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Inspection on 08/12/08 for The Westcliff Residential Care Home

Also see our care home review for The Westcliff Residential Care Home for more information

This inspection was carried out on 8th December 2008.

CSCI found this care home to be providing an Adequate service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Westcliff provides a safe, clean and comfortable environment. Residents tell us that their needs are met and they are well cared for. The home is in a good location for local amenities, and some rooms have lovely sea views. There is a relaxed atmosphere, visitors are made welcome and residents are treated with dignity and respect. The menu offers a wide range of meals that are home cooked, nutritious and appeatising.

What has improved since the last inspection?

Since the last inspection care plans have been developed so that they are more detailed and better reflect peoples needs and preferences. Residents records also have clearer information about medical advice and any action required by the home to address individuals personal and health care needs. The home has begun to show us that it meets the social needs of everyone at the home. It employs two activities co-ordinators who provide a range of group and individual activities and support. Since the last inspection a new walk in shower has become fully functional and this has improved bathing facilities at the home. The deployment of staff has improved so that staff are not working long hours without appropriate breaks or rest days. There was also evidence that staff had received appropriate adult protection training. Reports of visits undertaken by the registered provider are now held at the home and are available for inspection.

What the care home could do better:

The home needs to continue to develop individual care plans so that they clearly reflect everyones needs and preferences, particularly people with more complex needs such as dementia. This will be helped by their plans to provide a more advanced level of dementia training to staff. The homes Annual Quality Assurance Assessment should be more detailed so that we can see how the home evidences what it does well and how they intend to improve. The home has had two requirements following this inspection. They are related to the safe handling and administration of medication and medication training for staff responsible for handling medication. The home must ensure that medication procedures fully protect residents and staff are suitably trained and competent to administer medication.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Westcliff Residential Care Home The Westcliff Residential Home 51 Leopold Road Felixstowe Suffolk IP11 7NR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tina Burns     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Westcliff Residential Care Home 51 Leopold Road The Westcliff Residential Home Felixstowe Suffolk IP11 7NR 01394285910 01394271154 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hazelwood Care Limited Name of registered manager (if applicable) Mrs Margaret Jean Crowley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 26 care home 33 Over 65 10 33 0 0 Brief description of the care home 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. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection which focused on the core standards relating to older people. The report has been written using accumulated evidence gained prior to and during the inspection. The homes manager Mrs Margaret Crowley was present during our visit and fully co-operated with the inspection process. People living at the home were referred to as residents and this term has been used throughout this report. The inspection process included a tour of the building and observations throughout the day. The inspector also spoke with several residents, the manager, staff members and a visiting relative. Records examined included three residents care plans, three staff files, health and safety and maintenance records. Further records viewed are detailed Care Homes for Older People Page 6 of 26 in the main body of this report. Information was also provided in the homes Annual Quality Assurance Assessment that was completed by the registered manager and submitted to us in September 2008. We also received completed survey forms from one resident, one relative, one member of staff and two health care professionals. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 26 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can expect to be provided with the information they need to make an informed choice about where they live. They can also expect to have their needs assessed prior to moving into the home. The home does not provide an intermediate care service. Evidence: There was a wide range of information displayed through out the home including copies of the Service User Guide and Statement of Purpose and feedback from residents and their relatives confirmed that they were given enough information about the home to help them decide whether or not it was suitable. Records examined and discussion with the manager confirmed that prospective residents have an initial assessment of their needs completed before moving into the home and a further, more comprehensive assessment is undertaken after they have Care Homes for Older People Page 11 of 26 Evidence: moved in. The assessments seen in the three residents records examined covered a wide range of areas including; general health and personal care needs, mobility, mental health and social and cultural needs. Further more discussion with residents and their relatives during the inspection and feedback we received told us that people living at the home receive the care and support they require to meet their needs. The home does not provide intermediate care. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect to have their personal and healthcare needs met in a way that protects their privacy and dignity. However, they cannot be assured that they will be safeguarded by the homes procedures for dealing with medication. Evidence: Discussion with the manager and records examined evidenced that since the last inspection the home had improved care plans so that they were more detailed and individualised. The plans covered areas such as diet and nutrition, sensory needs and communication, personal care, oral health, foot care, mobility and dexterity, history of falls, continence, mental state and cognition, social interests and hobbies, religious and cultural needs, carer and family involvement, nursing input and medication. Residents spoken with and observations made throughout the day confirmed that overall individual care plans ensured their needs were met. However, the care plan of one resident with dementia did not fully reflect their needs and although staff were observed to be helpful and empathetic a more comprehensive care plan may have enabled them to provide support more effectively. Another residents care plan did not Care Homes for Older People Page 13 of 26 Evidence: reflect their preferences regarding the frequency that they liked to be given assistance to bathe. The manager agreed to ensure the relevant care plans were further developed. Residents records examined included health profiles and a record of their health appointments and visits and the outcomes. There was also clear information about medication and their dental, optical and hearing requirements. Weight and nutrition was assessed on a monthly basis. Records seen during the inspection confirmed that the home works in partnership with a range of health care providers so that residents health care needs are met, for example GPS and district nurses. Surveys that we received from two health care professionals were very positive and confirmed that the home seeks and acts on advice appropriately. Comments included I have always found the management and staff to be very professional and helpful. All the residents I see seem very happy and well cared for. One member of staff was observed administering lunch time medication. They were polite and respectful throughout the process, they ensured people had a drink to take their medication with and they waited with them while they took it. The Medication Administration Records (MAR charts) included photographs of each resident prescribed medication. Those looked at had been appropriately completed, there were no gaps identified and staff administering the medication had signed with their initials. There was also appropriate use of codes to identify if medication had been refused or not taken for any reason . However, observations made and discussion with the manager and the member of staff concerned identified a number of shortfalls in the homes medication procedures; There were times during the medication round when the trolley was left unlocked and unattended. The carer repeatedly handled medication with their fingers when administering direct from bottles and one resident prescribed half a tablet three times a day had their half tablet stored in a pot with their name on for administration later in the day. Further more, secondary dispensing sometimes took place because of the difficulty getting the medication trolley to bedrooms on the first and second floors. Observations were that staff interacted positively with residents and were polite and respectful at all times. All personal care was given in the privacy of residents rooms and people requiring assistance were attended to promptly. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to maintain contact with their families and friends, participate in recreational activities of their choice and enjoy healthy and appetising meals. Evidence: Observations made and people spoken with confirmed that visitors are made welcome at the home and residents are supported to maintain contact with their friends and family. On the day of inspection several residents were enjoying visits from their relatives and there was a very pleasant and sociable atmosphere. Residents could meet with their visitors in one of the communal areas of the home or in the privacy of their own bedrooms. At the time of our visit all residents had their own bedrooms, with the exception of one married couple who shared. Bedrooms seen were very personalised and confirmed that residents were able to bring some of their own possessions and personal effects with them when they moved into the home. People we spoke with told us that there is usually activities arranged by the home that they can take part in. These tend to be led by one of the two part time activities coCare Homes for Older People Page 15 of 26 Evidence: ordinators employed at the home. One of them was on duty on the day of inspection and was observed assisting a group of residents making some christmas decorations. Observations made, records seen and feedback from residents and staff also confirmed that they routinely provide one to one support so that people can get out and about in the community to do things like shopping or going to a cafe. The activities co-ordinator also told us that they spent time on a one to one basis with residents that found group activities difficult, this was the case for one of the residents we tracked who had dementia and preferred to spend most of their time in their room. They particularly enjoyed having a manicure and having their hands massaged. The co-ordinator told us that they referred to care plans to see what residents needs and interests were and this is where they had begun to keep a record of activities people had participated in. Information about local churches of various denominations was displayed on the homes notice board together with telephone contact numbers and there was also a carol service advertised. An afternoon of minced pies and sherry whilst watching A Christmas Carol was also planned and an entertainer had been booked for the homes christmas party later in the month. There was also a notice saying that the local mayor would be visiting the home on 19th December. People could take their meals in the large dining area or in the privacy of their own room. The dining area was pleasant and comfortable with enough space to seat everyone. Dining tables were attractively set with tablecloths, place mats, napkins, condiments, glasses and juice. The lunch provided looked wholesome and appetising. Feedback from residents and the menu on display confirmed that there is always a choice of meals. On the day of inspection most people were having steak and kidney pie with potato and vegetables. Comments we received about meals were very positive and included Food is very good. You cant fault it, I have seen good standards regarding food and meal times and Its excellent. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect their complaints to be listened to, taken seriously and acted upon. Further more they can expect to be safeguarded from abuse. Evidence: The home had a complaints procedure in place, which was displayed on the wall in the foyer. Information provided in the homes Annual Quality Assurance assessment and records seen indicate that there has been no formal complaints made since the last inspection. Discussion with the manager and feedback from residents suggest that any issues raised are dealt with promptly and resolved before they reach the complaints stage. The people we spoke with told us that they found the manager and deputy manager approachable and helpful. They said that they knew how to make a complaint and felt that staff listened to them and acted on what they had to say. The manager confirmed that the home works within the Suffolk Inter Agency Protocols for safeguarding adults. Care workers spoken with said that they knew the procedures for reporting concerns and training records examined evidenced that adult protection training was provided. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to benefit from a homely environment that is safe, clean and well maintained. Evidence: At the time of inspection all areas seen were tidy, safe and clean and the home smelled fresh and pleasant. The manager advised us that they employed two full time and two part time domestics and people we spoke with confirmed that the home was always clean. One resident said Its excellent..the place is exceptionally clean. The furniture, decor and facilities provided were comfortable and pleasant and created a homely and relaxing environment. Observations made, information provided in the AQAA and discussion with the manager confirmed that the home has an ongoing redecoration and maintenance plan in place. Since the last inspection several rooms had been redecorated and a number of carpets had been replaced, further more the shower room that was being installed was finished and fully functioning. Residents had the use of two communal lounges, one at either end of the home, and a large dining room with an additional adjoining lounge area situated in between. It was this area that seemed to be the heart of the home; where most people gathered to socialise, participate in activities or simply have their meal together. Care Homes for Older People Page 18 of 26 Evidence: The laundry was appropriately equipped with two commercial washing machines and a tumble dryer. Procedures were in place to ensure that clinical waste and soiled linen was handled safely. There was a stock of disposable aprons and gloves for staff use. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite some shortfalls in training, residents feel that there needs are met. Further more they can expect to be protected by the homes recruitment procedures. Evidence: Discussion with the manager and records examined confirmed that appropriate recruitment checks are carried out before people start working at the home. There was also evidence that staff induction programmes met the skills for care common induction standards and ongoing training was provided in core areas such as manual handling, protection of vulnerable adults, first aid, food hygiene, fire safety, health and safety and care planning. The homes Annual Quality Assurance Assessment tells us that only one of the seventeen care staff employed has completed NVQ level 2 in care or above. However, discussion with the manager and some of the staff on duty confirmed that eight more care workers are currently working towards completing the award and this means that the home is on the way to achieving the target of fifty percent qualified staff. Observations made and feedback from staff and residents indicated that the home is suitably staffed to meet residents needs. People told us that they always receive the support they need and assistance is given in a timely manner. Further more, staff and Care Homes for Older People Page 20 of 26 Evidence: residents spoken with and observations made during our visit indicated that although most care workers have been recruited from overseas and do not speak english as their first language, they have suitable language skills to communicate with residents. Discussion with the manager and examination of the staff rota confirmed that since the last inspection the rota is planned so that care staff do not work long hours without suitable breaks or rest days. Also, in addition to the manager, deputy manager and care staff there is a team of ancillary staff including a cook, kitchen assistant, maintenance worker and domestic staff. Records seen and staff spoken with confirmed that care workers currently undertake a short training session on dementia awareness but there is no one at the home with a specialised knowledge of dementia care. The manager advised that they had already identified dementia care as a priority training need and further training in this area was planned. Observations during the medication round (see section on personal and health care) and discussion with staff on duty indicated that the training provided to staff responsible for administering medication was not suitably thorough. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect the home to promote and protect their health, safety and welfare. Evidence: Margaret Crowley is the registered manager and has worked at the care home for many years. She has the Registered Managers Award and NVQ level 4 in management of care. On the day of inspection they could not provide us with any evidence to confirm that they undertake periodic training to update their knowledge and skills. However they said that they would bring their certificates in to display at the home and include all relevant information about their training in the Statement of Purpose. The manager was fully co-operative and receptive to the inspection process and welcomed discussions about how the home could improve. Feedback received from staff and residents throughout the course of the inspection confirmed that they found Care Homes for Older People Page 22 of 26 Evidence: the management team approachable and helpful. Observations made, records seen and people spoken with confirmed that there were appropriate health and safety procedures in place with regard to fire safety, food hygiene and infection control. Hot water temperatures were regularly monitored and close to 43 degrees centigrade. Staff training records viewed evidenced that staff had been provided with health and safety related training such as manual handling, food hygiene, first aid, COSHH (control of substances hazardous to health) and fire safety. However, our findings regarding the homes practice for handling medication (see Health and Personal Care section) indicated that systems in place for monitoring internal policies, procedures and practices were not suitably robust. The home has quality assurance processes in place that include asking for the views of residents, relatives and staff through surveys. Residents are also asked for their views at residents meetings. At the time of our visit the views of people had not been fully assessed. The homes Annual Quality Assurance Assessment that was submitted to the Commission in September 2008 provided some useful information but overall it did not fully evidence what the home does well and how it intends to improve. Regulation 26 visit reports were viewed and confirmed that the registered provider visits the home on a regular basis. The manager also completes Regulation 37 notifications for the Commission. Some discussion took place with the manager about the range of notifications required and we asked them to ensure that where we are notified of deaths we are given more detail about the circumstances. The Statement of Purpose tells us that the home does not handle residents pension books or cash or manage their financial affairs. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be administered safely and secondary dispensing must not take place. This is to safeguard residents at the home. 12/01/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 13 The training provided to 31/01/2009 staff responsible for the safe handling of medication must be reviewed. To ensure that it is suitably thorough and safeguards residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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