Random inspection report
Care homes for older people
Name: Address: West Bank Residential Home Walford Road Ross-on-Wye Herefordshire HR9 5PQ two star good service 07/10/2008 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Blake Date: 0 1 1 2 2 0 0 9 Information about the care home
Name of care home: Address: West Bank Residential Home Walford Road Ross-on-Wye Herefordshire HR9 5PQ 01989562741 01989562741 helen@skirosetta.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : West Bank Residential Home Ltd care home 36 Number of places (if applicable): Under 65 Over 65 0 36 36 36 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 36 0 0 0 The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) 36 Mental Disorder, excluding learning disability or dementia - over 65 of age - (MD(E)) 36 Physical Disability - over 65 years of age - (PD(E)) 36 Date of last inspection 1 2 0 6 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home West Bank is a large detached period house in a quiet residential area. It is within walking distance of Ross-on-Wye town centre, and is also on a bus route. The home is registered to provide personal care for up to thirty-six people who are over sixty-five years of age. West Bank has thirty-three bedrooms, most of which are en-suite. The home is owned by Buckland Care Ltd. The Service User Guide does not contain information on the range of fees. The schedule of fees for the home is available from the manager. Copies of this report can be viewed at the home. Care Homes for Older People Page 3 of 10 What we found:
We carried out this inspection in order to follow up our concerns about peoples safety and to check if the requirements made at previous inspections had been complied with. This was an unannounced inspection, and took place over three hours. The report is written using the areas of concern as headings. NIGHT-TIME STAFFING: Previously we had been concerned that staff working in the two parts of the home at night were not able to communicate with each other. We saw that the home now has four waking staff at night, although this can occasionally go down to three staff. There is a new and improved communication system between the two parts of the home so that staff can access support easily. We had made a requirement that the home must ensure that peoples needs can be met in a timely manner. We consider that this requirement has been met. MEDICATION MANAGEMENT: At a previous inspection, we had seen a discarded tablet on the floor of one of the communal rooms. We made a requirement that the home must improve the way in which medication is administered, so that people receive their medication as prescribed. We observed a senior carer administering medication. She was careful to check that each person swallowed their medication before she signed to confirm that it had been administered. We therefore consider that this requirement has been met. We saw that one person dropped a tablet on the floor as it was being given to them. The senior carer picked the tablet up and gave it to the person to take. The senior carer then went to the medication trolley and popped two tablets out of a blister pack into her hand before placing them in a medicine pot. She was not wearing gloves and did not wash her hands at any stage of this procedure. This places people at risk of cross-contamination and is an infection control risk. We will be requiring the home to ensure that an effective system is put in place to ensure that medication is administered safely. We saw that medication was stored in a locked cupboard, and that it was dispensed from this cupboard for people in the main part of the home. The senior carer was careful to lock the cupboard whenever it was unattended. When medication was taken into the extension area of the home, which is where people with more advanced dementia live, it was transported in a locked trolley. We saw that some medication in Monitored Dosage Systems (MDS) was kept on top of the trolley and was not locked away. The manager explained that this was because the trolley was not large enough to store the MDS racks. The senior carer asked another carer to keep an eye on the trolley while she gave out the medication to people in the extension. This is not good practice, as the medication is not stored securely and there is a risk that people could access medication which has not been prescribed for them. Care Homes for Older People Page 4 of 10 We have written to the responsible individual requiring her to ensure that the home puts an effective system in place to ensure that medication is stored securely at all times. Because we consider that this is an issue which needs to be addressed urgently, we have given the home 28 days to comply with this requirement. The responsible individual has subsequently written to us confirming that another trolley has been purchased, so that all medication is now stored securely at all times. RISK ASSESSMENTS: We had previously required the home to ensure that risk assessments are carried out for any identified risk, and that the outcomes from these risk assessments are used to inform care planning. We looked at the care records for two people who live at the home and spoke to the staff who support them. We saw that one person had been assessed as needing specialist equipment for assistance with their mobility needs. We saw the person being transferred using this equipment. The transfer was carried out safely and records showed that the risk assessment had been reviewed recently. The care plan included good information about the use of the equipment. We observed that another person was being cared for in bed. The care records were not up to date and did not include details of their current condition. For example, the persons care plan stated that they were eating a normal diet, but the risk assessment dated May 2009 included information that the person cannot eat independently and has a liquidised diet. We spoke to staff, who were able to explain clearly what the persons needs were and how they would be met. We saw that there was a food chart in their bedroom, which had been fully completed with details of their food and fluid intake. The person appeared to be well hydrated and looked well cared for. Although the written records were not up to date, the staff knew how to meet the persons needs and were aware of potential problems such as the risk of pressure sores. We consider that the requirement about risk assessment has been met, but we will be making a requirement that care plans must be kept up to date, so that people can be confident that all staff know the care that needs to be provided. What the care home does well: What they could do better:
Care Homes for Older People Page 5 of 10 Some of the homes medication practices put people at risk, by not ensuring that infection control measures are in place and by not ensuring that medication is always stored securely. Care plans do not always reflect peoples current care needs, which could mean that staff may not be aware of any changes to peoples needs and condition. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 7 15 (2)(b) You must ensure that 29/01/2010 care plans clearly direct staff as to how they should care for and support people who use the service across all of their changing needs and conditions. This is so that people can be confident that staff know how to care for and support them. 2 9 13 (2) You must ensure that an effective system is in place to ensure that medication is kept safely and securely at all times. This is so that people are not put at risk. 31/12/2009 3 30 18 (1)(a) You must ensure that 29/01/2010 staff who administer medication are trained and competent to do so, so that medication is administered in a hygienic manner. This is so that people are not put at risk of harm. Care Homes for Older People Page 8 of 10 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 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
