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Inspection on 24/11/08 for West Eaton House Nursing & Residential Home

Also see our care home review for West Eaton House Nursing & Residential Home for more information

This inspection was carried out on 24th November 2008.

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

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.

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

What the care home does well

The home has a committed team of staff who work hard to meet the needs of the people they support. Staff and managers have developed good working relationships with people who use the service. People are provided with a homely place to live. Bedrooms are personalised and the home is domestic in appearance.

What has improved since the last inspection?

The homes literature about the service has been replaced in the reception area, which is now up to date. Mental capacity assessments are now completed and incorporated into care plans. New equipment purchased in the kitchen.

What the care home could do better:

Staff should receive formal supervision at the required frequency, which is dedicated time set aside for staff to receive support and identify any training needs regarding their work. A quality assurance system should be in place to elicit the views of people who use the service, their relatives/advocates, staff and other interested stakeholders. The manager should be supported to undertake his management duties fully. This will enable him to develop sound management systems to ensure the home is run in the best interests of the people living at West Eaton House.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: West Eaton House Nursing & Residential Home Worcester Road Leominster Herefordshire HR6 8QJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Karen Powell     Date: 2 4 1 1 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: West Eaton House Nursing & Residential Home Worcester Road Leominster Herefordshire HR6 8QJ 01568610395 01568614407 graeme@frontsouth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Heritage Manor Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 33 Dementia (DE) 33 Old age, not falling within any other category (OP) 33 Date of last inspection Brief description of the care home 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, Heritage Manor 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 Care Homes for Older People Page 4 of 26 Over 65 0 33 0 33 0 33 Brief description of the care home meters so an assessment of equipment and space requirements for those residents with physical disabilities is essential prior to admission. Readers wishing to know the weekly fee arrangements should contact the home directly. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of the service was unannounced and took place on 24th November 2008 by one inspector over a period of five and a half hours. A range of evidence was used to make judgements about this service to include discussions with people using the service the registered manger, a senior manager of the organisation and staff. We also examined a number of records to include care records of people living at the home, staff training, staff recruitment and health and safety records. Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting them, discussing their Care Homes for Older People Page 6 of 26 care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Prior to the key inspection an Annual Quality Assurance Assessment, AQAA document was posted to West Eaton House for completion. The AQAA is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale. The registered manager completed this and some comments have been included within this inspection report. The purpose of the inspection was to assess all 22 Key National Minimum Standards for Care Homes for older people and any further standards necessary, including the remaining requirements and recommendations made at the last key inspection of the service. Information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. Fees range from 402.45 to 700.00 per week. Readers wishing to know more about this information should contact the service directly. 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 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Evidence: The home has an admissions procedure in place, which is documented in the Statement of Purpose and discussions with the manager demonstrated that he had a good understanding of the procedure. We looked at the file of the most recent person admitted to the home. We found that the registered manager had carried out a comprehensive assessment of the individuals needs, by visiting the person in hospital. This had taken place prior to the individual moving into the home. Through discussion with the registered manager and examination of the assessment documentation it is evident that information was Care Homes for Older People Page 10 of 26 Evidence: gained from a number of sources, including the hospital where the person was staying before their admission to the home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users care needs and risk assessments are set out in their individual plans of care, which are tailor made and ensure staff are provided with sufficient information for the delivery of care. Medication is managed effectively and in accordance with good practice. Peoples right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Evidence: It was stated on the AQAA that the home continued to embrace the practices of respect for care through care planning. They recognise the importance of documenting an individuals needs to ensure that they are able to plan the care to enhance the overall health and well being of people using the service. We examined the care plans of three people living at home in detail. We found them to Care Homes for Older People Page 12 of 26 Evidence: be clear and detailed, giving instructions to staff that provide care and support to people using the service. The home has undertaken training in the NHS Gold Standards Framework for Palliative Care. Letters of thanks from people who have had their loved one cared for in the end stages of their life were seen during the home tour. These comments included many thanks for the love and care shown to Mum while she was in your care, so beautifully cared for at West Eaton, she was treated with kindness, patience and respect and we had complete confidence in you all, we are unanimous in our praise for the manner during which you and your staff have cared for x during the three years at West Eaton and thank you most sincerely, the care and devotion and respect given to your clients is brilliant, although poorly her quality of life was the best it could have been at this time. Thank you so much for the wonderful way you all cared for mum during the last couple of years. Nothing was ever too much trouble at any time for any of you. She was extremely content living at West Eaton, feeling very safe and secure as indeed I did. It might not have been home but it has been the best thing. I always felt at home visiting her. I am so grateful to you all for making the last part of her life so happy. Assessments for risk such as nutritional, falls, manual handling, behaviours, and mental health were in place and we saw evidence of regular reviews. Discussions held with a number of people who use the service evidence that daily routines are flexible in accordance with their individuals preferences such as rising and retiring to bed. One person we case tracked had a risk assessment for the use of bed guards. Although the records stated the care plan and risk assessments had been reviewed, it was considered this had not been done fully. On examination of accident records it revealed that on three recent occasions the person was found on the floor during the night, and the use of bed guards had not been reviewed. It was discussed with the registered manager and director of operations who agreed for an urgent review and discussion with the individuals family and possibly the GP would be undertaken as a matter of urgency. Records held for the people we case tracked evidence that their health needs are monitored and kept under review and that the home arranges for health professionals to visit as required and all appointments and outcomes recorded. Medical histories were detailed in the needs assessments seen on the files we examined. On the day of the inspection visit the registered manager was liaising with a general practitioner in relation to the results of blood tests and the monitoring of the individuals medication as a result of the blood tests carried out. One health and social care professional who completed a CSCI questionaire as part of the pre inspection work stated on the few occasions I have come into contact I have Care Homes for Older People Page 13 of 26 Evidence: been unable to find any problems or feel concerned about anything. Aids and equipment were seen to be in place and in use in peoples rooms as detailed in the four care plans we saw, this ensures maximum independence for people. One person who was happy to talk to us told us the equipment in place was good and it not only protected them from being at risk if it were not in place but also the staff. The AQAA told us that the home has a medication policy and procedure in place, and that staff that administer medication have undertaken training in safe handling of medication. We looked at the storage of medication and administration records. We found these to be satisfactory. We also talked to a staff member on duty that confirmed that she had undertaken medication training. We also saw confirmation of training when we looked at certificates held on the individuals training files. Individuals felt that their dignity was maintained at all times. One person we spoke to was happy to tell us that his privacy and dignity in a shared room is not compromised in any way. Dividing curtains are in place between the two beds. Staff were seen respectfully speaking to people and addressing them politely. We saw staff knocking bedroom doors before entering. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to choose their lifestyle, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet peoples expectations. People who use the service receive a healthy, varied diet according to their assessed requirement and choice. Evidence: It was very clear from those spoken to during our visit that people are able to choose how they prefer to spend their days. Staff were seen to be attentive to peoples needs and there was a comfortable homely atmosphere throughout our visit. One person case tracked told us they choose to eat their meals in their room. Visitors were welcomed into the home, and seen to chat to staff in a relaxed way. There is one member of staff employed to offer social care to people living at the home. We spoke to her about her role, she is employed three days a week. She offers time to people on an individual basis or in small groups dependent on the activity taking place. She said that she spends time talking to service users, reads to them if they require assistance, assists people to write letters and assists people with feeding where required. It is hoped by the registered manager to increase the hours to offer Care Homes for Older People Page 15 of 26 Evidence: more activity time. Discussions with the cook evidenced that she is committed to providing people with a balanced diet taking into account special dietary needs. The menu was available to see and people told us the food is very good, we get nice things to eat and plenty of them, one person we case tracked told us they prefer not to eat lunch and that they have a good full English cooked breakfast every day, and a light meal at teatime. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives are able to express their concerns and have access to a complaints procedure. Procedures are in place to safeguard people from potential abuse and staff receive training ensuring people who use the service are protected from abuse and have their legal rights protected. Evidence: There is a clear complaints policy in place, which is in the statement of purpose. A copy of which was seen in the reception area of the home. It was stated on the AQAA that there has been one complaint received and dealt with at the head office. The complaint was not upheld. There have been no complaints to CSCI. The home has not had to refer any issues into the safeguarding of adults process since the last inspection. All staff receive training in the topic of safeguarding adults for which we saw evidence on individual training files examined. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Evidence: West Eaton House is a two storey building set in attractive grounds. The home was clean, tidy and warm on the day of our visit. People spoken with during the inspection indicated that they find their rooms comfortable. We looked at the rooms of those people we case tracked and seen that they were personalised with pictures, photos and ornaments. People living at the home are provided with a range of communal areas to use to include lounges and dining areas. The kitchen and laundry areas were clean and tidy. There is a dedicated house keeping team who keep the home clean and a maintenance man who keeps the home well maintained. Mains services are checked routinely by outside contractors and the maintenance man who has completed his training in Care Homes for Older People Page 18 of 26 Evidence: portable appliance testing undertakes this process. There are written infection control procedures for staff to follow to minimise the risk of infection. It was stated by the registered manager that infection control training is booked for all staff in the near future. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at West Eaton House are supported by staff that have been checked as suitable to work there. Training opportunities for staff are good, with access to both internal and external training to support their development. Evidence: The home has a robust recruitment procedure in place. The files of two of the newest recruits to be employed at the home were examined. All checks required by regulation were in place. We were satisfied that the recruitment process followed by the home protects people living there. Detailed examination of three training folders, for established and newer members of staff, showed that staff are provided with range of both basic and more specialist training, although on one file medication training certificate was dated 2002 which would suggest this training was in need of updating. Training files are in need of organising so that it clear to audit what training has been undertaken by staff. It was reported that an equality and diversity course was well attended last week, and on the day of the inspection nurses were undertaking syringe driver training. The homes induction process, consistent with Skills for Care expectations, is thorough and conducted over a period of time. We saw evidence of this on one out of the two Care Homes for Older People Page 20 of 26 Evidence: new staff files we examined. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at West Eaton House benefit from having a manager who is committed to meet their care needs. 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. Evidence: The homes manager is a qualified general nurse, with extensive experience of working in the care home. He has not yet started the registered managers award, which he and the service would benefit from, although as stated he has the necessary skills and qualifications to run the care home. Care Homes for Older People Page 22 of 26 Evidence: Mr Beedie is not supported by a senior or deputy and it was clear from this inspection that he would benefit from such support in order to for him to develop and carry out management duties to include the formal supervision of staff and quality management of the home. Further organisation of personnel/training files would better improve the audit process. The absence of a training matrix made it difficult to ascertain what training individuals had completed. Quality questionnaires have not issued since August 2007, therefore the home has not gained the views of people living at the home, their relatives, staff or other interested stakeholders. We saw compliments from people who had a relative cared for at the home in the end stages of their lives. These have been included earlier in the report. Feed back from CSCI pre inspection survey questionnaires were generally positive with no issues or concerns. Service users finances, where money is lodged with the home for safekeeping, are well managed and accounted for with detailed records kept of money given out or spent on someones behalf. All checks required such as of the fire safety systems, hot water systems, lifting equipment, gas and electricity are in place. People are protected through regular maintenance of systems and equipment and records to show this are well organised. Accidents and incidents are logged, recorded and reported to the manager. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 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 31 The registered manager should undertake the registered managers award or the Leadership and Management for Care Services Award. An effective quality assurance system should be developed. Staff should receive formal supervision at least six times per year 2 3 33 36 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 26 of 26 - 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. 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