the recruitment of four new care staff. We were surprised to learn that only four trained nurses are employed at the home, including the manager. We consider this could compromise the requirement for there to be a nurse on duty at the home at all times and/or result in the three nurses having to work long hours to cover all of the day and night shifts. The manager explained that she wants to recruit another trained nurse but has so far had no responses. Alongside this she wants to increase the ratio of care staff on duty and to develop the skill mix of care staff, including having more with NVQ level 3. She believes that this Care Homes for Older People Page 23 of 30 Evidence: will be a positive way to strengthen the overall competence of the staff team and support the trained nurses in their clinical role. In the surveys one or two people commented on staff not having enough time, for example two people told us they have to wait to use the toilet or commode. The managers plans to increase the number of care staff on duty should address this provided that staff are effectively deployed. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that West Eaton House is managed in their best interests and that the owners and manager are taking steps to improve the things that need to be done better. Evidence: The manager of the home had been in post for just over a month when we did our inspection. The previous manager left in the summer and the deputy manager had been in charge during the intervening period. The new manager has not yet sent us her application for registration but confirmed during the inspection that she would do this promptly. The manager has previously been the registered manager of another nursing home and has been qualified as a registered mental nurse for over 20 years. During this inspection the manager showed that she had already identified things that need to be improved at the home and was being proactive in dealing with these. The AQAA gave a realistic view of the strengths and limitations of the service and showed that the owners and manager are willing to be open with us as the regulator. Care Homes for Older People Page 25 of 30 Evidence: The plans listed for improvements throughout the AQAA, if actioned in a timely and effective way will ensure that the service achieves the necessary improvements. Regulation 26 visit reports were available for recent visits to the home by the organisations administrator and showed that the owner has maintained oversight during the prolonged absence of the operations director who has recently left. The manager told us that she had received very good support from the company directors, the administrator and other managers in the group since starting work. She also felt that she had been made very welcome by the staff team at the home. The home does not look after any cash for people at the home. If spending is done on behalf of a person unable to look after their money independently, their family is sent a regular invoice charging for purchases. Whilst this safeguards people from the risk of losing money, it has some limitations because it prevents people being involved in small financial transactions. Some work had begun on introducing meaningful quality assurance measures such as audits of key things like medication management and health and safety in the home. The maintenance man already has well established records of the regular routine tests and checks he does to make sure that the building and equipment is safely maintained. Although the fire safety tests and checks are done regularly, the fire risk assessment had not been updated recently. This needs to be done regularly to make sure it reflects the current situation at the home, including the needs of room occupants in the event of an evacuation being needed. The home is introducing opportunities for people and their families to have a say in how the home runs by sending surveys to them. The manager told us that these will be used to develop action plans so people can see that their views are acted on. In addition, regular meetings are planned for people who live in the home, and for staff. We were also told in the AQAA that the manager will be holding a monthly surgery so people can come and see her if there are things they want to discuss. The owners have told us that they intend to invest substantially in the home to make sure the resources are in place to achieve further improvements. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The statement of purpose should be reviewed so that the type and level of care offered is clear; particularly about the level of dementia related needs the home plans to cater for. When checking if the home can give the right care to someone new about to move in, thought needs to be given to the experience and skill mix of the staff group to make sure that any specialist needs can be catered for. Charts in rooms need to be completed more reliably so that staff have a good record to refer to about when care and attention have been provided each day. Improvements are needed in the recognition, recording and reporting of significant information to help make sure that concerns are always acted on quickly and correctly. Individual written guidance is needed to describe the circumstances when a person should be administered medication prescribed on an as required basis to help staff decide when it should be given. In situations where carers (not the trained nurses) apply creams, they should sign to show they have done this, not Page 28 of 30 2 4 3 7 4 8 5 9 6 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations the nurse on duty. 7 9 It is good practice to record the quantities of medications sent in to hospital with a person, and also, to record what has been sent back on their return; this helps to make sure the home has a complete audit trail of medication. More information is needed in the kitchen about all special dietary needs (ie not just the obvious ones such as diabetic diets) eg for people nutritionally at risk due to weight loss and pressure area damage. Recent safeguarding training for senior staff should be consolidated to make sure that potential safeguarding matters are correctly recognised and referred to the local authority under the multi-agency safeguarding process. The managers thoughts on improving the physical environment to make it more attractive and helpful to people in finding their way about the home need to be developed into a timetabled action plan. This will help to ensure that timely progress is made towards the necessary improvements. It would be good practice to record more information about the checks made to establish that references are genuine. This will help to provide a more robust audit trail of the employment decisions made. The planned training needs analysis should be done as soon as possible and adequate resources made available to address the slippage in staff training during the last year. In order to ensure the home fully complies with fire safety legislation the fire risk assessment for the home needs to be updated regularly. 8 15 9 18 10 19 11 27 12 30 13 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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