Inspection on 14/06/06 for The Westbury Nursing Home

This inspection was carried out on 14th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Westbury Nursing Home 20/06/07

The Westbury Nursing Home 08/11/05

The Westbury Nursing Home 01/07/05

The Westbury Nursing Home 21/07/04

The Westbury Nursing Home 27/05/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Westbury Nursing Home Falcondale Road Westbury On Trym Bristol BS9 3JH Lead Inspector Wendy Kirby Key Inspection 14th & 15th June 2006 09:30 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 The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 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. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Westbury Nursing Home Address Falcondale Road Westbury On Trym Bristol BS9 3JH 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) 0117 9079971 0117 9146665 Westbury Care Limited Mrs Penelope Anne Brown Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate 68 Persons over 50 years of age receiving nursing care. Staffing Notice dated 01/10/2001 applies Manager must be a RN on Parts 1 or 12 of the NMC register Date of last inspection 8th November 2005 Brief Description of the Service: Westbury Nursing Home is operated by Westbury Care Limited. The home is privately run and provides accommodation for 72 people who require nursing care. Accommodation is provided on three floors. The home has 67 single rooms with en suite facilities and four shared rooms with ensuite facilities. The home is set within its own grounds and is within a short walking distance from the village of Westbury on Trym. There are local shops and amenities nearby plus a bus route into the City centre. The cost per week to reside at Westbury Nursing Home will be from £520.00. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted as part of the annual inspection process. The inspection lasted two days. Prior to the visit the inspector spent some time examining documentation accumulated since the previous inspection, including the pre-inspection questionnaire, notified incidences in the home, (Regulation 37’s) and the unannounced reports conducted by the Registered Providers (Regulation 26’s). The inspector also received an anonymous letter expressing some concerns within the service provided at Westbury details of this are addressed within the report. The inspector sent questionnaires, “Have your say”, to forty residents in the home prior to the inspection and fifteen were completed and returned. Relatives and visitors “Comment Cards” were also sent and eighteen of these were completed and returned. Information from these has been collated and detailed throughout the report. The inspector spent time throughout the course of two days in discussions with the manager and a number of records and files relating to the day-to-day running and management of the home were examined. Six residents were case tracked. Their care plans and care files were examined. The inspector had discussions with the residents and observed them going about their daily routines. The inspector took a tour of the premises accompanied by the maintenance man. Time was spent observing residents in the home throughout the course of the visit and ten were spoken with at length. Several visitors were spoken with during the visit and some who could not meet the inspector requested a telephone call. Members of staff were observed on duty and thirteen were consulted individually. Feedback was given to the manager on the outcome of the inspection. What the service does well: The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 6 Admission procedures were resident focussed and supportive to residents. There are safe systems of medication. Meals were well presented and menus verify a healthy well balanced diet for all residents who benefit from a wide variety of choice. Staff training was well attended and ensured that residents were supported by competent and qualified staff. Westbury Nursing home is cleaned to a good standard and is well furnished, providing a homely and comfortable environment for residents. The recruitment procedure is robust and serves to protect vulnerable residents. Staff were observed as being respectful, warm in manner and sensitive towards the residents within a relaxed homely environment. The manager and staff had built a good rapport with individuals and were knowledgeable about the care needs of the individuals living in the home. The home was well organised and managed by an effective, stable management team. What has improved since the last inspection? What they could do better: The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 7 The home must continue to develop Care plans with the residents and/or their representatives, wherever possible and ensure that all residents have care plans, which accurately reflect their needs and how those needs will be met. The recruitment of an activities coordinator will help ensure that residents are given opportunities for stimulation through leisure and social activities, which suit individual needs and preferences. The registered provider must continue to investigate the provision of additional ventilation equipment to enhance the comfort of residents, staff and visitors. 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 Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 8 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 The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Prospective residents’ needs are assessed prior to admission to determine the suitability of placement to ensure that their needs can be met. EVIDENCE: Pre-admission assessments are comprehensive covering all activities of daily living, a full health screen and personal history background. The prospective resident, family and carers are involved in the pre-assessment and all information is used to determine the suitability of the placement. The manager through her assessments was able to demonstrate a good knowledge of the current residents, their medical history, personal background and their subsequent needs. The inspector looked at six pre-admission assessments and the information gathered provided a sound benchmark of the resident’s ability and state of health prior to admission. Prospective residents are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. A month’s trial period on both The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 10 sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. There was insufficient individualised planned care detailed in each residents file and the information had not been reviewed consistently, subsequently information was out of date and did not reflect current needs. Although health and personal needs are identified the resident’s social needs are not full in content. Staff have a good awareness of individuals needs and treat the residents in a warm a respectful manner, which means that they can expect to receive care and support in a sensitive way. Medication systems are safe. EVIDENCE: From the pre admission assessments the manager and the registered nurses should be able to develop a set of care plans based on identified needs. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 12 Six residents care files were looked at in detail, including pre-admission assessments, care plans, personal history profiles and risk assessments. All records evidenced lack of consistency in assessing, planning, implementing and evaluating the resident’s care. Intermittent care plans were not available when short-term needs had been identified, for example one resident in the home had had a recent bereavement. A plan should be developed to clearly identify how this was affecting the resident and how the staff would support the resident through this difficult time. From the residents pre-admission assessments the inspector had identified various needs, which required formation of a care plans. One resident had complex needs following a stroke including swallowing difficulties, diabetes, and immobility. Care plans had not been developed and therefore the care file did not accurately reflect the residents’ needs and how the staff would meet them. On examination of the records for the remaining five residents case tracked it was clear that this was usual practice. Inadequacies within the care planning system have been raised as an issue at the previous three inspections. At the last inspection a requirement was made to carry out an urgent review of the current system to clearly demonstrate that the home was providing an individualised service that takes into account personal preferences. One relative had replied to a survey on behalf of a resident and asked, “How are physical and mental health care needs going to be communicated to staff” and also felt that “carers needed a more comprehensive knowledge of clients care needs”. In discussions with the manager it was apparent that the system for care planning in the home was repetitive and confusing. There was a large amount of documentation, which hadn’t been completed, and although the basic care plan format was good it was not being used effectively. Time was spent looking at the paperwork and a simpler system was sought. As a result of her findings the inspector requested that the six residents case tracked had a complete review of all the information contained in their care files and that new care plans were developed. These were examined on the second day of the inspection. The results were very positive and encouraging. The manager and a registered nurse in the home spent time developing care plans for the six residents mentioned. Information written in the care plans was detailed and an accurate reflection of individualised needs. One residents’ chosen religion had a very detailed plan to ensure that wishes were met with regards to their religion, and explained the importance of prayer time and the daily routine for this. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 13 The resident mentioned previously who was recently bereaved had a care plan that would ensure staff would closely monitor how the resident was coping with their loss and how they could be supported. Comments received from the manager and the registered nurse were positive, they had found the system adopted much simpler to use and felt confident this would enable them to continue this good practice. A requirement will be made to continue the development of the remaining care files with the involvement of the residents and families wherever possible. This will be closely monitored by the inspector. In general the residents surveys evidenced that they receive the care and support they need. Visitor/relative comment cards stated, “I think my aunt is well cared for”, “Staff are caring” and “There is good communication between staff and relatives.” The home had met a previous requirement in that risk assessments were in place with detailed information to help ensure safe procedures for example, manual handling and the correct use of bed rails. Consent for the use of bed rails had been obtained. Another requirement made at the previous inspection was to ensure that all residents had a choice as to when they get up and that their preferences were recorded on their care plans and adhered to. The inspector looked at new documentation in the residents care files entitled “Daily Routine”. Each resident had completed this with a member of staff which detailed preferences such as when they like to get up, where they prefer to have breakfast and what time they liked to go to bed. Health Care needs were well evidenced in the Care Files and included, nutritional and pain assessments. Records of the General Practitioner (GP) visits with residents and the outcomes were also documented. Specialist referrals and visits from other professionals including, Physiotherapists, Chiropractors, Dentists and Opticians were also seen. The Inspector was informed that each resident was referred to a GP on admission to the home and an initial first visit was then set up. Although not all GP’s conduct weekly visits to the home, good working relationships with the GP have been formed and the GP’s will visit on request. Residents’ surveys stated, “The home is very good at supporting follow ups and referrals” and “ Specialist input is very good”. As a result from a previous requirement all accidents are now fully investigated within prompt timescales and actions are taken to reduce the risk of them occurring again. The accident forms are comprehensive and stay in the residents’ files for a period of time to determine any pattern. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 14 The home is in the process of developing a new initiative to complete a social assessment of each resident. It is a comprehensive document and should enable the staff in the home to relate to residents in a personalised way. It should also create topics of conversation, encouraging life review and reminiscence, which will have meaning to that individual resident. The inspector looks forward to looking at the progress of this initiative and its effectiveness at the next inspection. Policies and procedures for receiving, storing, administering and disposing of medications were examined and correct. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Although this was not looked at in great detail during the inspection, the manager and her staff are continuing to make every effort to establish resident’s wishes concerning palliative care and any provision residents and their families would wish for by developing end of life care plans. Staff were witnessed knocking on residents doors before entering confirming respect for the residents individual privacy and dignity at all times. All rooms have a telephone point from which residents can make and receive calls and private telephone lines can be installed. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. In general residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations, however some residents felt that new initiatives should be explored. Residents maintain family contact and staff encourage family and friends to join in with activities and any outings. Residents receive a varied and wholesome diet that they are able to influence. EVIDENCE: In consultation with the residents the manager develops a monthly timetable of activities and forthcoming events. A copy of this is placed in communal areas throughout the home, to ensure that all residents and visitors are aware of the planned activities. The home is currently in the process of recruiting an activities coordinator. A record of activities and residents participation is recorded in an activities file. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 16 Regular activities include a weekly visit from an art teacher who has been visiting the home for six years. This is a popular activity with the residents. Time was spent observing and talking to the residents during an art session. The residents are given projects to work on and had produced some lovely work, which they keep, and display in their rooms. Musicians also visit the home on a regular basis. The residents enjoy music played on the harp, acoustic guitar, and musical percussion. A musician was playing the guitar during the inspection. The music was relaxing and the session was well attended. The home provides activities throughout the week, which include, bingo twice a week, indoor games, quiz time, and reminiscence therapy. During one afternoon the inspector spent some time with a small group of residents discussing their daily routines. Most residents stated that although activities are provided some days in the home could seem very long with lack of things to do. Suggestions from residents included a visiting library, provision of talking books and more frequent outings. This was relayed back to the manager at the end of the inspection. Following a comprehensive course in dementia care the home has looked at ways in which residents with dementia can receive stimulation. A “rummage box” has been provided which contains various items that residents can relate to. These items provide memories and topics of conversation for residents where they are able to reminisce. This has been a very popular resource and the home is in the process of devising another box to enable more residents to benefit. One resident stated that she enjoyed having her weekly manicure, whilst one relative stated that some residents’ nails were too long and dirty. Although care staff try to accommodate nail care during their shift it is hoped that provision for this will be more adequate with the enrolment of an activities coordinator. Residents are supported to satisfy their religious preferences. Local denominations visit the home monthly to provide a service, and local church volunteers visit alternate weeks to sing hymns with residents who choose to attend. One couple who reside at Westbury have expressed a wish to be confirmed and plans have been made for this event to be held in the home. The home has recently provided a new mini-bus. One resident spoken with asked the inspector if she knew when the new mini-bus was being provided. This was discussed with the manager who stated that due to the absence of an activities coordinator there was a shortfall in monitoring which residents had benefited from the trips arranged. The manager will address this in order to ensure that all residents are given the opportunity to access this facility and that residents are informed about the home requiring a new mini bus. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 17 Residents have chosen several places of interest to visit including Severn Beach and local garden centres. Several residents have enjoyed trips around Bristol and talk about how Bristol has changed and how it is developing. Residents’ surveys and relatives/visitors comment cards gave positive feedback about the activities provided. Comments included, “Days out on the mini-bus and other activities are well received”, “I particularly enjoyed making Christmas cards”, “My mother enjoys the trips and musical entertainment” and “My aunt thoroughly enjoys herself”. One residents survey stated that, “Although activities are on offer, I usually decide not to participate”. Residents are able to pursue activities that interest them personally and are well supported to do this. The inspector spent time talking to one of the residents in their room. The resident told the inspector about a computer course they attend at a local college and that they are able to continue this interest by using a computer system with internet access in their room. The resident also informed the inspector that they would be going out for lunch with their brother later that day. The home operates an open door policy for visitors. Residents were able to see visitors in the privacy of their rooms and there are several semi-private seating areas around the home and in the garden. Relatives/visitors comment cards stated, “I always feel welcome when I visit” and “The staff are very happy and friendly”. The home has a monthly residents meeting which are well attended and minutes are taken. These are circulated on the notice boards. The home has recently had an inspection from the Environmental Health Officer. All requirements identified at the inspection have been met. The inspector spent time in discussions with the head chef and her staff. It was evident that the team work efficiently and effectively together and work hard to provide a good service to the residents in the home. Although there is a menu plan for the residents, each resident is visited daily in order for residents to choose what they would like to eat. Flexibility was evident in choice, providing one gentleman in particular with a daily spicy dish when requested. The chef explained that on most days they can prepare up to fifteen different choices. The staff were able to demonstrate their awareness of individual needs and preferences for residents and relatives are encouraged to visit the kitchens to also make requests on behalf of the resident. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 18 The head chef is responsible for managing her own budget and stated that it was ample to provide the variety of food required and the excellent standard of produce they access. All food is freshly prepared in the home on a daily basis including, cakes, pastries, bread, soup and fruit salad. There are robust policies and procedures in place for risk assessments using the “Critical Control Points and Monitoring System”. Each staff member has a delegated responsibility. Areas covered include, daily cleaning schedules, purchasing and receipt of goods, storage, preparation of food, and cooking, serving, cooling and reheating. Monthly hygiene audits take place and the staff meet on a daily basis to discuss any issues, which are then fed back via the head chef at a weekly-arranged meeting with the manager of the home. The kitchen was very clean and spacious. Stores exhibited a good range of foods. Documentation was provided to show that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked prior to serving. The size and layout of the dining room made it possible for all residents to enjoy the social advantages of dining together. Staff had used their expertise and knowledge of the residents, personalities, preferences and ability to eat independently, when seating them for lunch. The dining room was light, spacious and the tables were attractively laid with tablecloths and flowers. Residents that required assistance with eating their meals were supported by staff members, this was performed in a respectful, sensitive way, for example without rushing the residents and staff were sat at the same level as the resident. Staff were polite and helpful when serving the meals. Relative/visitors comments were very positive about the food and included statements, “The variety and desire to please is appreciated” and “My mother requires pureed food and the staff try hard to find alternatives”. One relative said, “I have had two meals when visiting the home and they were excellent”. One resident said, “I particularly enjoy the puddings”. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 19 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. There are robust and comprehensive policies in place to manage complaints or allegations of abuse. There are good arrangements in place for staff training and awareness of protection of vulnerable adults. EVIDENCE: A copy of the complaints procedure is on display in a well-frequented part of the home, which means people will know how to obtain the required information if they want to make a complaint. Information from completed relative/visitor comment cards confirmed that they knew where the information was available. The complaints policy and procedure is detailed and contains all the required information, which can be found in the service user guide and individual contracts, terms and conditions. Documentation of complaints received since the last inspection was examined and details confirmed that policies and procedures were followed correctly and that the complaints were dealt with and resolved effectively and efficiently. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 20 Some issues or concerns are discussed at the residents meetings, which are well attended by the relatives. One relative stated, “Any problem or complaint is taken notice of and thoroughly investigated, communication between relatives and staff is good”. There are procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse’ including the Local Authority “No Secrets” document. The staff handbook and induction training provides education on topics for whistle blowing, management of aggression and bullying. The availability of this information should increase staff awareness and understanding of their role in protecting vulnerable adults who live at the home. The inspector was informed by the manager that the organisation actively promotes staff training and education in these areas, all staff are encouraged to attend training in dealing with difficult behaviours and protection of vulnerable adults. Staff training records evidenced this commitment. At the previous inspection a requirement was made for staff to ensure that residents’ access to the call bell system was not restricted. The inspector spoke with one resident who confirmed that this had improved. A number of staff are undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Residents’ surveys asked, “Do you know who to speak to if you are not happy?” Generally the residents said they knew who to speak to and comments included, “Staff are approachable and supportive”, “Staff at all levels are receptive”, and “All staff talk to me and ask me if I am ok”. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26. Quality in this outcome area is good. The home is clean, comfortable, well decorated and furnished. It provides a safe, peaceful and well-maintained environment for the residents. The bedrooms, communal rooms and facilities are suitable and well presented for their purpose and meet the residents’ needs. EVIDENCE: Westbury Nursing Home is situated close to local facilities and amenities. The light and spacious communal areas of the home are open plan, with various adequate seating areas for residents and visitors to the home. Open plan areas on both floors create a perfect atmosphere for dining with attractively laid tables. The upstairs floor is also open plan with a mezzanine that overlooks the ground floor lounge/diner. A glass ceiling offers plenty of light to the dining area. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 22 An extension has been recently built providing five additional bedrooms with en suite facilities and a large conservatory. The home is on three floors, with level access to all via a passenger lift. The inspector walked around the inside of the home and viewed, most of the bedrooms, all bathrooms and sluices. Room sizes are generally adequate for their stated purposes, particularly the lounges and conservatory and some of the bedrooms. Rooms have en suite facilities provided and communal bathing areas; showers and toilet facilities are located throughout the home. All areas of the home were tastefully decorated and well maintained. Great attention has been given to ensure that all areas are homely. Residents had been supported to personalise their bedrooms with pictures and ornaments and residents are able to bring items of furniture should they wish. Residents were making full use of these areas and their bedrooms throughout the inspection. The home was clean and free from unpleasant odours. The home employs a large team of domestic staff on a daily basis who have an allocated housekeeper. The inspector received numerous comments about the cleanliness and ambience of the home; “In my opinion the home is spotless”, “Paintwork is clean and dust free, carpets are cleaned regularly”, “Any spills are cleaned up quickly”, “ Very rarely is the home not clean and fresh”, and “Communal areas are always clean”. One visitor said, “Sometimes I can smell urine” and another visitor stated, “If odours are present it is due to the time of my arrival”. The inspector visited the laundry room and spoke to one staff member. The room was spacious, well organised with ample appliances to accommodate the amount of laundry they receive. Linen bags were colour coded for soiled linen, residents’ clothes and bed linen. The staff member had a store of gloves and aprons on hand and was able to demonstrate an awareness of carrying out safe procedures with regards to manual handling and infection control. All residents’ personal clothing is labelled by the laundry staff and minor repairs are accommodated for. As mentioned previously in the report the inspector had received a letter regarding some concerns with the service provided at Westbury. One comment made reference to a stained carpet in a resident’s bedroom. The carpet was The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 23 inspected and found to be stain free. In discussions with the manger and the housekeeper confirmation was made that all carpets in residents bedrooms are cleaned on vacation and when spills/accidents are reported. Due to a spell of warm sunshine over recent months the home in certain areas can become quite warm and several residents and relatives have complained to the manager and subsequently notified the inspector. During the visit it was noted that large industrial fans had been placed around the home and although this had eased the problem on a temporary basis alternative provision may need to be sought. On the second day of the visit the inspector met briefly with the registered provider who confirmed that various companies had been contacted of which some had visited the home to discuss options of providing air conditioning systems within the home. The provider appreciated how the warm spell was affecting the residents, visitors and staff in the home and consultation will continue in order to make adequate provision for all concerned. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. Adequate staffing levels will help to ensure that resident’s needs are met. Residents are supported and protected by the homes recruitment policy. The residents are cared for by skilled staff that are trained and supported by management. EVIDENCE: The staffing levels are indicative of the needs and levels of care required by the residents. If levels of dependence were to increase, then staffing levels would need to be increased. One relative/visitors comment card stated that there were not enough staff on duty and that one resident who was bedridden lacked company during the day. The recruitment of an activities coordinator should help ensure that residents receive some stimuli on a one to one basis. This will be reviewed at the next inspection. The inspector examined staffing rotas. Some staff were on leave and replacement staff names had been inserted to keep the required levels. The manager uses her own staff group to cover any staff absences. This is good practice and provides a consistent care service to the residents. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 25 Comments from surveys confirmed that staff were friendly, caring, patient, supportive, approachable and happy. One visitor stated that her relative was welcomed on admission and well cared for by all staff, that staff were always available to talk to and most helpful. The inspector spent some time throughout the day sitting in the communal areas observing staff carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humoured and sensitive towards the residents within a relaxed, calm environment. The inspector had discussions with staff members individually and in small groups. All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to their residents. A robust recruitment policy and procedure is in place and the files inspected showed all the appropriate documents and checks were in evidence. CRB disclosures are being retained until the inspector has examined them. There is an induction programme, which covers all mandatory training, including Fire, Manual Handling, and Health and Safety. The home continues to support their staff with NVQ training and the enrolling programme continues. Requirements were made at the previous inspection with regards to ensuring that all staff were aware of the safe ranges for blood tests for diabetes and to ensure that appropriate manual handling techniques are carried out and arrange further training if necessary. The manager and her staff are conscientious in attending training relevant to the care needs of the residents, including updates on diabetes and wound care/skin care management, dementia care and how to meet the needs of residents with depression and anxiety. A training matrix had been developed and the inspector was able to see that all mandatory training including manual handling was undertaken and course dates had been organised for the future. Staff were observed transferring residents correctly using hoists and in discussions with one relatively new member of staff confirmation was made that training had been effectively received. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. Residents’ needs and best interests are central to the management approach in the home. Staff receive appropriate supervision. The homes record keeping policies and procedures safeguard residents. The health and safety of residents, staff, and visitors is protected. EVIDENCE: The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 27 Mrs Brown has been the manager at Westbury for four years. It was evident from discussions with Mrs Brown and her manager that the home has a stable management team that supports a commitment to providing quality care for the benefit of the residents. Mrs Brown has a dedicated team who work with her to try and ensure that the highest standards of care are achieved and maintained. Mrs Brown is a registered general nurse who demonstrated a good understanding of the needs of the individuals living in the home. Staff stated that the manager was very approachable and gives good direction and supports them. Comments from residents and relatives included, “Compared to other establishments this home is superior” and “This is a well managed home”. Further evidence of this was obtained when the inspector examined the minutes of staff meetings. The attendance of staff was generally good. The agenda was informative and useful ensuring that staff were kept up to date with new initiatives and issues within the home. Staff were given opportunity to express their ideas and any concerns they may have during the meeting and it was clear that relationships between staff were respectful and supportive. As mentioned previously in the report the inspector had received an anonymous letter prior to her visit. Some of the concerns raised were about residents call bells not being answered at night, unofficial staff breaks and staff using mobile phones whilst on duty. The manager confirmed that she would investigate this matter further and inform the inspector of the outcome. Staff receive supervision once every eight weeks. Arrangements in place confirm that individual supervision is based on an agreement between the manager/senior staff and staff member. Documentation showed that staff are able to discuss issues that are personal, review their last supervision, review of appraisal, organisational targets, looking ahead, personal development and any other items. There was a degree of satisfaction expressed by all of the residents spoken with. Based on the comments made and through the inspectors observation it is evident that in general the home is run in their best interests and to ensure their needs are being met. Relatives said in their surveys, “Me and my family are always encouraged to say if we have any concerns” and “We recently had an excellent response to accommodate my uncles desire to walk in the grounds”. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 28 The policy and procedure for holding residents pocket money was examined and four individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. The inspector spent some time with the head of maintenance. The team have various individual skills, which are utilised for the purpose of maintaining the home, including carpentry, welding, electrics and plumbing. The team are responsible for the ongoing redecoration and refurbishment of residents’ rooms once they are vacated. Monthly equipment checks, including bed rails, wheelchairs, beds and commodes are being conducted and recorded; any repairs carried out are also documented. The inspector saw that all relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed that all necessary service contracts were up to date including, gas and electrical services, manual handling equipment and lift servicing. Fire safety training for staff is given on induction and then at the recommended given intervals. Fire drills as recommended by the Fire Prevention Officer operate three-monthly for all night staff and six-monthly for day staff. The appropriate monthly visits take place (Regulation 26), which are unannounced and include interviews with staff and residents to review and assess the quality of care provided. The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 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 3 3 X 3 3 3 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 3 X 3 X 3 3 X 3 The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 15(2)(b) Requirement The home must continue to: 1 Develop Care plans with the residents and/or their representatives, wherever possible. 2 Ensure all residents have care plans, which accurately reflect their needs and how those needs will be met. Repeated requirement from the last three inspections Timescale for action 14/06/06 The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 31 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 OP12 Good Practice Recommendations The recruitment of an activities coordinator will help ensure that residents are given opportunities for stimulation through leisure and social activities, which suit individual needs and preferences. The manager should address the issue for residents to use the mini-bus this in order to ensure that all residents are given the opportunity to access this facility. The registered provider must continue to investigate alternative ventilation provision for residents, staff and visitors. 2 OP12 3 OP25 The Westbury Nursing Home DS0000020344.V290170.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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. 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