Inspection on 29/06/09 for Westbury Court

This is the latest available inspection report for this service, carried out on 29th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westbury Court 21/08/06

Westbury Court 21/11/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westbury Court Westbury Court Gardens Westbury-on-severn Glos GL14 1PD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Wilcox     Date: 2 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Westbury Court Westbury Court Gardens Westbury-on-severn Glos GL14 1PD 01452760429 01452760355 manager.westbury@osjctglos.co.uk 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) : The Orders of St John Care Trust care home 42 Number of places (if applicable): Under 65 Over 65 42 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who may be accommodated is 42. The registered person may provide the following category of service only: Care home providing nursing or personal care - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling into any other category - Code OP Date of last inspection Brief description of the care home Westbury Court is a purpose built care home located in the village of Westbury on Severn, and is approximately 10 miles from the centre of Gloucester. It is registered to provide personal and nursing care for 42 older people, and also has two designated respite accommodation rooms. The home is managed by the Orders of St John Care Trust. A registered general nurse is on duty twenty-four hours a day. All health care services are accessible from community resources, and residents can register with one of the local General Practitioners. The home provides level access throughout, and residents are accommodated on two floors; a staircase and shaft lift provide access to the first floor. Care Homes for Older People Page 4 of 32 Brief description of the care home Accommodation is provided in single rooms, though a small number of rooms have an interconnecting door if wanted for couples. Each room has its own wash hand basin, and three rooms provide en-suite facilities. Bathrooms and toilet areas are numerous and easily accessible, and are spacious and fully equipped to meet the needs of less able residents. Communal areas include a smaller lounge on both floors and a large lounge/dining room and a well appointed garden room on the ground floor. A pleasantly situated garden is at the rear of the home, and is easily accessible to the residents. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI/CQC report is available in the home for anyone to read. The charges for Westbury Court are between 564.96 pounds and 750.07 pounds per week. The home also provides care at the Local Authority rate of funding if applicable. Hairdressing, chiropody, toiletries, magazines and newspapers are charged as extra individual costs. Care Homes for Older People Page 5 of 32 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: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The last Key Inspection of this service was carried out on the 30th July 2007. One Regulatory Inspector carried out this inspection on one full day in June 2009. Care records were inspected, with the care of four residents being closely looked at in particular. The arrangements to manage residents medications were inspected. Care Homes for Older People Page 6 of 32 We met and spoke to a number of residents and visitors in order to gauge their views and experiences of the services and care provided at Westbury Court. Some of the staff were interviewed. Survey forms were also issued to a number of residents, staff and visiting health care professionals to complete and return to us if they wished. Five out of ten residents to whom we sent surveys returned them to us. Each of the four health care professionals and three out of five staff to whom we sent surveys returned them to us. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service, and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place with particular attention to the maintenance and cleanliness. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. What the care home does well: What has improved since the last inspection? A new garden room has replaced the old conservatory. This provides residents with a very pleasant, comfortable and well appointed communal space overlooking the attractive garden. A refurbishment and redecoration programme has continued to progress around the Care Homes for Older People Page 8 of 32 home ensuring that facilities are maintained to a good standard for the residents. An additional care worker has been provided overnight, bringing the total number of staff at night to four. There is an overall improvement to the way in which staff training is monitored and recorded on this occasion. What they could do better: 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 set out 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 32 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 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to good information and a very thorough and comprehensive assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. Evidence: The homes information brochure (Service User Guide), including the Statement of Purpose, was under review at the time of this inspection, with some revisions being made regarding certain rooms and the overall management. All interested parties were provided with a copy of the brochure at the point of their enquiry, and people were welcomed to look around the home and have any questions answered. People were also offered refreshments when they visited. Residents who responded to our survey confirmed that they had received information about the home prior to coming in here to assist them. Care Homes for Older People Page 11 of 32 Evidence: All prospective residents were assessed prior to being given a place at the home. We inspected three examples of pre-admission assessment, each of which was for a resident more recently admitted to the home. Each assessment had been carried out prior to admission being agreed and had been comprehensively and fully recorded on the homes designated tool for the purpose. The assessments had been signed and dated, with the location where it was conducted identified. They also identified if the persons family or representative was present. The assessments took account of their personal details and their past medical history; their health and care needs; their medications; their socialisation and cultural needs; their understanding and legal status. There was also a moving and handling assessment; a pressure sore vulnerability and overall skin assessment; a nutritional and a falls risk assessment. Information and assessments from the placing authority and from other health care professionals previously involved in the persons care were also obtained. Confirmation letters regarding residents admission to the home had been issued. The homes AQAA stated that There are good working relationships with all referral agencies and the manager ensures that good documentation is made available regarding care needs. Visiting health care professionals told us that the home made accurate assessments of peoples needs. Westbury Court does not provide intermediate care. Care Homes for Older People Page 12 of 32 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 in this home have their health and personal care needs met through good care delivery that is mindful of their privacy and dignity, and through a generally safe system for administering their medications, although there is a small degree of risk with storage and timings of medications which must be considered. Evidence: Residents had their own care plan that had been drafted on the basis of a detailed assessment of all their health and personal needs. Where it had not been possible to devise it in direct consultation with them staff had recorded that it had been done in their best interests, with their next of kin signing to acknowledge their involvement. Four care plans were selected for case tracking. Each was written in a detailed way, providing some good guidance for staff. However parts of the plans were in a standardised format with only minor amendments that were relevant to the particular resident. Care plans were not all as person-centred as they should have been. We were told that this was an area the home was working on, with additional training for Care Homes for Older People Page 13 of 32 Evidence: staff, so that much more person-centred care could be planned and recorded. Despite this shortfall in documented care the standard of care that we witnessed in practice was person-centred, with due account taken of individuals particular wishes, health and needs. Recorded risk assessments in each case included pressure sore vulnerability, falls, nutrition, and moving and handling. Where other risks existed, such as with personal safety and mental health issues for example, these too had been taken fully into account. Regular checks were made on residents weights, and there were some excellent monitoring and support arrangements in place to address particular nutritional risks and needs. Appropriate measures were in place for those who were at risk of falling. The AQAA stated that the home had good links with the local dentist, community nurses, and local opticians, and that the continence advisor, dietician, tissue viability nurse, and a chiropodist visited regularly. All the residents that we saw appeared well cared for, and those requiring a higher level of help had been supported to remain clean and well groomed. Residents we spoke to directly confirmed that they were satisfied with their care and the way in which they were looked after, with most saying that the staff were very kind and helpful. Those residents who we considered more closely as part of the case tracking, were receiving the care as it was recorded in their care plan, with appropriate support equipment, monitoring and recording charts, nutritional supplements and treatments in place. Residents who responded to our survey told us that they received the care, support and medical attention they needed. One particular resident told us that they were always helped to keep clean, and that they had a good room, comfortable bed and excellent food; everything was first class. A member of staff told us that the home had plenty of access to the multi disciplinary team to care for residents special needs. Visiting health care professionals told us that residents care needs were appropriately monitored and catered for, and that the home sought to improve peoples wellbeing. They also confirmed that the staff showed respect for residents privacy and dignity, and were responsive to diverse needs. One visiting General Practitioner (GP) told us that the home had excellent nursing staff. Care Homes for Older People Page 14 of 32 Evidence: Residents were enabled to manage their own medications if they wished and were able, but there was only one person currently doing it. This was being done within a risk management framework and there was secure storage provided for them. Medications were generally stored safely, with portable trolleys, wall mounted metal cupboards, and a secure medication refrigerator for those medications requiring cold storage. However it was an unusually hot day on the day of this inspection and the temperature in the main storage area was recorded as 28.5 degrees Centigrade, which was in excess of the required safe storage temperature for most medications. All medications were dispensed from the local GP surgerys pharmacy and were all in boxes. This meant that there were large amounts of necessary stocks in each medication trolley which, although reasonably segregated and tidy, appeared slightly overwhelming to consider as part of auditing or administration rounds. One of the nurses told us that it can take up to two and a half hours to do a medication round, which could affect the proper timings of certain medication administrations to residents. However boxes were clearly labelled and were dated on opening. Random audits on three such items were exact, showing that they had been given in accordance with prescribed instructions, indicating that the system was being well managed. The medication administration charts had been handwritten by staff, with two signatures to witness the entries. These were clear and gave precise instructions for medication usage. There were corresponding care plans for the use of analgesia and topical creams. There were a number of entries showing persistent refusals or valid omissions with certain residents and their medications. Where this had raised any concern it had been discussed with the GP. However there were some medications that needed a review by the GP as the instructions for usage seemed no longer to be appropriate. The Controlled Drug store cupboard was fixed securely, and a bound Controlled Drug register was maintained. There were remaining stocks of Controlled Drugs for two recently deceased residents. Staff were recording regular safety checks on these stocks until disposal took place. However in one case, although the stock balance was correct on audit, one of the nurses had incorrectly entered the amount remaining on the previous day. The manager agreed to follow this up with the nurse concerned. Although the majority of care was delivered in the privacy of residents rooms we observed that the staff on duty on the day of our visit were very respectful towards residents privacy and dignity. Staff were witnessed being attentive and sensitive. Care Homes for Older People Page 15 of 32 Evidence: Residents themselves confirmed to us that staff were polite and respectful, and that they knocked on their door before entering. We did not see specifically written plans of care to address any end of life care. In one case the home had endeavoured to explore this with the resident and family, but they had not wanted to discuss it; this had been respected by the home at this stage. Early assessments directed staff towards obtaining information about advanced wishes in this area, but these were not consistently completed. We were told that the Trust was currently working towards introducing advanced care planning and end of life care plans throughout the care homes in the group, which included Westbury Court. The manager appeared very sensitive to peoples needs in this area, including residents and their families. Care Homes for Older People Page 16 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have good opportunities to remain as socially active as they are able and choose, and also have a highly nutritious diet that offers choice and variety. Evidence: A member of staff told us that the home was committed to providing a varied programme of activities for different levels of cognition. The home had a designated social activities coordinator who was enthusiastic, creative and considerate to the social needs of the residents. Displays of eye-catching notices of organised events around the home and of photographic records of activities and events showed a good range of social opportunities for the residents, which suited a variety of needs and interests. There were planned trips out, group and individual activities, and entertainments. The home endeavoured to maintain links within the community for the residents. The local parish magazine was in the home, and residents who wished were supported to attend the local church services. An attractive monthly newsletter was produced in the home to help keep residents informed in this Care Homes for Older People Page 17 of 32 Evidence: area, and to seek their views and ideas for preferred activities and outings. The coordinator had been designated as the homes Dementia Care Champion, and work had begun on consulting with residents and their families in order to compile meaningful and useful life histories for them. However, this was very much in the early stages of development, with only minimal progress achieved so far. There was a large screen, wall mounted television in the main lounge, and some people read newspapers or watched television or listened to radio in their own room. One resident said that she preferred to spend time alone in her room, as this was the habit of a lifetime, enjoying as much independence and privacy as possible. She listened to Compact Disc recordings of her choice from the Articles for the Blind Association, as she was partially sighted. Another resident told us that she had had a stroke but that the strength and ability in her arms had improved by joining in with the music and movement exercise sessions. A visiting relative told us that the home always welcomed visitors. Another told us that they were always made to feel welcome here and were happy with the care and attention their relative received in the home. Residents confirmed to us that the home arranged social activities that they could join in with. A visiting health care professional who responded to our survey said that there was plenty going in the home for people to do if they wished, and said that Residents seemed to them to be well looked after and happy. They confirmed that residents were supported to live their life the way that they might choose. Residents told us that they felt able to choose what they did, with some saying that if they wanted a lie-in or to go to bed early or late they could. One particular resident told us about the high level of control and autonomy that she retained over her life and affairs. The home had provided a variety of useful information for people. Examples of this were Department of Health leaflets, Advocacy services, and the latest heatwave information. Cooling fans and plenty of cold drinks were readily available and in use. Most of the residents bedrooms appeared personalised as they had introduced many items of personal belongings, pictures and treasures. Residents had a good choice of food at all mealtimes. We observed service of the breakfast and lunch time meal. These both offered good portion sizes and wholesome, nutritious and nicely presented food. A heavily laden sweet trolley went round to Care Homes for Older People Page 18 of 32 Evidence: residents after their main meal and this offered an extensive range of desserts for them. The mealtimes were taken in calm and unrushed circumstances and staff were polite and offering choice and help throughout. Special diets were very well catered for with foods fortified where necessary. The cook was well informed in this area and was very involved in helping to manage nutritional risks and dietary needs for individuals. The kitchen was busy but well organised. The necessary catering records were being maintained. The Environmental Health Department had carried out an inspection of the kitchen just prior to our visit. This had raised a small number of issues for the home to address and this was reportedly in hand. Residents told us that they liked the food. One resident told us that the food was very nice but that there was a bit too much mashed potato on the menu. Care Homes for Older People Page 19 of 32 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 living in this home can be reassured by the homes complaints procedures and the policies regarding the prevention of abuse. Evidence: The home had a clear complaints policy and procedure, which was displayed in the entrance hall, and which was included in the information brochure issued to each resident. Despite this, two residents told us that they did not know how to make a complaint; others confirmed that they did. One resident told us Theres always someone to talk to though. Residents confirmed to us that staff listened to what they said and acted upon it. One resident told us that they had had cause to raise a concern on a previous occasion and that it had been addressed straight away and has since been satisfactorily resolved. Visiting health care professionals indicated in their surveys that the home always responded appropriately if any concerns were raised. A register of complaints was maintained, but this contained just one incident that had been investigated, about which CQC had been kept informed at the time. The AQAA stated that the home had an open door policy, and looked on complaints as a useful tool in getting to know clients needs and choices. Care Homes for Older People Page 20 of 32 Evidence: The home had clear policies and procedures for safeguarding the interests, wellbeing and safety of the residents. Safeguarding training had been provided for the staff, which had included recognition and prevention of abuse, whistle blowing procedures, and the Mental Capacity Act 2005 (MCA). Staff we spoke to had a good understanding of abuse and safeguarding issues, although at least two carers needed some prompting over the outside agencies that would become involved in such cases. We were assured that the training content had included this information. There was a good amount of information available to staff in the home in relation to the legislation and the local safeguarding protocols. In recent weeks there had been an incident of concern in relation to an aspect of a staff members medication practice, for which the homes disciplinary procedures were instigated appropriately. A resident told us about some allegedly inappropriate practice by a night carer towards them personally, which we referred to the manager to address. One relative told us that the home provided a caring and happy environment, in which her mother felt safe. Care Homes for Older People Page 21 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although most of the bedrooms are smaller in size, people living in this home are provided with accommodation that is suitable and safe to meet their needs. Evidence: A regular maintenance person was employed, and the home had access to the Trusts County Surveyor and a dedicated property team. The home was well maintained. The majority of the bedrooms were smaller in size, and did not have en-suite facilities. Some had been refurbished as they had become vacant, and a ground floor bathroom had also been refurbished. The conservatory had been replaced with a very well appointed garden room. Improved ceiling lighting had been provided in the downstairs corridors. Additional profiling beds had been provided in residents bedrooms, and a programme to fit double glazing to the windows had been completed. A small number of wheelchairs and a lifting hoist had been temporarily parked in the small ground floor lounge during the morning, which detracted from the otherwise homely feel of the room. When we asked the manager about this we were told that this was not routinely permitted, and that she would ensure that they were removed for the comfort of the residents. Care Homes for Older People Page 22 of 32 Evidence: The home was very clean and hygienic throughout. All grades of clinical waste were correctly managed. There were good supplies of liquid soaps, paper towels, gloves and aprons for staff to use as part of the infection control procedures. Staff had received training in Infection Control. The laundry room was well organised, with items appropriately segregated, and washed in accordance with infection control measures. One resident commented that the home was always fresh and clean. A visitor commented that The home is always bright and clean, and is almost always free of unpleasant smells. Care Homes for Older People Page 23 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home receive care from a competent and safely recruited work force. Evidence: Staff rotas were maintained, and there were generally consistent levels of staff each day. One qualified nurse was on duty throughout the twenty-four hour period, and there were seven and five carers for the morning and afternoon shifts respectively. An additional care assistant had been employed at night making a total of three carers on duty with the nurse. A member of staff who responded to our survey raised some concern over the agency nursing staff that the home had had to use, as recruitment of nurses had proven difficult. This person felt that this could lead to poor continuity of care. Another was keen to point out that there were times when they thought that more effort should be made towards ensuring full staff cover when there is absenteeism and sickness. When we discussed this with the manager we were assured that all efforts were made, but that there were occasionally times when late absenteeism could not be covered despite peoples best efforts. The home was facing challenges with recruiting registered nurses to fill the vacancy Care Homes for Older People Page 24 of 32 Evidence: created by one of the regular nurses being appointed to the deputy manager position. There were a number of options becoming available to the manager to address this, and she was hopeful that this would soon be resolved. Agency nurses had been used on a regular basis, although a degree of consistency had been achieved with this. We spoke to one of the agency nurses, and she told us that she had been attending Westbury Court regularly and knew the home and residents well. There was a good team of ancillary workers, which included catering, cleaning, laundry, maintenance, and administrative people. Staff were busy throughout our time in the home, with residents needs appearing to be met in timely ways. The call bell was heard to ring for longer periods in the afternoon. Staff appeared discreet, attentive and professional at all times. Residents spoke positively about them. One person told us that staff were very nice but there were odd times that the home appeared a bit short of them. One resident wrote in their survey response, I believe the staff are attentive at all times; they are exceptional. A visitor told us that the staff were exceptionally caring and understanding. Visiting health care professionals indicated in their surveys that the manager and staff were trained and skilled for their roles in their experience. There was an expectation that care staff started a National Vocational Qualification (NVQ) in Care, and there was a high number of carers qualifed in this area. There were currently eighteen care staff qualified to a level 2 standard and two to a level 3. We inspected recruitment files for two more recently appointed care and nursing staff. Application forms provided a full and detailed employment history. Two references, one of which was from the previous employer had been obtained, and proof of identity had been confirmed. Verification of why the worker had left their last place of work had been sought when applying for references. The correct Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks had been carried out, although in one case the full CRB disclosure had not yet been returned; this person was working under supervision whilst awaiting its return. Medical fitness and proof of qualifications had been confirmed. Equal opportunities monitoring was being carried out, and offer letters and terms and conditions of employment had been issued. The homes AQAA stated that A high standard of training was provided to staff inhouse and at county level. Staff confirmed that there were good induction and training arrangements in the home. One member of staff told us that the Trust was very good at providing training, and that they had found the Trusts training manager inspirational. Care Homes for Older People Page 25 of 32 Evidence: There was a designated training coordinator, and training schedules were being monitored and delivered more consistently on this occasion. There were well kept training records. Individual training files had been set up for the staff that contained evidence of their certificated achievements. New staff were going through the computer based training introduction to the Trust, and to the next level of training, which was to be the six modules of the Common Induction Standards for Care Workers. New staff were placed to work alongside a care leader and did not have unsupervised access to residents. All worked supernumerary for the first two weeks of their employment. Staff had an Induction Passport. This contained instruction on the homes ethos and management structure, the in-house induction programme, the computer based learning and the lists of mandatory learning courses. The home had a collection of training materials in a DVD format, which staff could watch and then discuss and answer questions about as part of assessing their understanding of what they had seen and heard. Topics included Infection Control, Health and Safety, Abuse, Nutrition, Food Hygiene, and Manual Handling. Manual Handling training was delivered in theory and practice by the homes designated trainer for this area. Dementia care training had been delivered by the Alzheimers Society. Care Homes for Older People Page 26 of 32 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. The management systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. Evidence: Since the last inspection and review of this service there has been a change of manager, with the previously registered person leaving and the previous deputy manager being appointed to the role. An application to register her with CQC is currently being processed. Throughout our inspection of the home the manager was helpful and cooperative with the process. She was evidently very committed to the welfare of the residents, and was very involved in the life of the home in all aspects. A visiting health care professional told us that it was always a pleasure to walk into Westbury Court and that they enjoyed a very good working arrangement with them. The AQAA submitted to CQC in advance of this inspection was completed to a good Care Homes for Older People Page 27 of 32 Evidence: standard. An annual quality assurance survey had been carried out in order to obtain the views of the service from residents and their relatives. The results of this were collated and were used to assist in identifying areas for improvement and setting objectives for the home for the following year. Six monthly reviews were also carried out with residents, and a member of their family if they wished, as another method of ensuring that residents could influence their care and any changes and improvements in the home. Regular residents meetings had been held. A range of internal quality auditing was being regularly carried out and external assessors had also successfully assessed the homes standards for the ISO quality award. The AQAA stated that the home was striving to become a centre of excellence. Individual care plans for residents regarding their mental capacity and decision making processes, including a best interests assessment were being planned, although these had not yet been commenced. Only one member of the senior staff team had received training in the Deprivation of Liberty Safeguards (DoLS) with the County Council at this particular time. Some residents had chosen to place personal money in the homes main safe for safekeeping. Records were maintained in each individual case, which contained evidence of running balances and transactions. Receipts were attached to account for any financial transaction carried out by staff on the residents behalf, and two members of staff signed records in the absence of a resident being able to sign for themself. A regular check on the accuracy of each arrangement had been recorded. Staff told us that they had regular opportunities to meet and have support from their manager. A staff supervision matrix showed that staff received a twice yearly appraisal, and had at least four other formal supervision sessions in a twelve month period. The matrix showed isolated gaps in achieving this but in general staff received good levels of supervision. The home had written policies and procedures to promote the health and safety of the residents, visitors and staff, and associated training was provided for staff. Records showed us that regular safety checks and planned maintenance visits had been carried out on the fire safety systems. The fire risk assessment had been reviewed; there were some issues within it that the home had identified, and was taking steps to rectify. Residents had an individual fire safety risk assessment in their care plan. Care Homes for Older People Page 28 of 32 Evidence: Fire safety training had been delivered to all staff and this had incorporated theory and practical training, with instruction in evacuation procedures in the event of a fire. There was a record of one fire drill during this year so far. The frequency of this should be reviewed to ensure that fire drill training is encompassing all staff. Hot water temperatures were being monitored for safe levels, and regular Legionella checks on the water supply had also been carried out with appropriate control measures in place. Timely safety checks and maintenance had been carried out on utilities and equipment. First aid facilities were available and staff had received First Aid training from an accredited training provider. Clearly recorded accident records were kept. The home was secure and there were coded door entries to higher risk areas. Care Homes for Older People Page 29 of 32 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 30 of 32 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 1 9 13 The registered person must ensure that medications are managed safely, and that there is a review of medication storage arrangements and administration times. This is to ensure that all medications are stored at the correct temperature and that residents can receive them at the most appropriate times. 31/08/2009 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 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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