Inspection on 07/10/08 for West Bank Residential Home

This inspection was carried out on 7th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Bank Residential Home 01/12/09

West Bank Residential Home 12/06/09

West Bank Residential Home 18/05/09

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: West Bank Residential Home Walford Road Ross-on-Wye Herefordshire HR9 5PQ     The quality rating for this care home is:   two star good 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: Sarah Blake     Date: 0 7 1 0 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. the things that people have said are important to them: They reflect 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 27 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): Name of registered manager (if applicable) Ms Judith Rosalind Powell Type of registration: Number of places registered: West Bank Residential Home Ltd care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection 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. This is the first inspection of West Bank since the change of ownership earlier this year. The home is now owned by Buckland Care Ltd. The Service User Guide does not contain Care Homes for Older People Page 4 of 27 Over 65 36 1 36 36 36 0 0 0 0 0 Brief description of the care home 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 5 of 27 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: two star good 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: We spent a day at the home talking to the people who use the service and the staff, and looking at the records which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. The information from these sources helps us understand how well the home is meeting Care Homes for Older People Page 6 of 27 the needs of the people using the service. 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 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 8 of 27 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 9 of 27 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. The home provides good information to help people decide if they wish to live there. Peoples needs are thoroughly assessed before they move in, so that the home can be sure that it can provide the care that is needed. Evidence: West Bank works hard to make sure that people have all the information they need to help them decide if they wish to live there. Many of the people who live at West Bank have a dementia illness, and the manager is very sensitive to the needs and wishes of family members in making this important decision. We spoke to relatives of people who live at the home, and they told us that they had been given plenty of information, and had found the staff and manager to be welcoming and very willing to answer any questions. We looked at the homes Statement of Purpose and Service User Guide, and these were both easy to read and Care Homes for Older People Page 10 of 27 Evidence: provided helpful information about life at West Bank. We saw that a senior member of staff had carried out a thorough assessment of peoples needs before they moved into the home. This means that the home can be sure that it can meet the needs of every person who lives there, and that staff know the care that needs to be provided. The home does not provide intermediate care, so Standard 6 was not inspected. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good standard of care for the people who live there, and the staff have a good understanding of the needs of people with a dementia illness. Medication is managed safely. Evidence: We looked at records for three people who live at West Bank. These showed that care is planned thoroughly and includes information for staff to help them provide care in the ways that people prefer. For example, we saw that one person is unable to communicate verbally and the care plan stated the importance of staff understanding the ways in which the person now communicates. The manager told us in the AQAA that the home uses the person-centred care planning system developed by the Alzheimers Society. This allows the home to concentrate on the strengths and abilities of each person who lives there. Although the care plans were thorough, they had not been reviewed recently. We saw Care Homes for Older People Page 12 of 27 Evidence: that the care plan for one person who is now confined to bed states that she enjoys spending time in the lounge and joining in the activities; something which she has not been able to do for several months. If care plans are not updated to take into account changes to peoples situation, staff may not know what care needs to be provided, especially if temporary or agency staff are employed. The manager told us that there is currently no deputy manager in post, but that she hopes to appoint one soon. The deputy manager will be responsible for reviewing and updating the care plans. The manager told us that she will start work on reviewing the care plans, and will then pass this responsibility onto the new deputy manager. This will mean that staff have accurate written information to help them provide the right care for each person. We saw records to show that healthcare professionals such as District Nurses and GPs visit whenever a person is unwell or if the home has concerns about anyones health. Earlier this year we sent out surveys to some of the professionals who visit the home, and all were very positive about the care provided. We spoke to three members of the care staff and they all showed a good understanding of the needs of people with a dementia illness. One member of staff told us that they always try to make sure that people who live at the home are given the opportunity to make decisions about their day to day life, for example, what time they like to get up in the morning and what they would like to eat. Another member of staff explained how important it is to understand the frustration experienced by people who cannot communicate verbally. We looked at the homes arrangements for the storage and administration of medication, and saw that these were safely managed. The local pharmacy had recently carried out an audit of medication, which showed that the home is managing medication satisfactorily. During the day we saw staff assisting people with their care needs in a respectful and caring manner. We spoke to relatives of some of the people who live at the home, and they told us that the staff are kind and do their best to encourage people to make decisions for themselves, as far as is possible. Care Homes for Older People Page 13 of 27 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. There is a range of organised activities, and these are planned to meet the individual needs of each person living at the home. The food provided by the home is nutritious and varied, and makes good use of fresh vegetables and local produce. Evidence: West Bank staff provide a range of activities for the people who live there. One of the care staff has responsibility for co-ordinating activities, and she tries to make sure that people have the opportunity for one to one activities as well as group activities. Staff sometimes accompany people for a walk into Ross-on-Wye, or people might choose to spend their one to one time having their nails done, tidying their bedroom, or a range of other day to day activities. The activities co-ordinator told us that there is an organised activity every afternoon, including monthly music and movement sessions and singsongs. This summer, some of the people living at the home had planted patio pots for the garden, and a Summer garden party had been held for relatives and friends. On the day of the inspection, a PAT (Pets as Therapy) dog was at the home, and we saw that people living at the home really enjoyed this. Care Homes for Older People Page 14 of 27 Evidence: Although the activities co-ordinator has had no formal training in the provision of activities for people with a dementia illness, she demonstrated a good understanding of the specific needs of the people living at West Bank, and understood the importance of knowing each person individually and understanding how the dementia affects their abilities. A local vicar holds a monthly communion service tailored to the needs of the people who live at West Bank. The manager told us that most people attend this service. Currently there are no people of other faiths living at the home, but the manager told us that the staff would do all they could to meet the needs of people of other faiths. One of the people living at the home was not fluent in English. We saw that a list of common words and their pronunciation in their first language had been put in the bedroom, so that staff were able to communicate with the person in their own language to some degree. This shows that the home is taking account of peoples individual needs. We looked at the menus for the month, and saw that there is a variety of meals and that these are nutritious and healthy, with fresh vegetables and meat from a local butcher. Lunch on the day of the inspection was beef stew with potatoes, runner beans and carrots, and rice pudding for dessert. The manager told us that the staff try to ensure that people living at the home get enough fresh fruit and vegetables. Main meals include fresh vegetables or finely chopped salad, and she told us that fresh fruit is sometimes served at teatime or supper, ready prepared so that it is easy for people to eat. Care Homes for Older People Page 15 of 27 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. People who live at the home and their relatives know how to raise any concerns, and are confident that they will be listened to. Staff are recruited using procedures which help to protect the people living at the home, by ensuring that only suitable staff are employed. Staff understand how abuse can occur and are trained in how to identify the signs of abuse and how to report concerns. Evidence: The homes complaints procedure is readily available to everyone who lives there and their families. We saw that each bedroom contains a copy of the procedure and it is displayed in the reception area. We talked to relatives of people living at the home, and they told us that they knew who to speak to if they had any concerns. The home had received one complaint during the past year, and this had been recorded in the homes complaints log. We saw that the complaint had been managed using the homes procedure. There has been one complaint made to the Commission for Social Care Inspection during the past year. The Local Authority has taken the lead on investigating this, and confirmed that the manager has been co-operative and helpful during their investigation, which is ongoing. Care Homes for Older People Page 16 of 27 Evidence: The home has good procedures for recruiting staff. When the home employs new staff, there are checks which must be carried out to ensure that unsuitable people are not employed. These include a Criminal Records Bureau (CRB) check and two written references. We looked at the files for three new members of staff, and saw that these checks had been carried out. We spoke to three members of staff, and they showed a good understanding of how to protect people from abuse. Training records showed that staff receive training in the protection of vulnerable adults. Care Homes for Older People Page 17 of 27 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. The home is comfortable and homely, and provides a safe environment for people to live in. Infection control is well managed. Evidence: West Bank provides a welcoming and homely place for people to live. There is an informal atmosphere where people are encouraged to use the lounges and dining areas throughout the day. There are two lounges downstairs, both of which have televisions. The manager told us that there are plans to provide access to the garden via a patio door from the smaller lounge. Currently the only access to the garden is either via the front door and side gate, or through the laundry. Both of these would require the assistance of a staff member, so it will be beneficial if people living at the home can access the garden without staff involvement. The garden is secure and is landscaped, with seating and tables. All the communal rooms are well maintained and have comfortable furniture. We saw that people are encouraged to personalise their bedrooms with their own furniture and ornaments. We saw that, in one bedroom, the drawers had been labelled to show the contents. The manager explained that the person whose bedroom it was liked to fetch her own clothes from the drawers, and the labels helped her to remember where each item of clothing was kept. This shows that the home is working to meet peoples Care Homes for Older People Page 18 of 27 Evidence: individual needs. We saw that one of the double occupancy bedrooms contained a privacy screen which was of the type which were used in hospitals many years ago. This type of screen does not provide full privacy for people when they are washing or dressing. The manager told us that this screen is shared with another double occupancy bedroom. This could increase the risk of infection spreading in the home. We have asked the manager to make sure that each double occupancy bedroom has its own privacy screen, and that these are designed to give maximum privacy to the occupants. There are three bedrooms in the basement, which are accessed via a lift. These bedrooms are quite dark and one of them has two windows whose only outlook is a stone wall directly in front of the windows. The manager told us that she is careful to make sure that the people who live in these rooms are happy, and that they tend to spend most of the day in the communal areas of the home. We spoke to the owners representative, who told us that the owners will look at these bedrooms and consider if they meet the needs of the people who live in them. The kitchen is due to be refurbished soon, and the home achieved a rating of Very Good for Food Hygiene from the Environmental Health Department in May 2008. People who live at the home and their relatives told us that the home is kept clean and tidy. One person told us in a survey that there is a high standard of cleanliness, and on the day of the inspection we observed housekeeping staff cleaning rooms. We spoke to staff about their understanding of infection control, and they were able to explain the procedures in the home for limiting the spread of infection. Care Homes for Older People Page 19 of 27 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. Staff at West Bank are kind and caring, and provide a good standard of care for the people who live at the home. There are not always enough staff on duty to meet the needs of people in a timely manner. Staff are well trained and are supported by senior staff and the manager. Evidence: During the day of the inspection, we observed staff providing care for people, and this was done with kindness and a caring manner. We received many positive comments about the staff from people living at the home and their relatives. However, many people told us that they were concerned that the home is sometimes short staffed. A healthcare professional who visits the home regularly told us in a survey it is sometimes very busy and clients have to wait to be attended to. A relative told us sometimes I come in and think where are the staff?, and another said the staff are very nice but are rushed off their feet sometimes: there are days when theyre very thin on the ground, its very noticeable. A member of staff told us in a survey form that there is a problem with staff always off sick making us short. On the day of the inspection, there were seven care staff on duty, and we saw staff rotas which showed that there are three staff at night. The manager told us that she has found it difficult to recruit staff. Recently the home recruited two new members of Care Homes for Older People Page 20 of 27 Evidence: staff whom the manager told us can only speak very basic English. This has caused some problems with the people who live at the home, and with other members of staff, as there is a risk that important information may not be understood or passed on correctly. We looked at files for three members of staff. All had received a thorough induction programme to prepare them for the work they would be doing at West Bank. Staff had also received some training in dementia care. Training records were not up to date, but staff with whom we spoke were able to tell us what training they had received and to demonstrate good knowledge of the topics covered. Staff feel well supported by the manager and the senior staff at the home. New staff are supervised and observed by senior staff, and all staff receive regular supervision sessions. Care Homes for Older People Page 21 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the people who live there. The health and wellbeing of the people who live at the home is given a high priority. Evidence: The manager is now registered with the Commission for Social Care Inspection, having been promoted from deputy manager. This leaves the home without a deputy manager; a situation which will be improved shortly, as the manager hopes to appoint a deputy. Since the last inspection in December 2006, the home has changed hands and is under new ownership. The owners representative visits the home regularly and provides a written report of the visit. Surveys received from healthcare professionals all showed a high degree of confidence in the home. The manager was able to demonstrate an excellent understanding of the Care Homes for Older People Page 22 of 27 Evidence: needs of people with a dementia illness, and she is clearly committed to providing a high standard of care to the people who live at West Bank. The manager is knowledgeable about the Mental Capacity Act, and how it affects the people who use the service, and she makes sure that staff are aware of its implications. The home does not manage peoples personal finances. Day to day expenses are met by the home, and invoiced to relatives on a monthly basis. If anyone wishes to keep a small amount of cash for their own day to day expenses, the home will provide secure storage but will not take responsibility for the cash. The manager completed the Annual Quality Assurance Assessment (AQAA) thoroughly. She told us in detail what the home does well, where improvements are needed, and how she intends to make these improvements. Our inspection confirmed that the AQAA was accurate and a good reflection of the current state of West Bank. The manager told us that she will be sending out questionnaires to the people who live at the home and their families at the end of the year, so that the home can carry out its own quality monitoring. Health and Safety are well managed. and the home employs maintenance personnel to ensure that the home is well maintained. Care Homes for Older People Page 23 of 27 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 27 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, 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 7 14 You must ensure that care plans are reviewed regularly and revised as necessary. This is so that staff know the care that needs to be provided for each person. 31/12/2008 2 27 18 You must ensure that 31/12/2008 sufficient staff are on duty at all times to meet the needs of the people who use the service. This is so that people who use the service have their needs met in a timely manner. 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 1 12 You should provide the opportunity for the activities coordinator to attend specialist training in the provision of activities for people with dementia. You should ensure that, where mobile screens are provided for privacy, they screen the occupant fully. This is to ensure Page 25 of 27 2 23 Care Homes for Older People that peoples privacy and dignity are maintained. 3 23 You should consider current guidelines and best practice regarding the environment for people with a dementia illness, when deciding whether the basement bedrooms meet the needs of the people who live in them. You should ensure that, where mobile screens are provided for privacy, they are not to be moved between rooms. This is to prevent the spread of infection, and to minimise the risk of harm caused by unsafe moving and handling. 4 26 Care Homes for Older People Page 26 of 27 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 © (2008) 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. Care Homes for Older People Page 27 of 27 - 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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