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Inspection on 25/08/05 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 25th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Residents` rooms are personalised and staff were seen interacting with residents in a kindly and friendly manner. The service offered to residents is personalised, a member of staff was taking a resident to an optician`s appointment.

What has improved since the last inspection?

The registered manager has spent time on a recruitment drive and the induction of new staff into the home. Carpets have been replaced in six bedrooms and the dining room.

What the care home could do better:

The registered manager oversees two other homes in the group in Worcestershire; both have required time away from West Eaton.Care plans are of a poor quality and do not reflect current care needs. Risk assessments are out of date. Documentation required by legislation has not been submitted to the Commission for Social Care Inspection. Staff were unable to locate hazard warning sheets which give first aid treatments for spillages or ingestion of hazardous products. Some of these products were found stored in an unlocked cupboard and were readily available to residents, which placed residents at an unacceptable risk. A number of environmental safety issues were identified during the inspection such as bars of soap for staff to wash hands which breaches infection control policies. Fire doors were wedged open; rooms which should have been locked were open and accessible to residents.

CARE HOMES FOR OLDER PEOPLE West Eaton House Nursing and Residential Home Worcester Road Leominster Herefordshire HR6 8QJ Lead Inspector Chrissy Presley Unannounced 25 August 2005 08.50 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 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 and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service West Eaton Nursing and Residential Home Address Worcester Road Leominster Herefordshire HR6 8QJ 01568 610395 01568 614407 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Frontsouth Limited Graeme Millar Beedie Care Home with Nursing 33 Category(ies) of DE(E) Dementia (over 65) - 33 registration, with number OP Old Age - 33 of places PD(E) Physical Disability (over 65) - 33 West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 January 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 accomodated. 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. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the morning, the registered manager had a meeting in another home and had to leave; time was spent with the team leaders. The inspection concentrated on care plans, risk evaluations, medication and a tour of the premises. Four residents, five staff including the cook and registered manager were spoken to during the course of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The registered manager oversees two other homes in the group in Worcestershire; both have required time away from West Eaton. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 6 Care plans are of a poor quality and do not reflect current care needs. Risk assessments are out of date. Documentation required by legislation has not been submitted to the Commission for Social Care Inspection. Staff were unable to locate hazard warning sheets which give first aid treatments for spillages or ingestion of hazardous products. Some of these products were found stored in an unlocked cupboard and were readily available to residents, which placed residents at an unacceptable risk. A number of environmental safety issues were identified during the inspection such as bars of soap for staff to wash hands which breaches infection control policies. Fire doors were wedged open; rooms which should have been locked were open and accessible to residents. 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. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 Residents are assessed prior to admission to ensure their needs can be met; staff are kind and friendly to residents. EVIDENCE: The assessment of need documentation was inspected; the document used satisfied the requirements of the Standard, more specific information needed to be collected at the assessment to ensure all aspects of care needs could be met by the home. Staff were observed speaking kindly and addressing residents needs during the inspection, staff felt there were not enough staff on at times to meet the needs of residents however the registered manager ensures that staff shortages through sickness or holiday are addressed if possible; there is always a senior manager on call. There were language barriers with some staff. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 &10 Care plans did not reflect current care needs and placed residents at unacceptable risk. EVIDENCE: Four care plans were inspected. On inspection it was noted that these did not reflect current care needs, had not been reviewed regularly and contained out of date information. Risk assessments for falls had not been audited and a resident who had had two falls within 48 hours had not had the care plan reviewed to reflect this current care need. Care plans on two occasions stated weight continues to drop yet no nursing intervention followed. Care needs for all aspects of care were not specific. Resident’s in the home had a tendency to wander outside and one care plan seen did not contain a photograph as required by the Care Homes Regulations 2001 and therefore placed any resident newly admitted to the home at an unacceptable risk level. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 10 Medication was observed to be given out in accordance with the homes policies on medication administration. There were a number of signature gaps on the medication charts seen, medications not signed for included diabetic medication. The medication fridge was open and the door to the office was wedged open, making this medication accessible to untrained staff, ancillary staff and residents. Staff were observed treating residents kindly and talking to them when they had time in a friendly manner. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 &15 There is currently no activities co-ordinator employed residents are therefore offered limited activities. EVIDENCE: The home’s activities co-ordinator was on maternity leave and the registered manager had been unable to recruit a replacement, residents were offered a limited variety of activities. Staff said they had very little time to spend with residents to undertake activities due to resident’s personal care needs becoming more complex over the past year. Some external activities were sourced. It was pleasing to note residents were escorted to appointments by one of the homes staff, who was insured to drive residents to and from appointments. Lunch on the day of inspection was Roast Lamb or Fish Fingers the alternative choice for those residents who did not like Lamb was not appropriate. There were no fresh vegetables being served on the day of inspection. Food was not being heat probed on a daily basis, and therefore placed residents at risk. There was an up to date record of food given to residents. The Environmental Health Officer had visited the home and requirements from that report had been acted upon, including fitting an air conditioning unit in the kitchen. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 12 The fire door leading into the Kitchen did not close on its rebate, and was therefore a fire hazard an immediate notice was left with the home to ensure this was addressed immediately. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards in this section of the inspection were inspected during this visit. EVIDENCE: There have been no complaints to the Commission for Social Care Inspection since the last inspection West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,24,25 & 26 Residents’ safety is compromised there being a number of unacceptable environmental risks around the home, making it unsatisfactory for the residents safety and comfort. EVIDENCE: The home was clean and odour free except one bedroom on the day of inspection. Bedrooms had been personalised, not all bedrooms had lockable storage space for money or valuables. On the day of inspection the double rooms had single occupancy. A number of fire doors did not close on rebates or were wedged open. The fire log book was inspected and contained a number of shortfalls with regard to testing and inspecting equipment such as fire extinguishers and emergency lighting. Records of bath temperatures could not be found in one bathroom and recording had lapsed in another bathroom. A number of toiletries were found in bathrooms. The staff toilet did not have a toilet seat, and the lid to the cistern was missing. There was no soap hand wash for staff. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 15 There was no evidence of a room audit and no evidence of furnishing belonging to residents kept in care plans. During a tour of the premises it was noted a residents bedroom was being used as a hair dressing salon for other residents this practice must cease immediately as residents rooms should be considered their own personal and private space. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 At times during the day staffing levels do not meet the needs of the residents. EVIDENCE: From staff rotas seen, observation during the inspection and speaking with staff there was evidence there were not enough staff on duty throughout the day to meet the needs of the residents in the home. The registered manager has spent time away from the home recruiting staff and ensuring new staff have a full induction programme, he agreed this had caused some of the shortfalls identified in this report. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 37 & 38 Health and safety of residents and staff working in the home is compromised, risk assessments are not in place and care is compromised. EVIDENCE: Hazard warning sheets giving information about first treatments for hazardous products which might be spilt or ingested could not be found by the team leader on the day of inspection. Immediate requirement notices were left with the home. An environmental audit was required as there were a number of health and safety issues including a carpet, which was badly frayed by a door into a residents bedroom causing a potential trip hazard. On checking records at the Commission there was evidence the Commission not received recent notifications under Regulation 37. These notifications were of a serious nature. West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 1 3 2 x x 2 3 2 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 2 x x x x 2 2 West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 19 yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14 Requirement The assessment of need document filled in prior to admission must be more specific to ensure care needs can be met and a care plan formulated Residents plans must cover all aspects of care needs and must reflect current care needs Care plans must have up to date risk assessments in place and must be reviewed monthly Residents whenever possible must be involved in drawing up their care plan All care plans must contain a photograph of the resident Identified risks must be acted upon; weights of residents must be audited Wound dressing must be more precise and wounds must be dressed in accordance with a properly written care plan Inappropriate language must not be used in care plans Medication must be signed for when administered The medication fridge kept in the office must be locked at all times Timescale for action Immediate 2. 3. 4. 5. 6. 7. OP7 OP7 OP7 OP7 OP7 OP7 13,15, & 17 13 15 13& 17 Schedule 3 13 13, 15 & 17 17 Immediate Requirment Notice Immediate Immediate Immediate Immediate Immediate 8. 9. 10. 11. OP7 Immediate OP9 OP9 13(2) 13(2) Immediate Immediate Page 20 West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 when not in use 12. OP12 16 Residents must be offered a stimulating range of activities and records of activities must be kept Residents must be offered a nutritious diet including fresh vegetables and an adequate second choice of meal Hot food must be probed and records kept Fire doors must not be wedged and must close on rebates The fire log book must be brought up to date and equipment regularly tested and inspected Staff must have access to liquid hand wash at all times The staff toilet must be refurbished Temperatures when residents are bathed must be recorded Communal toiletries must not be used and toiletries must be returned after bathing to residents bedrooms keypad locks must be fitted to sluice doors and any other doors to rooms where hazardous substances are accessible to residents; these doors must be kept locked at all times The boiler rooms must be kept locked at all times The door leading to a fire escape must be able to be opened easily from the inside and must be in working order All of the items specified in Standard 24.2 must be provided in rooms occupied by residents. If the provision of any item poses an unacceptable risk to the resident or they decline the E52 S27693 West Eaton House NH V242507 250805.doc By 30th September 2005 Immediate 13. OP15 16 14. 15. 16. OP15 OP19 OP19 13 23 23 Immediate Immediate 17. 18. 19. 20. 21. OP 21 & 26 OP21 OP21 OP21 13 13 13 13 Immediate By 30th September 2005 Immediate Immediate 22. OP21 13 By 30th September 2005 23. 24. OP21 OP19 13 23 Immediate This has been addressed 15th October 2005 25. OP24 16 West Eaton House Nursing and Residential Home Version 1.40 Page 21 26. OP24 12,13 27. 28. 29. 30. 31. OP24 OP26 OP24 OP26 OP27 17 13 12,13,16 13 18 provision, details of the discussions and decisions must be recorded in the care plan Residents must have lockable storage space in their bedrooms unless the reason for not doing so is explained in the care plan Records of furnsihings belonging to residents must be kept Infection control policies and procedures must be adhered to all times. The practice of using a residents bedroom as a hair dressing salon must cease immediately All chemical products must be stored safely There must be enough staff on duty at all times to meet the needs of the residents 31st October 2005 30th September 2005 Immediate Immediate Immediate Action plan to the CSCI with reviewed and future staff arrangeme nts; within 14 days of this report. Action plan to the CSCI within 7 days of this report Immediate To be made safe immediatel y and replaced by 15th October 2005 Immediate Notice Page 22 32. OP27 9 & 10 33. 34. OP37 OP38 37 13 The registered manager must review his current work load to ensure more time is allocated to West Eaton to ensure care needs of residents are not compromised Regulation 37 notifications must be sent to the CSCI as soon as possible after the event The carpet identified as a trip hazard must be replaced 35. OP38 13 COSHH hazard warning sheets must be available to staff at all times E52 S27693 West Eaton House NH V242507 250805.doc West Eaton House Nursing and Residential Home Version 1.40 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. Refer to Standard Good Practice Recommendations West Eaton House Nursing and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 23 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 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 and Residential Home E52 S27693 West Eaton House NH V242507 250805.doc Version 1.40 Page 24 - 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!