Inspection on 22/02/07 for West Eaton House Nursing & Residential Home

This inspection was carried out on 22nd February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

West Eaton House Nursing &... 24/11/08

West Eaton House Nursing &... 28/11/07

West Eaton House Nursing &... 01/11/05

West Eaton House Nursing &... 25/08/05

West Eaton House Nursing &... 25/01/05

West Eaton House Nursing &... 27/09/04

West Eaton House Nursing &... 02/03/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE West Eaton House Nursing & Residential Home Worcester Road Leominster Herefordshire HR6 8QJ Lead Inspector Andrew Spearing-Brown Key Unannounced Inspection 09:10 22 and 27th February 2007 nd 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 West Eaton House Nursing & Residential Home DS0000027693.V331213.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. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Eaton House Nursing & Residential Home Address Worcester Road Leominster Herefordshire HR6 8QJ 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) 01568 610395 01568 614407 graeme@frontsouth.co.uk Frontsouth Limited Graeme Millar Beedie Care Home 33 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (33), of places Physical disability over 65 years of age (33) West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: West Eaton House is situated in a rural setting close to the town of Leominster. The two-storey building is suitable for its purpose and is in attractive grounds. The providers Frontsouth Limited also own homes in other areas of the country. The home has thirty-three beds and provides care for older people who either require nursing care or personal care. Residents who have additional physical disabilities or dementia can also be accommodated. None of the single rooms are twelve square meters so an assessment of equipment and space requirements for those residents with physical disabilities is essential prior to admission. The pre inspection information received by the Commission prior to this inspection stated that fees at West Eaton House currently range from £386.50 to £640.00 per week. Additional charges are made for personal items such as hairdressing, newspapers and private chiropody. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspector from the Worcester office of the Commission for Social Care Inspection (CSCI) carried out this inspection. The focus of any inspection carried out by the CSCI is to assess the outcomes for people who use the service. As part of the overall inspection of the service offered at West Eaton House two visits to the home were undertaken. Both visits were unannounced commencing at 9.10 am on the first visit and 10.15 am on the second visit. The last statutory visit to the home, which was also unannounced, took place during November 2005. This inspection takes into account information received by the CSCI since the previous inspection as well as the visits to the home. Prior to the visits a pre inspection questionnaire was posted to the registered manager requesting certain information. The information was returned to the commission before the inspection. In addition to the pre-inspection questionnaire a number of questionnaires were also sent to the home for residents, relatives and other persons to complete. A total of 14 residents questionnaires were returned to the CSCI prior to the inspection. In addition twenty-six comment cards were returned from relatives / visitors. Eleven comment cards were received from General Practitioners. The findings from the questionnaires are included within this report. A partial look around the home took place concentrating primarily on communal areas and facilities. The care documents of a sample number of residents were viewed including care plans, risk assessments and some other care records. Other documents seen included medication records, some service records and some staffing records. The registered manager was present throughout this inspection. At the start of this inspection the home accommodated 31 residents. In addition to the registered manager discussions took place with a number of trained nurses, some carers and the cook on duty. Discussions took place with a number of residents throughout the inspection as well as a small number of visitors to the home. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Documentation available to prospective residents and their representatives needs to be reviewed following some recent changes in the law as more information about fees has to be available. Written confirmation of the homes ability to meet care needs is not taking place. Improvements are needed to ensure that care plans are accurate and give the necessary information and detail to enable care staff to provide consist and appropriate care to residents. Evidence to demonstrate that some aspects of personal hygiene care needs are met were insufficient. The management and administering of medication needs to be improved to ensure the health safety and well being of residents. Some concerns were expressed regarding the availability of staff to undertake the feeding of residents. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 7 A number of health and safety matters were brought to the attention of manager in relation to the environment. A number of these concerns could potentially affect the health and welfare of residents and staff. Staff training shortfalls were identified and need addressing. The number of staff on duty needs to be reviewed to ensure that the care needs of residents can be met. Recruitment procedures were not sufficiently robust to ensure that residents are protected. 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. West Eaton House Nursing & Residential Home DS0000027693.V331213.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 West Eaton House Nursing & Residential Home DS0000027693.V331213.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): Standards 1, 2, 3, 4 and 5. Standard 6 is not applicable. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service users guide available to residents and or their representatives needs to be up dated and needs to include the recent changes in the regulations regarding fees and the nursing contribution. Although external formal training regarding dementia care is not provided the registered manager undertakes training however this is not recorded to evidence that it has taken place. Areas of good practice were seen involving staff and residents with a dementia type illness demonstrating a good knowledge base. EVIDENCE: West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 10 A copy of the service users guide was situated within the hallway for residents and relatives / visitors to view. The service users guide was briefly viewed and assessed. It was evident that the document is in need of up dating and reviewing. In one place it was noted that it stated that the ‘home is registered by the NCSC’. The NCSC (National Care Standards Commission) was the former regulator of care homes until the introduction of the CSCI in April 2004. In addition the information provided to potential residents needs to be reviewed due to changes made to the Care Homes Regulations, which came into force on the 1st September 2006. As a result of the changes to regulations further information now has to be supplied to residents including matters regarding the nursing contribution payment. The registered manager was aware of the changes to the regulations and recognised the need to amend the current documents including both the service users guide and the contract / statement of terms and conditions. Following any additional changes to these documents an amended copy should be sent to the local office of the commission. The previous inspection report dated November 2005 stated that the registered manager believed the assessment of need documents could be more detailed in their content although he felt they contained enough detail to formulate a care plan. As part of this inspection the assessment of a recently admitted resident was viewed. The above assessment contained brief details and some information as to how care needs could be met. From the details obtained a care plan was generated which covered the areas of need identified within the assessment. It was evident that family members or residents representatives are able to view the home prior to a potential residents admission. The registered manager was not aware of the need to confirm in writing that the home is able to meet care needs following their assessment. West Eaton House is registered to care for up to thirty-three persons who may have a dementia type illness. The care of persons with a dementia type illness is specialised therefore making it necessary for staff to received suitable training in order that care needs can be met. The registered manager stated that he has in the past provided this training and continues to provide input into best practice. The training is not however recorded to demonstrate what has taken place and when. The inspector did however witness one carer demonstrating good practice in her approach to meeting the care needs of one resident with a dementia illness. In addition another situation was observed involving the registered manager, a senior carer and a resident, the intervention was well managed and provided a good outcome for the resident who could of easily become distressed. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 11 West Eaton does not provide intermediate care and has no plans to provide such a service in the foreseeable future. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A care planning system is in place however it fails to fully demonstrate that all care needs are met and that changes to care needs are recognised and taken into account. Records indicate that medical care needs are addressed. Although some good records were seen a small number of shortfalls were noted regarding the management of medication. These shortfalls need to be addressed to ensure that residents receive the medication they require. EVIDENCE: As part of this inspection a number of randomly selected care plans were viewed. The previous inspection report (November 2005) concluded that care plans had improved since the earlier inspection (August 2005) and that they reflected care needs. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 13 Care plans were in place on each file viewed. The home does not maintain daily notes however records do exist of significant events and a record is held to direct staff to the files, which contain additional information. Although the actual existence of daily records does not form part of the regulations they are however a good source of evidence to show that care is being provided as detailed within the care plan. Furthermore daily notes can help ensure a consistent approach and good quality of care for residents. The National Minimum Standards state that care plans need to be up dated on at least a monthly basis to reflect changing care needs and current objectives for health and personal care. The care plans viewed demonstrated a range of care needs however the lack of daily records made it difficult to establish any small changes in identified needs over the course of the month. The registered manager was confident that these changes would be noted. It was however evident that some improvements in care documentation are required. Records are maintained of significant changes however this information was not always referenced within the care plan for example in relation a chest infection or following deterioration in mobility. Some parts of care plans were insufficient in the details and failed to give strategies as to how care needs could be met. As a result parts of some entries were too global therefore not enabling the reader to obtain a full and accurate account of care needs for example ‘encourage fluids’ on a care plan regarding a resident with a chest infection. Finally it was evident that when changes or events were noted the records failed to record further follow up action or indication as to whether the individual improved. Evidence to demonstrate that residents had received a bath or shower were insufficient. As no daily records are maintained the only other evidence available were temperature records however these were lacking. The care plan of a recently admitted resident was signed by the individual resident agreeing to its contents. Risk assessments were in place however it was difficult to fully establish the accuracy of the frequent reviews, which are taking place. Nevertheless risk assessments were seen regarding moving and handling, use of bed rails and pressure damage. Resident’s weights are recorded and screening upon nutritional care needs are in place. It was evident that medical needs are maintained. The registered manager and his staff team had a good knowledge of residents medical care needs. A number of questionnaires completed by GP’s were returned to the commission prior to this inspection. No concerns were highlighted upon the questionnaires returned; two contained additional information one stating that the ‘care seems very good’ while the other stated ‘knowledgeable staff and seniors.’ West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 14 Upon the questionnaires either completed by or on behalf of residents the majority stated they receive the care and support needed and all stated that staff listen and act on what is said. Residents and visitors who were consulted during the inspection visits to the home confirmed these positive comments. One resident stated that the care is ‘ second to none.’ The previous inspection report stated that ‘recording when medication was administered was excellent.’ As part of this inspection the storage and recording of medication was assessed including the examination of the current Medication Administration Record (MAR) sheets. The sheets in use are not pre-printed therefore each item of medication has to be recorded by hand. Each MAR sheet covers a 12week period as a result the start date on each sheet is not consistent due to the system in place. Hand written entries to MAR sheets need to be double signed therefore in the case of West Eaton House this needs to take place for all medication when entered on to record sheets; although this often happens frequent occasions when it did not happen were noted. MAR sheets did show any known allergies or stated none known when this was the case. The majority of MAR sheets were signed as required to evidence the administering of medication. A number of gaps were however evident on the MAR sheets whereby trained nurses (or senior carers in the case of residents receiving personal care) had failed to either sign for medication administered or enter a code if the medication was omitted. It was noted that one resident did not have an item of medication for 5 days because the drug was unavailable (the home had run out of stock). It was noted that correction fluid had been used on a small number of occasions; this must not be used on either MAR sheets or any other legally required document. It was of some concern that medication was still been administered late into the morning; the time on the MAR sheet was therefore incorrect. The registered manager stated that it was unusual for medication to be late and that he had ensured that residents who received medication late were those who were not also prescribed medication at lunchtime. Controlled medication is suitably stored. The records of one drug were checked against the amount held and balanced correctly. An up to date copy of the BNF (British National Formulary) for reference regarding medication was available. Residents consulted were complimentary regarding the staff at the home. The inspector had no concerns regarding the up holding of resident’s privacy throughout the visits. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Following the recent appointment of an activities coordinator the opportunities to stimulate residents and therefore enhance quality of life should increase. Meals served are well presented and nutritious using fresh vegetables where possible to provide a well balanced diet. EVIDENCE: Visitors are able to visit at any reasonable time. Visitors are able to use communal areas such as the lounges or dining area as well as residents own rooms as they wish. Visitors were seen signing in and out of the home and seemed to be made welcome within the home. A small kitchenette is available were staff as well as residents visitors can make drinks. The home is somewhat isolated from the local community however the home has a car, which designated staff can use to drive to Leominster on errands such as medical needs or to obtain shopping on behalf of residents. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 16 A list of Christian churches within Leominster was on display. Holy communion was reported to take place within the home once per month. An activities co-ordinator who was appointed during November 2006 was within the home during this inspection. The activities co-ordinator works 3 days per week. The questionnaires returned to the commission showed a variety of responses regarding whether activities are provided with the majority answering either usually or sometimes. The provision and suitability of in house and external activities and entertainment needs to be assessed further as part of a forthcoming inspection to ensure that residents social needs are met providing good outcomes for residents. Prior to the inspection the registered manager supplied the commission with a number of menus. These menus included the day of the first visit to the care home. It was noted that a number of residents needed assistance with feeding. This was generally carried out with sensitivity and in line with good practice. Staff members sat alongside residents while feeding them however it was noted that one member of staff had to feed two residents at the same time. It was noted and discussed with the registered manager that every resident within the dining room was wearing a disposable ‘bib’ and has a disposable sheet on their lap while eating lunch. A very brief observation suggested that these items might not be completely necessary for all individuals. The registered manager, while accepting this observation, commented that residents often requested these items to ensure that clothing was not stained. It is recommended that a review takes place to ensure that the use of these items is a positive choice and that residents dignity is fully upheld. Lunch on the second day of this inspection was a choice between beef hot pot or lamb casserole. The meal was served plated up from a heated trolley. The meals seen including those which were puréed were well presented and looked appetising. Fresh vegetables were seen within the kitchen store area. Residents were offered a choice of different squashes with their meal. A water dispenser is located in the dining room and jugs of squash were located in the lounge areas. Comments received prior to the inspection in relation to food and drink included: ‘Tea is too strong and not very hot.’ ‘The meals are excellent.’ ‘The sprouts are overcooked.’ ‘Meals are always very good.’ West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 17 West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a clear and accessible complaints procedure in place. Residents were confident that concerns would be listened to. Some staff have attended training in relation to adult protection. Together these areas assist in safeguarding residents. EVIDENCE: West Eaton has a complaints procedure, which was included within the service users guide held in the hallway of the home. The procedure is clear and includes the address of the Worcester office of the commission should anybody wish to raise any matters of concern with the regulator. The commission have not received any complaints, concerns or allegations since the last inspection. The registered manager stated that he had not received any complaints regarding the service provided although the complaints log was not sought during this visit. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 19 Residents consulted during this inspection stated (or indicated) that they would speak to Graeme (registered manager) if they had any complaints or worries. A copy of Herefordshire multi agency procedures was available within the manager’s office. The staff-training matrix evidenced that a number of staff have received training in relation to the safeguarding of vulnerable adults. It was reported that a further event is due to take place shortly as it was evident that not all staff have received this important training. During this inspection two senior carers were asked about the action they would take if an allegation of abuse were brought to their attention; the response given by both individuals was satisfactory. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 20 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): Standards 19, 21, 24 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Recent improvements have taken place within the environment to safeguard the health safety and welfare of residents. Further improvements need to be addressed in the near future to remove or reduce potential risks. EVIDENCE: Three lounges including one in a conservatory are located on the ground floor. The lounges were pleasant in appearance. A dining area is situated near to the lounges. Some of the furniture in the dining room is new in appearance with gliders fitted to chairs to make them easier to manoeuvre. Other furniture is older and needs to form part of a refurbishment plan. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 21 It was noted that some bedroom doors contained a single action lock, which is suitable for purpose. Other bedroom doors had no lock fitted, the registered manager stated that residents in these rooms would not wish to have a lock fitted. The absence of a lock on these doors needs to be kept under review. It was of concern to note that some bedrooms had a lever action lock fitted; in one case a key was in place. It is of concern as staff would not be able to access the bedroom in case of emergency should the door be locked with the key in the lock. It was noted that one freestanding wardrobe was secured to the wall. The registered manager confirmed that all wardrobes were suitably secure. The restraints fitted on some bedroom windows on the first floor were viewed. The home is currently replacing the devises to ensure they are suitable to prevent accidentally or intentional falling from windows. Some larger windows were locked to prevent opening although the registered manager assured the inspector that restrictors were in place. The current review of restrictors should continue and be continually re assessed to ensure residents safety. A passenger lift is available for residents to access all areas of the home. The inspector was informed that residents do not use the lift independently. As the lift does not have a full sensor around the door it is possible that the doors could close onto a person if the beam is not broken. A full risk assessment is necessary and suitable action must take place following the findings of this assessment to reduce or eliminate the risk. The home has two bathrooms on the first floor and one shower on the ground floor. The facilities appeared to be suitable to meet the needs of residents. One toilet on the ground floor is particularly suitable for wheelchair users due to the size of the room, this room is also used to stow wheelchairs. Storage and cupboard space within the home is limited. The laundry is located on the ground floor close to some bedrooms. It was stated that the door from the laundry forms part of the homes fire escapes therefore the laundry door cannot be locked. As a result it is imperative that the laundry area is safe in case residents gain access. A number of health and safety concerns were brought to the attention of the registered manager. The liquid detergent feeding the washing machine was easily accessible and needs to be secured. In addition a number of pipes from a hot water tank were uncovered and were within easy reach. Although a full assessment of pipe work was not carried out some unboxed hot pipe work was noted. A full assessment of pipe work needs to be carried out and suitable action taken. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 22 The sluice on the ground floor was found to be open during the second visit. Upon investigation it was discovered that the lock was on its catch therefore preventing it locking. It was of concern that somebody had done this as it left cleaning items unsecured. It was noted that all areas of the home viewed were clean. One resident described the home as ‘spotlessly clean.’ No offensive odours were detected. Personal protective equipment such as gloves and aprons were available around the home for staff to access. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Recruitment procedures were found to have some short falls, which could potentially place residents at risk. A review of staffing levels needs to take place to ensure that suitable and sufficient numbers are on duty at all times in order that care needs are able to be met. The number of qualified carers employed within the home is below the required standard. EVIDENCE: The duty rota was viewed as part of this inspection. The registered manager is on occasions the only trained nurse within the home and therefore has to carry out tasks such as the administration of medication as well management responsibilities. Duty rota showed that 5 carers plus one nurse to be on duty during the morning shift and 4 carers plus a nurse during the afternoon shift. 2 carers and a nurse cover the night shift. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 24 The dependency levels of residents such as the number of residents who need assistance in mobilising or feeding must be taken into account when determining the number of staff on duty. West Eaton House has a mix of both male and female carers. Staff responded well when a resident activated an emergency call. Domestic staff are employed commencing at either 6.00 or 6.30 am. It was reported that laundry duties are undertaken at this time. The file of one recently appointed member of staff was seen and gave some cause for concern in relation to the robustness of recruitment procedures within the home. The National Minimum Standards (Older people) state ‘Two written references are obtained before appointing a member of staff and any gaps in employment records are explored.’ One reference was dated following the commencement of employment while another was not dated and not signed. The registered manager believed that CRB (Criminal Record Bureau) disclosers under 12 months old were transferable between employers. Since the introduction of the PoVA (Protection of Vulnerable Adults) list this has not been the case. As a result the registered manager should have obtained at least a PoVA first prior to a new CRB before commencing the employment of the person concerned. The registered manager undertook to take immediate action to apply for a new CRB. An audit of all other files needs to be undertaken to ensure that a suitable CRB is in place. At the time of this inspection it was reported that 5 carers have achieved a NVQ (National Vocational Training) level 2 accounting for 33 of the total number of carers. Although some carers have a nursing qualification from outside the United Kingdom this training is not seen as equivalent to an NVQ award. It was anticipated, within the National Minimum Standards, that 50 of carers would have achieved an NVQ prior to 31st December 2005; West Eaton House has not therefore met this standard. A training matrix was viewed and discussed. The inspector was previously informed that staff had recently received training in relation to fire awareness; this needs to be entered on to the matrix to demonstrate that all staff have received this training. Other training gaps were evident primarily in relation to moving and handling. The records held showed that a number of carers had not received training in moving and handling; other carers received training during August 2005. The actual practice observed during this inspection was generally good with staff each wearing a handling belt, which were used during transfers. The inspector did bring to the attention of the registered manager one observation where a West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 25 resident was lifted who was not weight bearing. Hoisting equipment was used with some other residents. No training in relation to infection control has taken place other than induction training and unrecorded refreshers undertaken by the registered manager regarding infections. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 26 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): Standards 31, 33, 34, 35, 36, 37 and 38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The registered manager is a trained nurse and has extensive experience, management training as required needs to be sought to fully ensure that the home is managed effectively. The quality systems in place need to be developed to seek residents and relatives’ comments regarding the service provided Some health and safety matters including training need addressing, to fully safeguard residents. EVIDENCE: West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 27 The registered manager holds a nursing qualification. The National Minimum Standards state that the registered manager needs to obtain two qualifications one of which is covered by having an active nursing qualification. The second needs to be an NVQ (National Vocational Qualification) level 4 in managing care services. The registered persons need to ensure that suitable steps are put into place to ensure that the management qualification is obtained. One GP described the registered manager, upon a questionnaire returned to the commission, as ‘excellent.’ At the time of the last inspection (November 2005) the registered manager was continuing to develop a quality assurance programme. The planned course of action at that time did not continue and a commercial tool was purchased in its place. Although some work has taken place using this tool further work is necessary in order to fully self audit the service provided at West Eaton. The self-audit needs to take into account feedback from residents and their representatives The previous inspection report stated that the home did not act as appointee for any resident and that the home did not have facilities to keep personal monies secure therefore residents or next of kin were invoiced for any extras occurred. Although the above primarily remains to be the situation the registered manager did have access to money held on behalf of two residents. The balance of one residents money was checked and found to balance with the record held. Neither the homes Annual Development plan nor the business plan were sought during this visit. The registered manager confirmed that these documents would be available and open to inspection by the commission if needed at the head office A certificate of public liability insurance was on display however the date of expiry was August 2006 therefore 5 months before this inspection. Following a telephone call to the homes head office suitable evidence of insurance cover was faxed to the home. The certificate of registration was displayed as required. Under regulation 26 of the Care Homes Regulation the registered provider or a representative must visit on at least a monthly basis and prepare a written report upon the conduct of the home. These reports need to be given to the registered manager and available for inspection. No reports were available during this inspection. The pre-inspection questionnaire lists a range of policies and procedures that may be needed within care homes. It was noted that a number of these were not ticked as ‘in place’ when this form was returned. The registered manager West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 28 confirm that no policy and procedure is in place regarding a) access to records b) discharge c) sexuality and relationships and d) working with volunteers. It was noted that some staff were wearing jewellery; this can be a risk to the health and safety to residents and staff as well as an infection control concern. The registered manager confirmed that no policy existed regarding the wearing of jewellery. As highlighted earlier within this report a number of health and safety concerns were noted during this inspection including hot water pipes, the lift doors, access to the laundry and a sluice and locks on bedroom doors. Staff training concerns are also highlighted earlier including moving and handling. Although at least one qualified nurse is on duty at all times nobody has received appointed first aid training. The training matrix evidenced that staff have received first aid awareness. Some time was spent sorting conflicting evidence regarding the number of pieces of fire fighting equipment within the home. This was finally sorted to a satisfactory conclusion. The homes fire log was briefly seen. The registered manager was aware of the recent fire safety order, it is strongly recommended that the former guidance issued by Hereford and Worcester fire authority is incorporated into the homes fire risk assessment and procedures. It was noted on both visits that hoisting equipment was blocking a fire extinguishers within the entrance hall. Another extinguisher was blocked near to the kitchen by mops and a bucket. These vital pieces of equipment must not be blocked at any time. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 17 X 18 2 2 X 3 X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 3 X 2 West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 5A 5B Requirement The service users guide and if necessary the terms and conditions must be amended in line with recent changes to the regulations to ensure that residents are supplied with sufficient information. A letter confirming the homes assessment and the ability to meet care needs must be sent to potential residents or their representative. The registered manager must ensure that care plans are up to date and set out in detail the actions to be taken by staff in all aspects of health, personal and social care needs. The registered manager must ensure that Medication Administration Record (MAR) sheets are completed correctly following the administration of medication. Correction fluid must not be used. Timescale for action 30/04/07 2 OP4 14(1) (d) 31/03/07 3 OP7 15 (2) (b) 31/03/07 4 OP9 13 (2) 22/02/07 West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 31 5 OP9 13 (2) The supply of medication prescribed to residents must not run out. The registered manager must ensure that unnecessary risks to the health and safety of residents including door locks, the passenger lift, the laundry, pipe work and the sluice room are identified and as far as possible eliminated. The registered persons must review staffing levels to ensure that they are sufficient to meet the care needs of residents. The registered persons must ensure that at least 50 of carers have achieved an NVQ 2 or higher in care. The home must ensure that the appropriate checks are completed for all new staff prior to them commencing work. 22/02/07 6 OP19 23 (2) 22/02/07 7 OP27 18 (1) (a) 31/03/07 8 OP28 18 (1) (a) 30/06/07 9 OP29 19 22/02/07 10 OP30 18 (1) (c) The registered persons must 31/05/07 ensure that all staff are appropriately trained to meet the assessed needs of residents. The registered person must develop the quality assurance document in place. The registered person or a representative acting on their behalf must visit the home and prepare a report on a monthly basis. The report needs to be available to the manager and to the commission. The registered manager must ensure the health safety and welfare of residents within the DS0000027693.V331213.R01.S.doc 11 OP33 24 30/04/07 12 OP33 26 30/04/07 13 OP38 13 31/03/07 West Eaton House Nursing & Residential Home Version 5.2 Page 32 care home RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP15 OP19 OP38 Good Practice Recommendations The registered manager should continue to review the activities provided to ensure that the social and recreational care needs of residents are met. It is recommended that maintaining of residents dignity while eating meals is reviewed. It is strongly recommended that the former guidance issued by Hereford and Worcester Fire Authority is incorporated into current fire prevention procedures. West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 West Eaton House Nursing & Residential Home DS0000027693.V331213.R01.S.doc Version 5.2 Page 34 - 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!