Inspection on 08/11/05 for The Westbury Nursing Home

This inspection was carried out on 8th November 2005.

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 14/06/06

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 Sam Fox Unannounced Inspection 06:45 8th, 9th & 10 November 2005 th 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.V263940.R01.S.doc Version 5.0 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.V263940.R01.S.doc Version 5.0 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 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.V263940.R01.S.doc Version 5.0 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 1st July 2005 Brief Description of the Service: Westbury Nursing Home is operated by Westbury Care Limited. The home is privately run and provides accommodation for 68 people who require nursing care. Accommodation is provided on two floors. The home has 62 single rooms with ensuite 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 Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s second unannounced inspection and resulted from an anonymous complaint regarding a number of practices within the home. These issues will be addressed in the report. The inspection took place over two days. On the first day two other inspectors were also involved, one focused on the nursing practices within the home, the other interviewed six staff and spoke to visitors. Evidence was collated from inspection of key records, with a major focus on care plans and discussion with staff and residents. The premises was also fully inspected. Some of the requirements made at the last inspection were not looked at during this visit and will be the focus of a forthcoming additional visit, as a consequence they will be carried forward at the end of this report. Between the time of the inspection and the publication of this report a number of meetings have taken place between the CSCI and the Home. They have positively and promptly responded to concerns. What the service does well: What has improved since the last inspection? Staff now receive more regular supervision. They displayed a good understanding of their role and a commitment to providing good standards. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 6 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 Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 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 The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of these standards were assessed during this inspection and will be a focus of future visits. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 9 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 Care plans and procedures in place for some health care needs should be improved – residents can then be more assured that they will receive an individualised service which protects their welfare and promotes their health. The medication system is safe. EVIDENCE: Five residents’ files were inspected in detail during this visit. They contained initial assessments, risk assessments and care plans. Inconsistencies continue to be found within the recording systems. Some care plans were repetitive and some were not personalised. For example, it was noted that the care plans for assistance with dressing and washing for two residents were the same – indicating that they do not include individual routines and preferences. It was also noted that a lot of care files had blank pages, which tended to make the system harder to follow. Inadequacies within the care planning system have been raised as an issue in the last two inspections. The home must carry out an urgent review of the current system if they are to more clearly demonstrate that they are providing an individualised service that takes into account personal preferences. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 10 Some residents use bed rails. The home must ensure there are risk assessments and consent forms in place for the use of these. There were two instances when it was implied to the inspectors that there had been deliberate restricted access to the emergency call bell system. This was bought to the attention of the manager to investigate. The home must ensure that residents have the means to summon help at all times. Generally records held in relation to diabetes care were adequate and the appropriate blood tests were being carried out at regular intervals. It was of concern to note, however, that not all staff knew what the safe range was for one resident. This should be more clearly recorded on monitoring charts. There are some residents accommodated with mental health needs. A CPN visiting the home said she felt the staff would benefit from more training about this and that they were not always consistent in their approach. There was one instance when an inappropriate manual handling technique was observed being used. This has also been the subject of a recent complaint made by a relative. An immediate requirement was made regarding this. In addition to this the manager has been asked to assess the competency of all staff to carry out manual handling and arrange training if necessary. If staff continue to fail to follow the appropriate instructions then the disciplinary procedure should be used. It was not clear whether some residents, who were identified as having a high risk of developing pressure sores, were being turned two- hourly. The recording of this on daily running notes was inconsistent. An immediate requirement was issued in relation to this. The inspector spoke with one visitor who said ‘I am quite relaxed about the care, that ripple mattress is always on, I am told the pressure area is 99 clear. Foam cushions are used on the wheelchairs for prevention’. One resident was identified as having significant weight loss over six months. The home waited five months before seeking specialist support. They must ensure that the relevant specialist input is sought more promptly. It should be noted, however, that the home had implemented a fluid and food intake chart so they could monitor the situation. There were individual nutritional assessments, some of which have led to the development of care plans. The recording for this, however, appeared to be inconsistent and it was noted that on one instance this was identified as an issue during an initial assessment but this did not result in a specific plan. The home is advised to review all nutritional assessments. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 11 The accident book was viewed. Some accidents had been reviewed and could be related to specific care plans and risk assessments. There were others, however, that were not fully investigated and could represent significant risks. The home must ensure that all accidents are fully investigated and that care plans and risk assessments are reviewed accordingly. There were two specific accidents that the manager was asked to investigate separately and report back to the CSCI. The home operates a monitored dosage system for the administration of medication that is supplied at regular intervals by the local pharmacist. There were medication policies in place, although these were not looked at in-depth during this visit. Records held in relation to the administration of medication were generally found to be well maintained. A discrepancy found in relation to the stock held for one prescription has subsequently been resolved. It is recommended, however, that the home review their method of stock control for ease of use. The GP signs on the medication recording sheet for any changes made. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 12 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 Residents should be given more choice as to what time to get up so that they have more control over their daily routines. Residents can be assured that they will benefit from an appetising, nutritious and wholesome diet. EVIDENCE: This inspection was conducted early in the morning. It was noted that there were 26 residents up, some of whom were dressed and some of whom were in their dressing gowns. Four residents commented that they did not want to get up that early. Information about daily routines on care plans were inconsistent and preferred times that residents wanted to get up were not always recorded. An immediate requirement was issued that all residents are given a choice when to get up and that preferences are recorded on care plans. Relationships between staff and residents was observed to be respectful and friendly and residents were observed being treated with respect and being offered choices. Opportunity was taken to join residents with their lunchtime meal. This was served in a sensitive and unhurried manner. Residents were observed being appropriately assisted to eat. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 13 The food was appetising and well presented. The menus provided evidence that residents benefit from a wide variety of nutritious meals and that they are given a choice. Some eat their meals in their bedrooms and it was understood that they also receive a choice. One visitor commented that his relative (who stays in their bedroom) was not helped to eat her food on one occasion. They said, however, that this was the exception rather than the rule and that it was not a major concern. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 14 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 The recording of complaints is inadequate; this must be improved so that residents and relatives can be more re-assured that their concerns will be fully investigated. Staff displayed a good understanding of the need to protect vulnerable adults from abuse EVIDENCE: Westbury Nursing Home has a complaints procedure which includes timescales for action. The manager maintains a logbook of all concerns raised. There has been a recent complaint from a relative and records indicated that this is being appropriately investigated by the home. During this visit, however, conversations with visitors to the home indicated that they had had cause to complain and these had not been recorded in the log. This has been discussed with the manager and she must ensure that such concerns are logged. Staff were asked about their knowledge of the complaints procedure and protection policy. Staff were aware of the ‘No Secrets’ in Bristol DOH document and how it linked to the POVA policy. They confirmed that they had received training about this. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 15 One staff member said ‘I have never seen poor practice and I would tell if I saw nasty behaviour, I don’t think anyone has ever been abusive in front of me’. Another said ‘I take my job very seriously and my concern is my residents’ I expect a good quality of care’. ‘I say to new people, treat the residents as you would your mother, grandmother, father etc’. The area manager said, ‘every week we have a department meeting and go over any concerns or complaints, I also meet with the cook, handyman and laundry assistants’. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 16 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, 20,24,26 Residents benefit from living in a homely, clean and comfortably furnished environment. Action needs to be taken, however, to increase their safety by improving security measures. EVIDENCE: Westbury Nursing Home is purpose built and situated close to local facilities and amenities. This visit was conducted early in the morning. It was observed that both the external and internal doors were propped open, making it fully accessible to strangers. Some visitors commented that the front door was not very secure as they just walked into the building unchallenged. The inspectors were not asked for ID. An immediate requirement was issued that the premises be secure at all times. Subsequently the home has informed the CSCI that they will be installing a new keypad on the front door for added security. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 17 The home is laid out in an open plan way, with large seating areas close to the dining area. Bedrooms lead off this space on either side. 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. An extension is currently being built with includes the addition of five more bedrooms and a conservatory. Opportunity was taken to view a number of bedrooms. These were found to be personalised and to reflect individual tastes- indicating that choice and independence are promoted in this respect. All bedrooms have ensuite facilities. All areas of the home were found to be cleaned to a good standard and there were no unpleasant smells. Residents and relatives commented that they were pleased with the levels of hygiene. Westbury Nursing Home have policies in relation to infection control, these, however, were not looked at in detail at the time of this visit. Opportunity was taken to speak with a laundry assistant who described arrangements in place for washing the clothes. She was satisfied with the equipment available for her to achieve this successfully. The washing machines are capable of reaching the appropriate temperatures to clean soiled linen, which is washed separately. There are also separate sluicing facilities available. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 18 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): 27,29 There is a robust recruitment procedure in place for the protection of vulnerable adults. EVIDENCE: 7 staff members of various skill mix were formally interviewed in private, all were asked questions regarding the management of the home, team working, supervision and everyday working practice. Various policies and procedures were discussed including the Whistle Blowing policy, complaints and ‘Protection of vulnerable adults’ policies. Staff were asked if they enjoyed working at the home and how they felt about team dynamics. All of the staff members interviewed said they enjoyed working at the home. Comments made included: “I’m quite new and I like it here, they are a very nice, helpful staff team, they are lovely girls”. Another staff member said ‘it was bad but things have improved now as those staff have left, I’m not afraid to make complaints’. ‘The management team are approachable’. Three personal files were looked at in detail. These confirmed that the home has a robust recruitment procedure in place, which includes the obtaining of references and CRB checks. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 19 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): Residents’ benefit from a well supervised staff team. EVIDENCE: Staff members confirmed regular supervision takes place and the unit manager on the ground floor said, ‘the manager carries out my supervision and I supervise the other staff approximately every 8 weeks’. One staff member said ‘yes I had supervision a while ago we talked about training and any issues or concerns’. Another staff member said ‘I have supervision about every 6 weeks there are no concerns because there is a good crew on at the moment’. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 20 A unit sister confirmed she had supervision approximately every 6 weeks and showed the inspector the format currently used. Topics for discussion are: personal issues, review of the last supervision, new issues arising, review of appraisal, organisational targets, looking ahead, personal development and any other issues. She added ‘the staff are very honest and would tell you if they were unhappy’. The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 21 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 3 x x The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 22 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 Review and further develop care plans Timescale for action 30/12/06 Repeated requirement from the last two inspections 2 3 OP8 OP12 13(4)(c) 12(1)(a) 4 5 OP8 OP8 13(5) 12(1)(a), 18(1)(a) 12(1)(a) 12(1)(a) 12(1)(a) 6 7 8 OP8 OP8 OP8 Ensure there are risks assessments and consent forms in place for the use of bed rails. Ensure all residents have a choice as to when they get up and that their preferences are recorded on their care plans and adhered to. Ensure the appropriate manual handling techniques are carried out at all times Assess the competency of all staff to carry out manual handling techniques and arrange further training if necessary Ensure that residents’ access to the call bell system is not restricted. Ensure that all staff are aware of the safe ranges for blood tests for diabetes. Ensure all residents, identified as at risk of developing pressure sores be turned regularly and this should be recorded. Repeated requirement 30/12/06 09/11/05 09/11/05 30/12/05 09/11/05 09/11/05 09/11/05 The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 23 9 OP8 12(1)(a), 13(4) 10 OP16 22 Ensure all accidents are fully investigated within prompt timescale and that actions are taken to reduce the risk of them occurring again Ensure all complaints are investigated and logged, with outcomes Repeated requirement 09/11/05 09/11/05 11 12 13 OP8 OP19 OP11 12(1)(a) 13(4)(c) 12(3) Review nutritional assessments The front door to be kept secure at all times Residents preferences or wishes in the event of their death to be recorded This requirement was made at the last inspection and not looked at during this visit. 30/12/05 09/11/05 30/12/05 14 OP15 12(2) Individual plans to support residents nursed in bed at meal times must be established 30/12/05 This requirement was made at the last inspection and not looked at during this visit. 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 2 Refer to Standard OP8 OP9 Good Practice Recommendations Provide training in relation to mental health issues that arise Review system for stock control of medication The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI The Westbury Nursing Home DS0000020344.V263940.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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