Inspection on 13/07/07 for The Westcliff Residential Care Home

This inspection was carried out on 13th July 2007.

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 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

The Westcliff Residential Care... 08/12/08

The Westcliff Residential Care... 18/12/07

The Westcliff Residential Care... 20/07/06

The Westcliff Residential Care... 24/11/05

The Westcliff Residential Care... 26/08/05

The Westcliff Residential Care... 17/03/05

The Westcliff Residential Care... 04/11/04

The Westcliff Residential Care... 03/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Westcliff Residential Care Home The Westcliff Residential Home 51 Leopold Road Felixstowe Suffolk IP11 7NR Lead Inspector Pauline Dean Unannounced Inspection 13th July 2007 09:00 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 The Westcliff Residential Care Home DS0000052323.V346156.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. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Westcliff Residential Care Home Address The Westcliff Residential Home 51 Leopold Road Felixstowe Suffolk IP11 7NR 01394 285910 01394 271154 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) Hazelwood Care Limited Mrs Margaret Jean Crowley Care Home 33 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (33) of places The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2006 Brief Description of the Service: The Westcliff is registered as a care home for older people. The Home comprises two Victorian houses, situated on parallel roads in the town of Felixstowe and close to the seafront. The town facilities are close by and include various shops, a library, post office and Doctors surgery. Initially the two houses were linked by a single storey extension, however an extension linking both houses at first floor level was completed in September 2001. The second floor is reached by shaft lift on the West wing and by stair lift on the East wing. There is a small patio area leading from the dining room, with a small enclosed garden at one end of the property. There is limited parking at the front entrance of the property. The Home was first registered in 1972. Mrs Crowley became Manager in June 2001 and Hazelwood Care Limited purchased the home in October 2003. Mr Singh is the Responsible Individual acting on behalf of the company. The Home is registered for 33 older people with 29 single bedrooms and two shared rooms. In June 2006 the home registered to care for up to 10 older people with dementia, and is developing its service to meet their needs. The range of fees charged by the home is £341 - £555 per week. Additional costs apply for hairdressing, chiropody, toiletries, newspapers and outings. This information was provided to the CSCI on 13/07/07. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit of The Westcliff Care Home was carried out on 13th July 2007 lasting 9.50 hours. The inspection involved checking information received by CSCI since the last inspection in July 2006, looking at records and documents at The Westcliff, and talking to the deputy manager, care staff and catering staff. A tour of the premises was also completed. Questionnaires were left with the deputy manager for distribution to all of the people living at The Westcliff and thirteen completed surveys was returned to the Commission for Social Care Inspection (CSCI). In addition surveys were left for distribution to family and friends and eight completed surveys were returned to the Commission. This enabled them to give theirs views about the service directly to the CSCI. During the site visit three people who live at The Westcliff were spoken with. All were happy about way they are supported and assisted by the staff. One visitor to the home was also spoken with and they were positive with regard to the welcome they received. Twenty-five National Minimum Standards were inspected. This included all key standards. Twelve requirements and three recommendations were made as a result of this inspection. This is an increase from the last inspection and is indicative of a fall in meeting the Standards. What the service does well: The home continues to offer a warm, friendly and homely environment. Staff are supportive and sensitive to the residents needs. Both the people living at the care home and their relatives held both the registered manager and the deputy manager in high esteem. They were seen as being ‘hands on’ and ‘friendly and helpful.’ Overall, the accommodation of the home was comfortable. The Westcliff continues to be very popular with the people living at the home and their relatives. Survey work completed by the Commission supported this and comments such as ‘Well-presented home’ and ‘Good Name’ were found in surveys completed by service users. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The admission processes and procedures need to be implemented for all new admissions. The home still needs to clearly identify the care needs assessments of all residents including those people with dementia. Care needs and risk assessments need to be clearly detailed and acted on within the care planning documentation and record keeping. Development of the social aspect of care should also been given consideration, for it is clear from speaking with management, residents and their relatives that this is viewed as lacking. Improvements to the staffing levels within the home requires immediate attention. The current practice of care staff undertaking household tasks at the deficient of providing more interaction, social and leisure care is highlighted as an immediate need. In addition the practice of care staff working 13½ hour days is seen as damaging to the ‘fitness’ of staff, but also to the ‘fitness’ of staff to offer good quality care at all times. Improvements are required in the home’s recruitment practices and paperwork and both the home’s complaints procedure and adult protection procedure require revision and correction. Within the home some decoration and maintenance issues were found. Whilst the majority of bedroom accommodation was in good order, some rooms do require decoration and new carpeting to brighten up the tired interiors. External paintwork and the cleanliness of the windows were highlighted as requiring attention by both residents and their relatives and further landscaping to the newly created enclosed garden is required to entice people to use this area. Bathing and showering facilities also require attention, for at the time of the site visit, the home was operating with only two facilities in use, either because the others were out of action or because they could not be used by the present resident group. The management of the home needs to give this matter some immediate attention to ensure that there are sufficient facilities to meet the needs of the people living at the care home. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 7 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. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 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 Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A comprehensive admissions process is not in place to ensure that people who come to live at The Westcliff are assured that their needs are assessed. Intermediate care is not offered at The Westcliff Care Home. EVIDENCE: Evidence was seen of paperwork to be used for assessing the needs of a person entering The Westcliff. However this was not being used for the admissions of those files sampled as part of the case tracking. Three care planning files for three people living at The Westcliff were sampled and inspected. One of these had been admitted in April 2000, whilst the other two had been admitted in 2006 and 2007. The deputy manager confirmed The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 10 that they had been party to the initial assessment visit of at least one of these people, but no records were available to evidence the processes completed. The Annual Quality Assurance Assessment detailed the admission procedure. It spoke of new residents visiting the home for the day prior to admission and information such as the home’s brochure and the Statement of Purpose being given to prospective residents. This was not detailed in records held on the individuals’ files and it was impossible to establish if these procedures had taken place. Survey work completed by the Commission resulted in completion and returns from thirteen people who use this service. Eleven of these said that they had received enough information about the home before they had moved in so that they were able to decide if The Westcliff Care Home was the right place for them. One said that their relative had arranged their admission, although they had been aware of the previous proprietors and another said that the home had a ‘Good Name’. The Westcliff does not offer intermediate care. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall care planning documents were comprehensive detailing health and physical care needs, thus ensuring that the people who use the service receive the care they wish and require. Management of medication with regard to Controlled Drug storage, administration and dispensing was poorly managed and did not ensure that the people living at The Westcliff are safeguarded and protected. People who live at the home can be expect to be treated with sensitivity and respect. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care plans of three people living at the home were sampled and inspected and they were used to case track care in the home. As highlighted at the last inspection a new format had been introduced. This was evident in the most recent admission to the care home. Assessments covered a wide variety of care needs such as diet and weight including dietary preferences, sight, hearing and communication, personal care, oral health, foot care, mobility and dexterity, history of falls, continence, mental state and cognition, social interests and carer and family involvement and other social contacts. Each topic had a plan of care, which detailed the action needed. This document was not dated. A review had been completed in June 2007 and whilst it was stated that there was no change needed to the care plan it was evident that there had been some changes in the mobility of the individual and this was not reflected in the care planning objective or action plan. In addition, an incident had occurred which had been noted in the daily records. These events required a review of the care plan and the implementation of risk assessments. This had not been actioned. Care plans for the two other people living at The Westcliff Care Home were reviewed. Detailed personal assessments were seen with reference to the individual noted. Monthly reviews were recorded with the most recent review conducted in June/July 2007. Overall care planning documentation had improved. The only shortfalls being the lack of dating, updating risk assessments and the filing and archiving of old paperwork on some of the older care planning files. On the care planning files sampled there was evidence of health care needs being met. This was detailed in the daily records. Evidence was seen of visits by and to the Optician, General Practitioner and District Nurse visits and visits to the hospital. Records were seen of the weight of a person living at the care home and nutritional assessment records. Whilst these were seen as appropriate, no reference to them could be found in the individual’s care plan. This would have been expected, as it was relevant to the care and welfare of that individual. Medication administration, storage and dispensing was sampled and inspected at the site visit. Medication for three people who live at the home was sampled and inspected. Medication held in a secure medicines trolley was seen to be in good order, with a monitored dosage system (MDS) in place. Records were seen of medication entering the home and auditing processes are in place. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 13 The inspector was told that carers who administer medication have only received in-house medication training or a two-hour medication advisory session by the home’s pharmacist. The Deputy Manager thought that the last course had been over one year ago. Controlled Drugs were held in a cash tin fixed to the wall of a cupboard in the bathroom. The deputy manager was informed that this container was not acceptable for it did not comply with the Misuse of Drugs (Safe custody) Regulations 1973 requirements. In addition, the care home no longer uses a Controlled Drugs Register for the receipt, administration and disposal of Controlled Drugs. They were using pre-printed record sheets in an A4 file. Concern was also raised by the inspector as to the current practice of dispensing controlled drug medication. The deputy manager said that the home had the practice of dispensing and signing by two people for this medication in the bathroom, and then one carer taking this medication to the service user. They were therefore signing that medication had been given and witnessed to be given before it had been given. Observations of care during the site visit overall was both respectful and promoting dignity. Care staff were seen to go around the home knocking on bedroom doors and waiting for admittance and assistance was given in a sensitive manner. One inappropriate action was overheard in the dining area and when brought to the attention of the deputy manager they said that they would speak to the carer concerned. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 14 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The daily routine and activites in the home were flexible and optional, with people who live at The Westcliff being encouraged to make choices with regard to their social, cultural, religious and leisure activities. Family contact and visiting arrangements were open and relaxed, with family links encouraged and promoted. The Westcliff provides a varied and nutritious menu for individuals to select from. EVIDENCE: Throughout the day of the site visit, staff were seen interacting in a positive manner with the people living at the home. They were seen chatting with the people living at the care home as they went about their tasks. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 15 Within the three care plans sampled there was evidence of the individuals being able to exercise choice in the leisure and social activities they wished to pursue. This was particularly evident in the care plans of two individuals sampled. They were able to tell us what they enjoyed doing and how they were able to achieve this. One person said that they continue to attend concerts and clubs in the community and had regular visits to family and friends or they were able to entertain them in their room. Music was important and they enjoyed sitting in their room listening to their music and reading their newspaper. The second person living at the care home also chose to spend their time in their room. They were aware of some activities on offer in the home, but they chose not to take part. Survey work completed by the Commission for Social Care Inspection (CSCI) identified a lack of activities and outings as a shortfall. Three relatives commented that they wished their relatives were taken out for outings and one spoke of their relative suffering from ‘boredom.’ The deputy manager said that a designated carer is allocated one hour a week for activities and activities such as bingo and skittles are offered. This is clearly too little. Both group and individual activities need to be introduced. With the current personcentred care plans in place, the home should be able to identify meaningful and appropriate activities for all of the people living at The Westcliff. Whilst it was recognised that the management and staff of the care home were keen to offer and arrange activities the lack of staff and funds clearly limited this. The deputy manager, two care staff and two people living at the home raised these concerns as a hindrance to providing social activities. The deputy manager said that visitors are made very welcome and they are able to visit as they and the resident wish. One visitor spoken to during the site visit, confirmed this and said that the ‘staff were very friendly’. Within the survey work completed by Commission for Social Care Inspection (CSCI), three relatives commented on the welcome they received when visiting the home. One said that they found the staff ‘friendly’ and ‘ busy’ and they ‘always have time for questions.’ Another said that staff ‘show care and support for the individual residents’ and a third said that ‘There is always time to stop and have a chat with us when we are around the home’. During the site visit it was evident that people living at The Westcliff were able to move around the home as they wished. They were able to choose whether they wished to go into the communal areas or they were able to sit in their room. Evidence was seen of personal possessions in bedrooms. Items such as televisions, CD players, pictures, ornaments and photographs were seen in the bedrooms. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 16 People living at The Westcliff are supported and encouraged to manage their own financial affairs either with assistance from families, relatives or appointed persons. All three people who were part of the case tracking managed their own monies and therefore a further three persons monies were sampled. These were found to be in good order, with records held. A good practice recommendation was made regarding the use of an invoicing book for some billing. The Westcliff offers a four-week rotation menu with choices offered at lunch and tea. At least two choices of the main course and dessert are offered at lunchtime and teatime. The home’s cook said that fresh meat is purchased three times a week from a local butcher; fruit and vegetables twice a week from local suppliers and dried and tinned goods are purchased online from a supermarket. Two kitchen assistants provide cover when the cook is off. The majority of the people living at The Westcliff have their meals in the dining room at lunch and teatime, whilst breakfast is served in their bedrooms. A card record system is used to detail breakfast requests, but no records are kept of the food eaten at breakfast time. A good practice recommendation was made that records of food eaten at breakfast is added to the current nutritional record keeping to fully detail the meals eaten. Survey work completed by the Commission had comments such as ‘Food is good, well received’ from one person living at the care home and another person spoken to at the site visit said that they enjoyed their food and their likes and dislikes were taken into account. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 17 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. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People cannot be assured that they are fully protected by robust complaint and adult protection procedures in the care home. EVIDENCE: The Westcliff had a complaints procedure, which was reviewed and inspected on the site visit. As stated in the Annual Quality Assurance Assessment copies of the complaints procedure were found on notice boards in the home. This document needs to be reviewed for it made reference to the Commission conducting complaint investigations. This is not the role of the Commission and therefore the procedure needs to be reviewed and revised. A complaints logbook was found in the dining room and this detailed complaints received from people who live at the care home and their relatives. The most recent entries were in April 2007 related to laundry and food. The deputy manager said that both of these matters had been dealt with, with records held on the action taken on the individual’s files. Both an Adult Protection Policy and information giving the definitions of types of abuse were available within the care home. These need to be revised and reviewed for there were some inaccuracies and omissions regarding references The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 18 to current legislation and details regarding the referral process under safeguarding adults was not detailed in this document. The deputy manager related recent events, which had resulted in a disciplinary hearing and the dismissal of a care staff member. The concerns were a member of staff shouting at residents and medication administration. Following this site visit the registered manager was advised of the need to act on and consider making an adult protection referral regarding this matter. The deputy manager was unable to identify when the most recent adult protection training had taken place and one care staff member spoken to said they had not had any training in this aspect of care. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 19 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, 21 and 26. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, The Westcliff provides a safe environment that is accessible to the people who live at the home. It is homely and meets individual’s needs, with the exception of the bathing facilities. EVIDENCE: The Westcliff comprises of two Victorian houses situated on parallel roads in the town of Felixstowe. Initially the two properties were linked by a single storey extension, with a first floor extension added in 2001. Access to the first and second floor is by passenger lift and a stair lift. Since the last inspection, an enclosed garden area has been created at the Stanley Road end of the property. A new lawn has been laid. This area is to The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 20 be a designated garden area for the people living at the care home, but at the site visit it was looking uninviting with little planting evident and a large expanse of tarmac (the former driveway) and lawn. No people were seen to use this area on the day of the site visit. The only other outside sitting area was a small decking area off the dining room. Overall, the grounds were tidy and safe, although exterior paintwork was in need of repair. This was commented on in the survey work conducted by the Commission. A relative said that they felt the ‘Windows need to be cleaned more often and paintwork outside could be improved’ and another relative commented that they felt ‘more cleaning staff and money to keep the home in good decorative state and repair’ was needed. This was further confirmed at the site visit, for there was a slight odour problem in one bedroom and the decoration and colours of curtains and carpets were at odds with one another and did not enhance the room. It was noticeable that some areas of the home where decoration had been completed recently were markedly better than some other rooms and bathrooms in the home. Bathroom and shower facilities were found to be limited on the day of the site visit. Only two of the bathing facilities in the home were in use – the ground floor bath with bath hoist and the first floor shower. The shower located on the ground floor was said to be out of use and a second floor bathroom with a damaged bath panel was not used as the current resident group could not use this facility. On the first floor there was a bath with a bath chair. The deputy manager said that this bath was not popular as there was restricted space in the bath when using the bath chair. A third bath was located on the second floor and as this was not a full size bath, residents do not like to use this bath because of its size. The Westcliff has an in-house laundry service, which had one domestic and one industrial washer and one industrial dryer. At the time of the site visit, the home did not have a laundry person and it was noticeable that care staff were kept busy managing the laundry throughout the day. The deputy manager said that the home is considering appointing a laundry person. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 21 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. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff were not roistered in sufficient numbers to ensure that individuals needs are addressed. The people who live at the home are not protected by the home’s recruitment practices or a staff training programme. EVIDENCE: As at the last inspection, staffing levels were found to be low at the site visit. It was evident that care staff were working excessively long days (13½ hours) from 08:00 hours to 21:30 hours, resulting in one care worker working five long days plus two normal shifts of either 08:00 hours to 14:00 hours or 14:00 hours to 21:30 hours and no days off over a seven day period and two carers were working four long days plus three normal shifts of either 08:00 hours to 14:00 hours or 14:00 hours to 21:30 hours with no days off over a seven day period. A further three carers were working three to one long days of 13½ hours over a seven day period. In addition the management of the home needs to consider domestic, maintenance and catering staffing levels. The home currently has no laundry The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 22 worker and at weekends has no domestic, catering or maintenance staff. Care staff are expected to cover these duties. Care and management hours are clearly compromised for both care staff and the manager and the deputy manager are covering both care and domestic duties. An Immediate Requirement was left following the site visit and the home was required to review staffing arrangements in the home to reduce the excessively long working hours and to ensure that staffing levels meet the dependency needs of the current service users. Correspondence and clarification resulted in a review by the home of their current staffing levels. Staffing levels have been reviewed for the current occupancy of twenty-nine people at the care home. Staffing levels are now detailed as 5 care staff from 08:00 hours to 14:00 hours and 4 care staff from 14:00 to 21:30 hours, with 2 awake care staff from 21:30 hours to 08:00 hours. Whilst there has been some improvement, it is still noticeable that daily at least one carer is working a 13½ hour day. This is excessive and seriously impedes the fitness of carers working at the home. Whilst some consideration has been given to the dependency needs of the resident group the needs those people with dementia need requires further consideration. The building is large and spreads out over three floors, stretching between two streets and it is therefore not an easy layout and working environment to work in. The care home needs to review staffing levels again, reducing long working days and recruiting more auxiliary staff and care staff to fully meet the resident groups needs. The deputy manager was unclear as to whether the nursing qualifications held by the foreign staff are equivalent to a National Vocational Qualification (NVQ) level 2 in care. She said that the home currently employed 6 care staff with these qualifications. This was out of a total of 10 care staff. The deputy manager clarified the position regarding staff recruitment and employment with regard to foreign staff. The home continues to rely on a specialist agency to recruit these staff abroad and it is only on entry to the United Kingdom that the registered manager is able to assess the candidate’s English. The deputy manager said that this has resulted in some carers being rejected for care work at the home. People living at the home said that they had no problems with communication between themselves and the carers. Staff recruitment documentation had improved since the last inspection. The paperwork and processes for three care workers was sampled and inspected at the site visit. Omissions were found in written references – one carer had only a photocopy of a reference on file. This was not dated. Another file had just one very brief reference. Details on application forms were also found to be lacking. Fuller details are required regarding employment history and college details. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 23 Protection of Vulnerable Adults (POVA) first checks were completed for all three care staff and two had evidence of a completed Enhanced Criminal Record Bureau (CRB) disclosure. The third care worker’s disclosure was still awaited and they were being supervised whilst it was being processed. The deputy manager said that all new staff complete induction training to the required standard for Skills for Care. The newest member of staff was to be started on this training. No training records were viewed or inspected at this site visit. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 37 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service do not benefit from competent management. People who use this service do not benefit from a developed quality assurance and quality monitoring system. People who use this service benefit, from safeguarding cash held in safe custody and good record keeping. Health and safety certification and insurances promotes a safe working environment. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home has a relaxed and homely atmosphere. Both the registered manager and the deputy manager are in daily contact with the people living in the home. One person living at the home spoke highly of the management of the home, saying that they were both approachable and survey work completed by the Commission said that they found ‘Staff and Management are friendly and helpful.’ A quality assurance and quality monitoring system has been started. Surveys had been sent out by the care home to relatives in June 2007. The deputy manager said that they were waiting for their return and on completion a quality audit would be completed. Ways in which these results could be considered were discussed. Regulation 26 visits and reports were considered at the site visit. The most recent report held at the home was dated August 2006. The deputy manager was not aware of more recent visit reports. As detailed earlier in this report, people living at The Westcliff are supported and encouraged to manage their own financial affairs either with assistance from families, relatives or appointed persons. All three people who were part of the case tracking managed their own monies. The arrangements for the management of a further three persons monies were sampled. These were found to be in good order, with records held. A good practice recommendation was made regarding the use of an invoicing book for some billing. Records held on behalf of the people living at the home were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998. Records viewed at this inspection included: care plans, health care records, medication records, hot water temperature checks, fire alarm checks, fire alarm and emergency light and fire equipment test inspections, safety certification for a bath hoist and a mobile hoist and a passenger lift service and maintenance check completed 10/08/06. From discussion with the deputy manager and a review of correspondence with the care home it was evident that the registered manager had been failed to notify the Commission of any notifications of deaths, illness and other events as required under the Care Homes Regulations 2001, Regulation 37. Guidance is readily available on the Commission for Social Care Inspection (CSCI) website. A staff training overview for 2007 was viewed at the site visit. Basic training in fire safety, health and safety, manual handling, first aid and food hygiene are offered to all care staff. In addition, Skills for Care training and some The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 26 dementia care training has been offered and planned. Staff files sampled had evidence of some basic training courses completed by care staff in the past year. However, shortfalls already noted earlier in this report e.g. adult protection training and medication training need to be addressed. The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 27 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 3 2 The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14, Schedule 3 (1)(a) Requirement People who use the service must be assured that a full assessment of their needs is made prior to their admission, or immediately upon admission, including appropriate risk assessments. (This is a repeat requirement from the last inspection. Previous timescales of 27/07/06.) 2. OP9 13(2) 17(1)(a) Schedule 3(3)(i) People who use the service must be assured that Controlled Drugs are stored securely, administered and dispensed correctly to ensure their safety and well being. People who use the service must be assured that all staff have experience and skills to administer medication, including Controlled Drugs through the introduction of a training and development programme. 10/09/07 Timescale for action 10/09/07 3. OP9 13(2) 17(1)(a) Schedule 3(3)(i) 10/09/07 The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 29 4. OP12 16(2)(m) (n) People who use the service must be assured that that their social and leisure needs are addressed as identified in their care planning assessments. People who use the service must be assured that that they are safeguarded by a clear, accurate complaints procedure. People who use the service must be assured that they are safeguarded by clear, accurate adult protection procedures. People who use the service must be assured of a homely, comfortable and safe environment through the introduction of a planned maintenance and decoration programme. People who use the service must be assured of sufficient bathing facilities to meet their needs. People who use the service must be assured that there is an effective staff team to support their individual needs and assessment. This requirement is the subject of an immediate requirement notice. (This is a repeat requirement. Previous timescale of 20/07/06 was not met.) 10/09/07 5. OP16 22(1)–(7) Schedule 4 (11) 12(1)(a), 13(6), 17, 21 23(2)(d), (5) 16(2)(j) 10/09/07 6. OP18 10/09/07 7. OP19 10/09/07 8. OP21 23(2)(j) 10/09/07 9. OP27 18(1)(a), 19 10/09/07 10. OP29 19(1)(a)(c) (2)-(7) Schedule 2(5) People who use the service must be safeguarded by thorough recruitment practices and procedures. 10/09/07 The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 30 11. OP33 26 People who use the service must 10/09/07 be assured that they are safeguarded by the registered provider completing there monthly visits/reports and copies of the reports are readily available in the care home for inspection. (This is a repeat requirement. Previous timescale of 20/07/06 was not met.) 12. OP38 37(1)(a)(g) (2) People who use the service must be assured that that they are safeguarded by the registered manager notifying the Commission for Social Care Inspection (CSCI) of deaths, illness and other events as required by the Care Homes Regulations 2001 – Regulation 37. 10/09/07 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 OP8 Good Practice Recommendations People who use the service should be assured that their care plans include reference to health care record keeping and monitoring, so that it can be included in their plan of care. People who use the service should be assured that that 50 care staff have undertaken NVQ level 2 or equivalent. People who use the service should be assured that the home is run in their best interests through the development of a quality assurance and quality monitoring system. DS0000052323.V346156.R01.S.doc Version 5.2 Page 31 2. 3. OP28 OP33 The Westcliff Residential Care Home Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 The Westcliff Residential Care Home DS0000052323.V346156.R01.S.doc Version 5.2 Page 32 - 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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