Inspection on 14/02/07 for Chestnut House Care Home

This inspection was carried out on 14th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Chestnut House Care Home 04/09/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Westwood Residential Home 69 Crumpsall Lane Crumpsall Manchester M8 5SR Lead Inspector John Oliver Unannounced Inspection 14th February 2007 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westwood Residential Home Address 69 Crumpsall Lane Crumpsall Manchester M8 5SR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 721 4949 Beech House Care Homes Limited Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of 19 people aged 65 or over (OP) who require personal care only by reason of old age. Date of last inspection Brief Description of the Service: Westwood has recently changed names and, in future, will be known as Chestnut House Care Home. Chestnut House is a care home providing personal care and accommodation for up to 19 older people and is owned by Beech House Care Homes Limited. No nursing care is provided. The home is situated in the Crumpsall area of Manchester. It is close to local shop and bus routes. However, local shops are not easily reached by residents, as a busy main road has to be crossed in order to access them. The home is a three storey building set within its own grounds. The garden is well maintained and easily accessible. Off road parking is available at the front of the building. There are 15 single bedrooms and 2 shared bedrooms. The rooms are not ensuite, however there are adequate toilet and bathing facilities available. There is a passenger lift to enable access to the first floor. The owners use the third floor as private accommodation. At the time of the inspection site visit, weekly fees averaged £373:54 and additional charges are made for hairdressing, private chiropody, newspapers, dry cleaning, some activities and the use of the telephone. Cost of transport such as private hire vehicles is not included in the weekly fee. Some charges may be made for escorting residents to ‘private’ appointments but this is by arrangement with the management of the home. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There have been recent changes in the ownership and management of the home. In August 2006, Beech House Care Homes Limited, owned by Mr R Gupta purchased the home. There was an ‘acting’ manager in post at that time who has since left. At the time of this site visit a new manager was in post that confirmed that an application would be made to the Commission for Social Care Inspection for registration. At the inspection visit in May 2006, there were many things which needed putting right in order to improve the quality of the service for the residents living at the home. When the new owner took over the home in August 2006 it was confirmed that many of these things needing doing had been carried out. This unannounced inspection site visit took place over one and a half days and involved gathering lots of information about how well the home was meeting the National Minimum Standards. This included the manager filling in a questionnaire about the home, which gave information about the residents, the staff and the building. Questionnaires about the service were sent to the home prior to the site visit but none were returned to the Commission. During the visit, lots of information about the way the home was run was gathered and time was taken talking with the residents, the manager, the owner and the staff team about the day-to-day care and what living in the home was like for the residents. Other information was also used to produce this report. This included information held by the Commission about any events that had taken place in the home that may have affected residents. What the service does well: The home had a group of staff that had worked at the home for varying lengths of time and residents spoken with like the present staff team, including the new owner and manager. Comments included “We get well looked after”, “all staff are good but one is really good – she’s my favourite”, “I get my medication on time” and, “food has improved”. One relative spoken to also felt that the care was good and comments included “I am very happy with the home now”, “my mum is well looked after” and, “she has everything she needs”. It was obvious when watching staff talking to and looking after residents and from the way that residents responded to the staff that the residents were well looked after and respected and that in the main, their privacy and dignity was maintained. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 6 The home was good at making sure residents,’ health was maintained and looked after. This was done by sending for district nurses and other health care professionals whenever they were needed. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information provided to residents to assist them in making a decision about the home and about the facilities offered need further reviewing to ensure that the information contained is accurate. Residents were fully assessed before coming to live in the home. EVIDENCE: A recent review of the Statement of Purpose and Service User Guide by the new owner had been carried out. However, some of the information was inaccurate and needed further reviewing. One example being “Chestnut House has been operating since 2000” which is not the case. A copy of the previous Statement of Purpose and Service User Guide was seen in residents’ bedrooms during a tour of the home. Again, information in these Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 9 documents was now out of date and all residents should be furnished with an updated copy. The file of the most recently admitted resident was examined and was found to contain a full care management assessment as well as one that had been carried out by the manager of the home. This resident had difficulty in remembering the pre-admission assessment process although further evidence was available on their file to show that a Speech and Language therapist had also carried out an assessment of need prior to admission. Discussion with the manager confirmed that she was aware that should a privately funded resident want to come and live in Chestnut House, she would need to carry out an assessment prior to any admission into the home taking place. It is recommended that the home confirms, in writing, following appraisal of all pre-admission information, that the prospective residents’ needs can/cannot be met. The manager confirmed that the home did not offer an Intermediate care service. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home supports people to maintain their personal and healthcare in the way they prefer. However, improvements in the safe management of medication is needed. EVIDENCE: Two people’s files and information relating to them were examined. Both files contained a good deal of information relating to the person, including background information that informs staff of things that are particularly important to the individual. Risk assessments were in place where risks had been identified i.e. continence, falls, nutrition and moving and handling. However, this information was inconsistent and not included on all files seen, although the acting manager had already identified this as a shortfall and said that she would be addressing the issue. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 11 The resident and/or their representative had not signed the care plans or related documentation. It is important that this is done wherever possible to clearly demonstrate that the resident has fully participated in the development of their care package. At the time of this site visit the acting manager was in the process of reviewing the files of the individual residents. Evidence was available to demonstrate that care plans and risk assessments were being reviewed and updated. Care plans had been developed to meet specific needs and to inform staff how best they could support the resident to meet those needs. At the time of the visit the manager confirmed that no resident was suffering from pressure sores. Community Nursing Care Plans were seen in place for a number of residents with evidence that those residents who may be prone to developing pressure areas were monitored. Health care needs were well recorded and care plans addressed continence, oral care, toileting, mobility, foot care, personal hygiene (bathing) and sight and hearing. On the day of the site visit a number of healthcare professionals visited the home to see various residents. This demonstrated that the home ensured that the overall health of the individual resident was being appropriately maintained. One resident spoken to said, “we get well looked after”. Further discussion took place with one of the senior carers about the care planning practice in the home. Comments from this member of staff included, “care plans are being looked at and improved and residents are getting a better (quality of) life because of this”. A number of staff, including the acting manager had recently attended training given by an assessor from Wythenshawe hospital regarding Nutritional screening of residents. Following this training, the new MUST tool (Malnutrition Universal Screening Tool) was being put into place and will be used for all new residents. This now needs using for any resident assessed at high nutritional risk. Only senior staff in the home had responsibility for administering medication and evidence was available to show that they had recently received medication training from an external agency. The acting manager confirmed that no resident was self-medicating at the time of this site visit. The Medication Administration Records (MAR) file was examined and staff specimen signatures had been recorded. No gaps were apparent in the signatures of medication administered to residents and each MAR had a photograph of the resident on the front to help staff to clearly identify each resident. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 12 The MAR for one resident was randomly selected to be checked. This particular resident had been prescribed an antibiotic and 28 tablets were received and commenced on 17/02/07 – one tablet to be taken four times a day. A ‘spot check’ of this medication demonstrated that ten tablets should have been administered – leaving 18 in the bottle. 22 tablets were found still to be in the bottle. This clearly demonstrated that some staff had signed and had not given this medication. Such omissions could place the residents’ health at risk. Medication was stored in a locked ‘medication room’. This room also served as a ‘treatment room’ for district nurses to use and appropriate hand washing facilities were available. An appropriate medication refrigerator was available for the storage of any medication that may need to be kept at specific temperatures. An appropriate medication trolley was used to take medication to residents. This trolley was ‘anchored’ to the wall in the dining room and then taken to the medication room when administration was completed. The balances of medication to be given ‘as and when required’ such as Paracetamol were difficult to check. Where this type of medication indicated one or two tablets to be given, no indication was made of how many tablets had been administered at any one time. No remaining balance was recorded. This meant that an accurate ‘audit trail’ of such medication could not be maintained. This could place residents at risk from errors occurring in the administration of such medication. Prescriptions were collected directly from the surgery by the pharmacy. It is important that the management of the home are aware of all medication that is prescribed to each resident and it is therefore recommended that all prescriptions are seen and checked by the management of the home prior to being sent for dispensing by the pharmacy. One resident who is diabetic was asked about their medication. This resident said “I am a tablet controlled diabetic and I get my medication on time and when I should”. Observation of staff interacting with residents throughout the visit demonstrated that the privacy and dignity of residents was respected. Privacy locks were available on all toilets and bathroom doors and, each bedroom had a lock that could be overridden in an emergency situation. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and activities and to maintain contact with their relatives. EVIDENCE: Since the inspection carried out in May 2006 further work had been done to develop activities and stimulation for the residents and this had greatly improved. Although the activity programme was still very limited, an activity book was being used to record both individual and group daily activities. Two staff had been identified to be involved in leading activities in the home and, at the time of this visit, the activity programme was under review. From the entries recorded, it was demonstrated that more one to one activities were taking place and there was evidence that individual residents had been supported to go shopping and visit the local community. Residents’ spoken to say they were satisfied with what was being offered. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 14 Discussion with the acting manager confirmed that no restrictions were placed on visitors to the home and examination of the visitors book clearly demonstrated that visits to the home by relatives/friends was fairly frequent. One visitor spoken to during this visit offered the following comment, “I am very happy with the home now”, “mum is well looked after”, “and she has everything she needs”. Feedback from residents’ spoken to was generally positive about the food served in the home. Menus were planned over a four weekly cycle and a main meal was observed being served during the visit. This meal consisted of beef casserole, mashed potatoes and various fresh vegetables. This meal looked appetising and was nicely presented. Discussion with the cook confirmed that although no resident was having anything different, choice was offered. The cook said that she informed residents on a daily basis what was on the menu for the day and that alternative choices were offered. Evidence was available (daily record) to show that this was done and residents spoken to confirmed this. Specialist diets could be provided for and the cook confirmed that any medical information regarding an individual resident and menu planning are made known to her. She was able to demonstrate this via the menu planning for those diabetic residents who live in the home. Food stocks were plentiful and appropriate records were kept of ‘fridge and freezer temperatures. Since the last visit to the home the following new equipment had been provided in the kitchen: * * * * Double range gas cooker. New freezer New fly screens New crockery A recent visit by an Environmental Health Officer did not raise any specific concerns but did offer advice on some available training – “making food safely” which, both the cook and acting manager attended. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An effective complaints system was in place and adult protection training had improved since the last inspection visit helping to further protect residents from abuse. EVIDENCE: A complaints procedure was in place, which was displayed throughout the home. Although this document contained all the relevant information, it is written in a very ‘formal’ manner and uses some terminology that could be difficult to understand in relation to making a complaint i.e. “The complaints manager will be the named person who deals with the complaint throughout the process” however, the home does not have a ‘complaints manager’. The home had a complaints ‘log’ but on examination was found to be insufficient in detail to accurately record any complaints that may be made. This was demonstrated by one complaint that had been logged as “…. complained he was cold in his room”. There was no indication of who had dealt with the complaint, any investigation that may have taken place or whether the complaint/concern had been satisfactorily dealt with. (Discussion with the named resident confirmed that it was dealt with appropriately). Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 16 The Commission for Social Care Inspection (CSCI) had not undertaken any complaint investigations since the last inspection visit in May 2006. One resident spoken with was very clear that they could speak to any staff about problems and that they would be listened to or that they would “go to the manager or senior carer”. One senior carer was asked whom she would go to if she had any complaints or concerns and was very clear of the procedure to adopt. No Protection of Vulnerable Adult (POVA) investigations had taken place since the last inspection visit in May 2006. All staff had attended POVA training with an external trainer and discussion with the acting manager demonstrated that she was very clear about what action would be taken in the event of any allegation of abuse being made. Further discussion with one of the senior carers confirmed that she and all the other staff had received training in POVA and was aware of what action to take in the event of any allegation of abuse being made. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In the main the standard of cleanliness and improvements made to the home demonstrated the new owners commitment to improving the environment for the residents. EVIDENCE: The new owners took over the management of the home in August 2006 and evidence was available to demonstrate that he had prioritised work regarding a refurbishment programme for the home. A written maintenance and renewal programme was available for examination on request. A maintenance book was in operation and was used to identify any jobs that needed to be done. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 18 On the day of the site visit the ‘general assistant’ who is employed in the home to carry out repairs and maintenance was in the process of completing the redecoration and repainting of the main hallway to the home. During a limited tour of the premises with the owner it was noted that a number of bedrooms and corridors had been repainted and redecorated. A new bed had been provided in one of the bedrooms seen and this made it easier for staff to use the hoist when assisting this particular resident. The bath in the bathroom/shower room near room 2 needed replacement. A chair hoist was used to support residents into the bath. However, this bath was plastic and had been repaired twice with filler where the chair hoist had damaged it. This bath must be replaced for the comfort and safety of those residents using it. A requirement has been made under Health & Safety in standard 38. Also, the tiles in the shower cubicle in this bathroom must be repaired and replaced where cracked and missing. A requirement has been made under Health & Safety in standard 38. The floor covering in two bedrooms needed replacing because of the strong odour of urine and the owner confirmed that this was on the plan of refurbishment and renewal. The hot water was tested in 2 bedrooms and the bathroom and found to be of a satisfactory temperature. The main lounge was comfortably furnished and had seating of various styles and height. However, a number of chairs were suffering from ‘wear and tear’ and should be considered for replacement sooner rather than later. The carpet in this area was also badly stained and parts of the lounge smelled of urine. It is strongly recommended that this carpet be deep cleaned or replaced. Infection control policies/procedures were in place. Liquid soap and paper towels were supplied in those toilets and bathrooms seen. The laundry room in the home is quite small and storage space was very limited. On the day of the visit this room was found to be quite ‘cluttered’ and untidy. Although a sink was available for staff to wash their hands after handling laundry and soiled linen no liquid soap or paper towels were available. This demonstrated that staff were not washing their hands before leaving the laundry which could therefore place residents at risk. It is strongly recommended that anti-bacterial handwash and paper towels are made available in the laundry area at all times. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 19 Although 7 members of the staff team completed infection control training in June 2006 it is recommended that this training be re-arranged for all staff to attend. The vinyl flooring was split and could become a tripping hazard and must be appropriately repaired/replaced. A requirement has been made under Health & Safety in standard 38. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels in the home were meeting the needs of the residents and relevant training was being provided. EVIDENCE: There were sufficient care staff on the rota to ensure that the residents’ health and personal care needs could be met. Feedback from residents, relatives and the staff team indicated that it was generally felt that enough staff were employed in the home. Observation of staff during this inspection visit demonstrated that staff were available in those areas used by residents, especially in the main lounge area. Comments from staff spoken to during this visit included, “we always have enough staff on duty” and, “someone covers if someone is off sick”. Rotas seen during the visit demonstrated that no ‘overlap’ of time between night/day staff was available to carry out a handover of information. The acting manager said that most staff arrived early for their duty and are willing to carry out a handover during this time and evidence of this was seen in the Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 21 ‘handover record’ used. It is recommended that consideration be given to identifying ‘handover time’ when next reviewing the staffing rotas. Policies and procedures were in place for the recruitment and selection of staff. The files of two recently recruited members of staff were checked and were found to be in order. Although an induction programme was in place for one of these members of staff it had not been fully completed and it was difficult to ascertain which parts of the induction had been carried out. It is recommended that the acting manager makes sure that all staff undertaking Skills for Care training does so within 12 weeks of employment, which should include all the mandatory training. A training matrix had been developed that identified all training that was being planned for the following 12 months. Staff each had an individual training file that clearly identified what training they had participated in. The file of one member of staff was randomly selected and contained evidence that the following training had been completed: * * * * Basic Food Hygiene Medication Protection of Vulnerable Adults Nutritional Screening It was also confirmed that Moving and Handling training took place on 25/01/07 and that 8 members of the care staff team attended. Evidence was available to show that another training session in this subject had been arranged for 17/04/07 for the remaining members of the care staff team to attend. Generally, opportunities for staff to undertake training had greatly improved since the last inspection visit and staff spoken to confirm this. Comments included, “the manager is really good and very supportive”, “encouraged me to do NVQ Level 2”, “we get supervision and training”. The acting manager confirmed that 5 members of care staff had achieved National Vocational Qualification (NVQ) level II and that a further 5 were registered and awaiting commencing this training. Staff felt that teamwork had improved in the home and that practice had improved because of the support and input of the new acting manager and new owner. Residents’ spoken to during the visit were complimentary about the staff team in the home. Throughout the inspection staff were observed spending time with the residents either chatting, sitting quietly with them or interacting with some gentle exercise routines. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The owner and acting manager are experienced and had a clear understanding of where further improvements were needed in order to benefit residents. EVIDENCE: The acting manager had been in post for a number of months and had made significant improvements in the way in which the home was managed and in the way that care services were delivered to the residents. However, an application must be made to the Commission for Social Care Inspection for the registration of a manager for the home. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 23 At the time of this site visit the acting manager was in the process of reviewing and updating the individual files and care planning information for each resident and care staff were being encouraged to participate in this process to further develop their knowledge and skills in record keeping. Regular staff supervision and training was now part of the management routine of the home and this was confirmed as taking place by those staff spoken to during the visit. The acting manager was continually encouraging senior staff to be more involved in the day-to-day management issues of the home and comments from senior staff included: * * * * * * “All paperwork in the home is now in order” “The manager is really good and supportive” “Encouraged me to do NVQ level II” “She (the manager) is always encouraging everyone to do their best” “We get supervision and training” “There has been a very big improvement (in the home) under the new owners and manager”. There was no quality assurance policy in place and discussion with the acting manager confirmed that although no ‘formal’ quality audit process was used, some quality audit tools had been developed. A number of questionnaires were available to seek the views and opinions of residents living in the home although these had not yet been distributed. It is recommended that such questionnaires be further developed to include seeking the views and opinions of the service offered by the home from other interested parties such as healthcare professionals/relatives/GP’s etc. The results provided by returned questionnaires could then be analysed to produce an on-going development plan for the home and the results should also be published in the Service User Guide. A satisfactory system was in place to monitor income and expenditure of residents’ finances. This included an on-going record for each individual resident with receipts being retained for any expenditure made. The pre-inspection questionnaire and further discussion with the acting manager confirmed that all maintenance records were in order and up to date. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 24 Random sampling was undertaken of the fire alarm test record, Gas Safety certificate and the Environmental Health Officer’s report. A requirement has been made in this section of the report under Health & Safety regarding the bath, tiling and vinyl flooring identified in standard 19. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13 (4)(b)(c) Requirement All residents in the home must be assessed to identify any risks to their health and wellbeing. Such information must be included in the residents’ care plan and be readily available to staff to ensure that any risks identified are minimised and appropriately managed. Medication must be signed for immediately after administration to the individual resident, to ensure that resident’s receive the correct levels of medication at the correct time. When medication is given ‘as and when required’ a clear audit trail must be available to show how much medication was administered at any one time and how much medication is left at any one time An application must be made to the Commission for Social Care Inspection to register a suitable person as manager of the home. The ‘repaired’ bath identified to the owner must be replaced for DS0000067980.V329718.R01.S.doc Timescale for action 25/05/07 2 OP9 13 (2) 28/02/07 3 OP31 8 27/04/07 4 OP38 13 (4) (c) 29/06/07 Westwood Residential Home Version 5.2 Page 27 5 OP38 13 (4) (c) 6 OP38 13 (4) (a) (b) (c) the risk this presents to residents using this bath. The wall tiles in the shower area where broken and missing must be replaced for the risk this presents to residents using the shower. The vinyl flooring in the laundry area must be appropriately repaired or replaced for the risk this presents to residents who may go into the laundry area. 25/05/07 25/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is strongly recommended that the Service Users Guide and Statement of Purpose be updated to include relevant and up to date information. Once this has been done, all residents should be provided with a copy. It is strongly recommended that following assessment of a prospective resident, the manager writes to the resident and/or their representative to confirm that the home can/cannot meet their assessed needs. It is strongly recommended that wherever possible, care plans be signed by the individual resident and/or their representative. It is strongly recommended that all prescriptions are seen by the management of the home prior to them being sent to the pharmacy for dispensing. It is strongly recommended that a suitable method of recording complaints be developed and used to ensure details of any investigation carried out by the management of the home is clear. It is recommended that consideration be given to replacing those lounge chairs that are showing signs of wear and tear as part of the rolling programme of maintenance. It is recommended that the floor covering in the two bedrooms identified to the owner be replaced as part of the refurbishment and renewal programme. DS0000067980.V329718.R01.S.doc Version 5.2 Page 28 2 OP3 3 4 5 OP7 OP9 OP16 6 7 OP19 OP19 Westwood Residential Home 8 9 10 11 OP19 OP26 OP26 OP27 12 OP30 It is recommended that the carpet in the main lounge area be deep cleaned or replaced to eradicate the unpleasant odour that was present. It is strongly recommended that anti-bacterial handwash and paper towels are made available in the laundry area at all times. It is recommended that Infection Control training be arranged for all staff to attend. It is recommended that when reviewing staffing rotas consideration be given to ‘building in’ specific time for a handover of information to be given between shifts without relying on the goodwill of staff to come in early or stay late. It is recommended that all staff undertaking Skills for Care training does so within 12 weeks of commencing their employment in the home. Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westwood Residential Home DS0000067980.V329718.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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