Inspection on 04/09/06 for West Heath House

This inspection was carried out on 4th September 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

West Heath House 09/07/07

West Heath House 15/03/06

West Heath House 07/11/05

West Heath House 23/03/05

West Heath House 18/08/04

West Heath House 19/02/04

West Heath House 03/09/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE West Heath House 90 Alvechurch Road West Heath Birmingham B31 3QW Lead Inspector Monica Heaselgrave Announced Inspection 4 September 2006 th 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 Heath House DS0000033605.V306730.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 Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Heath House Address 90 Alvechurch Road West Heath Birmingham B31 3QW 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) 0121 475 3614 0121 478 0130 Birmingham City Council (S) Mrs Imelda Walley Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That home is registered to accommodate 26 people over 65 years who are in need of care for reasons of old age which may include mild dementia. Registration category will be 26 (OP) That minimum staffing levels are maintained at 3 care staff throughout the waking day of 14.5 hours. That additional to above minimum staffing levels there must be two waking night care staff. 15th March 2006 Date of last inspection Brief Description of the Service: West Heath House is a large purpose built two-storey building, located on the Alvechurch Road in West Heath. It is situated at the top of the road overlooking the main road with views all around the immediate area. The building is approached via a drive to the front with some off road parking. West Heath House offers accommodation to twenty-six older adults. All bedrooms are single with a wash hand basin facility, and emergency call system. Bedrooms are located on the ground and first floor, with access via a passenger lift. There are two lounges, and a separate smoking room, a dining room, main kitchen and office and medical room. The laundry is situated on the first floor. Newly refurbished toilets and bathrooms are situated on both floors these have facilities suited to those people who require assistance. Facilities meet the needs of service users living at the home. There is level access for wheelchair users to the front entrance and throughout the home. Corridors are wide and spacious and allow service users to move around the home freely and safely. The home has hoisting equipment available for service users who have decreased mobility. An accessible well maintained garden area with outdoor seating is provided. The home is approached through a driveway with limited parking for visitors, alternatively there is ample off road parking. Inside the home, the reception area has notice boards, which display information about forthcoming events and other articles that may be of West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 5 interest. The current charge for living at the home is £64.65 per week low rate, £136.00 higher rate for respite care. Additional charges include chiropody, hairdressing, and outings, which are partially subsidised from donations and budget. There is an enclosed garden with a patio to the rear of the house, and open lawn areas to the front and sides. The home is opposite a church and parade of shops; a number of bus routes to the city and surrounding area are within walking distance. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork of this unannounced inspection took place over one day lasting about 10 hours, enabling the morning, lunchtime and evening routines to be observed. Prior to the inspection the inspector received a pre inspection questionnaire completed by the home. The inspector contacted relatives for their experiences of the care and service provided. A number of service users were spoken with individually and the care delivered to service users was observed. A review of all information that the Commission has received since the previous inspection, was undertaken, considered and included in this report. Three service users were chosen to be case tracked in order that a judgement could be arrived at as to how well their needs are known, explored and planned for. This included looking at their care file and daily records. Records relating to the recruitment, training, supervision, and work patterns of staff were examined. Medication records and stocks were sampled. Two staff were interviewed as well as the manager. A tour of the building was undertaken and bedrooms were sampled to ensure they met with service users needs. Examination of the procedures in place to protect the health and safety of service users was undertaken. What the service does well: The home provides useful information about the service the home offers. Service users have access to this information on the notice board and included planned activities, meetings, and events or trips. Health concerns raised in daily records are attended to and professional health care advice and assessment from doctors and district nurses are arranged if needed, which means that service users needs are addressed in a timely manner. Staff interaction with service users was positive, and showed some skill in engaging those who had dementia. This ensures an inclusive approach for those service users who would find it difficult to initiate activities or conversations by themselves. Service users appeared well cared for with personal care needs met in a positive manner. Staff have a clear understanding of the need to protect service users from potential abuse and know what to do when they have concerns. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 7 There are good systems in place to manage complaints made and this gives service users the confidence to use procedures. Service users’ finances are recorded well and an audit trail was evident for all transactions. Care plans were available to describe general daily care needs. Risk assessments were in place for service users who have diabetes, continence and mental health issues, this means service users are protected from unnecessary risks. What has improved since the last inspection? What they could do better: The home receives assessment information from placing social workers, but at times this information is basic. The outcome for service users is that some key aspects of their care may be missed and not included in their care plan. The manager must ensure that all people referred to the service have a full assessment, which can be incorporated into their care plan. This will ensure that the service users’ needs fit with the registration of the home, and that the home is able to meet the assessed need. Prospective service users should be given the opportunity for staff to meet them in their own homes or current situation so that a full assessment of their needs is carried out. After the home has assessed service users’ difficulties and abilities the home needs to send a letter to the potential service user or their representative saying whether they can meet the residents needs, so that the service user and their relative or representative know what to expect from the home, in this way their rights are protected. Care plans were available but require further development to ensure they follow on from the original assessment and show how needs will be met. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 8 Daily recordings must detail what care was delivered and the response to that care, this will offer a means of reviewing how well the care plan is being implemented. Service users who were unable to join group activities did not have a plan to ensure that they had some one to one time with staff. This was particularly evident for those who have dementia and those being cared for in their bedroom, they did not have the same opportunities as other service users.. Risk assessments relating to falls, manual handling, risk of pressure sores and those service users who require monitoring due to low body weight, must be incorporated into the care plan, some care plans seen did not include this information and this could mean care staff do not have all the information necessary to assisting a service user in a safe manner. The procedures for the recruitment of staff are very worrying. Relevant police and Protection Of Vulnerable Adults checks have not been completed where a redeployed staff member took up post in the home. These checks are normally carried out by the Social Services Personnel Department and in this case are long over due. This potentially, could put service users at risk. The manager needs to monitor the number of staff on duty and ensure that these are sufficient to meet the assessed needs of service users. Training in the management of pressure care areas and incontinence would provide staff with skills relevant to the care they currently provide to service users. 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 Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 9 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 Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 3&6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The assessment of service users needs is not comprehensive. The absence of detailed information may prevent service users needs being met, and does not ensure they are within the admission category for the home. Confirmation that the home can meet the needs of service users must be provided so service users and their relatives’ rights are secured, and that the home is certain it can meet prospective service users needs. EVIDENCE: The home receives assessment information on service users from placing social workers. The three files examined showed that the information provided is variable and in two instances was basic. Recently a service user was admitted on the basis of an assessment carried out four years ago. Consequentially when the service user was admitted they were found to have higher dependency needs than expected. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 11 As a result staffing levels were increased to meet the persons needs until an alternative placement was found. The home’s manager said that she does not normally have the option to either visit prospective service users in hospital or their own home to carry out their own assessment. Assessment information is therefore relied on to give a good account of the individuals needs. This can have implications for the home in terms of dependency levels and the impact on staffing levels. Pre visits are made which offer some opportunity for staff to gather further information as to the needs of the individual and how they are met during the visit. However the manager stated that this is not a stringent process. In order to ensure that service users who are admitted to the home are within the registered category for the home, it is important that every referral includes the single assessment form being completed in detail and sent to the home prior to any pre visits being planned. Whilst some assessment information had been gathered and utilised to develop a care plan for daily living, there was little correlation between the records. The plan of care lacked significant key points, which could prevent staff from knowing how to support individuals. The lack of a thorough assessment could result in prospective service users being admitted when they do not fit into the registration category for the home. This also hinders the home in forming a judgement as to whether they can be certain to meet the assessed needs. It was positive to note that the bedrooms offered to the service users who were case tracked, were in line with the assessed needs. Records showed that alternative bedroom was offered to allow more space for a person who required mobility aids and the occasional use of the hoist. The furniture in both the rooms had aids such as leg raisers on the chairs and beds to enable easier access by the individual. The service users’ spiritual and cultural needs are assessed and staff make efforts to ensure that these needs are met. Service users that wish are assisted to go to local religious services or see the visiting clergy. Care files did not contain correspondence to the service user or their representative stating whether the needs of the service user can be met by the home. West heath House does not provide intermediate care. West Heath House DS0000033605.V306730.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,&10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of gaps in planning could mean that service users health and social care needs are not met, and may prevent service users receiving individualised care. Good practice in respect of medication administration ensures service users receive their medication in a timely and safe manner. Service users are treated with respect and are clearly happy in the company of staff. EVIDENCE: Care plans are developed for all service users these are called Individual Service Statements, (I.S.S.). The three files examined had a plan of care generated from the initial assessment. One service user was identified as requiring weight monitoring, weight records were in place and a weight gain noted, however the I.S.S. did not specify weight monitoring was required or in place. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 13 A tissue viability assessment had been undertaken for one person and showed a high-risk score, requiring a risk assessment, which should be incorporated into the care plan in order that staff know how to respond to this need. There was no mention in the I.S.S. of concerns or the actions to be taken. The lack of review of tissue viability and nutrition is concerning. Relatives were contacted by phone and offered the following comments; ’I worry about her weight and eating, staff tell me she does eat but she looks so frail, I don’t know if she has food supplements but that would be worth a try. I’ve seen her at the table but she only nibbles, I think she needs more help.’ ‘She eats really well, loves her food particularly the sweets, staff are approachable and the personal care is very good.’ A second file showed that a manual handling risk assessment was in place, but this said, ’follow Individual service statement.’ When this was viewed there was no mention of how this person was to be supported in a safe manner. A third file for a service user who requires full care and is confined to bed had no detailed plan for daily living that specified how her needs were to be met. A turning chart was in place for this person, which was completed regularly. When staff were asked about her needs they gave a good description of these and a good verbal account of what they do to assist and comfort her. However this was not recorded in her care plan or daily records. The files of those service users case tracked showed that there were a variety of health care needs identified. These included the management of continence, weight monitoring, ulcerated legs, risk of falls and poor tissue viability. On the day of the inspection the district nurse was called to see one service user for a suspected pressure sore. It was positive to see that where concerns are noted staff seek medical advice this ensures the health care needs of service users are met. Records showed that health professionals such as the G.P. district nurse, dentist and consultants offer clinical advice as to how needs should be met. Service users spoken with made the following comments, ‘I see the G.P regularly and can ask staff to call them out staff are good in that way.’ ‘I have problems with …….and see the district nurse, I’m made comfortable and staff are caring.’ Service users’ call bells were within reach for those that were in bed and this ensures that they call for help when needed. The lounge and communal areas were staffed consistently through the inspection ensuring service users who are vulnerable to falls, or confused had the support they needed to keep them safe and comfortable. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 14 In summary whilst some assessment information had been gathered and utilised to develop a care plan for daily living, there was little correlation between the assessment information and care plan. The plan of care lacked significant key points; and did not in all cases set out in detail the action that needed to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service user are met. Service users with cognitive impairment are referred to specialist services to help meet their needs. Care plans did not however demonstrate how these needs would be met. Good dementia care looks at both strengths and weaknesses. It is essential that staff have an accurate understanding of the declining cognitive processes that affect each individual. Some staff had received training in dementia care, and this is positive. The manager needs to improve the social/background profiles for service users so that the values, preferences, and lifestyle of the service user they are looking after, is known and can be planned for in a positive manner. The manager informed the inspector that the I.S.S. (care plan) has been updated since the last inspection. Three updated care plans were seen. Significant information relating to manual manual handling, falls risk assessment and weight monitoring were not incorporated into the plan, therefore there was no means of knowing how these needs are managed. This could result in needs being overlooked, and poor direction to staff in responding to these needs. Records did show some service users and or their representatives contributed to the review process. One relative informed the inspector a review was planned which he would be attending, he was very positive about the care his mother received, particularly the arrangements for her health care. The medication administration records (MAR) were kept well. There were no gaps in signing for medication. There was a photograph of each service user to assist with identification. The storage of medication was secure making it safe for service users. The home had a copy of medication administration policies and procedures and showed that they were aware of what they contained. A daily audit is carried out between shifts to ensure that all medication is given out correctly and signed for this ensures that any errors made can be picked up quickly and rectified. Staff who administer medication have received appropriate training to do so. Staff had good knowledge of the care routines of service users. Observations showed that staff know who needs assistance and in what areas. There was good support to assist service users moving around the home, and accessing the toilet areas. Service users were spoken to in a kind and consistent manner. Staff supported service users in both the introduction and their interaction with the inspector, and observation of service users in the presence of staff was positive. Personal hygiene needs were attended to; service users appeared well cared for, appropriately dressed and comfortable. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 15 Some service users described aspects of their personal care they maintained independently, with respect from the staff to do so. One service user said ‘staff knock doors and you can have privacy in your own room’. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 12,13,14,&15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The activities on offer meet the expectations, and interests of some service users, but not all. The needs and interests of service users with dementia need to be explored more fully, and records should demonstrate how the individuals social activity needs are met, to ensure they experience a meaningful lifestyle. Service users are supported to maintain contact with their families and friends. Service users exercise decisions over their daily lives ensuring they maintain some independence and individuality. The dietary needs of service users are well met, they benefit from meals that are well presented, wholesome and varied. EVIDENCE: There was evidence of a range of activities being offered to service users, quiz’s, card games, musical instruments, visiting entertainer, mobile library and planned visiting entertainers and trips, recently a trip to Weston was enjoyed. Some service users said that they did enjoy these. An activities list is posted on the notice board to advise service users of events. New equipment such as arts and crafts had been purchased on the service users request. It is evident that staff endeavour to meet the social needs of service users, but unfortunate that they do not record this to see if it meets with the initial plan. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 17 There were some positive examples of written information, which guided staff in the action to be taken to ensure social care needs are met, for example; ‘is a roman catholic and would like the priest to visit’. ‘ Would like to do the lottery, place a bet on the horses and receive a daily paper.’ ‘Likes to take a walk to the shops’. However the daily notes lacked any detail that would allow staff to monitor whether these things were being offered or taken up by service users. Some service users did confirm they had been out to the shops, or placed a bet, but there was no accurate means of monitoring this on behalf of service users. Daily notes were looked at the majority of entries were poor, for example, ‘Resting in the lounge.’ ‘Watching T.V.’ ‘Played Bingo’. One service user went shopping with staff and clearly enjoyed this. Staff said that they have little time to spend with service users because the needs of service users are high and warrant a lot of physical care. One staff said that to play a game of bingo, one staff called the numbers, one assisted service users to fill in their card and the third stayed ‘on the floor’ to supervise or toilet service users. Clearly staff recognise the importance of providing stimulating activities for service users, but given that a high proportion have dementia and high physical needs, staff resources are used to their full. Service users said they have some time in one to one chats with staff, and enjoy this. An organised fete day was planned for the coming weekend and service users were looking forward to this. Music was heard playing in the lounge. A number of the service users were sat chatting in the garden with a staff member. One relative said that she worries about the level of confusion and availability of staff to support service users in activities. An I.S.S.’ was looked at for a service user who suffers with dementia, it did not show how choices are arrived at, for instance one entry said, ‘Would like to be involved in social activities’. This did not say what activities the individual used to engage in or what would be offered on a trial and error basis, the daily records gave little indication that activities were engaged in, for instance most entries said, ‘relaxing in the lounge, or watched T.V.’ A number of service users have dementia that can make motivation difficult. The home needs to demonstrate how the individuals social activity needs are met. Service users appear to be able to rise and go to bed when they wish and they did not raise any concerns in this area. Staff described areas in which service users who are able, exercised their own choices and made decisions, this included what they wore, decisions on menus, activities and attending church or other community amenities. The service user meetings confirmed their involvement in these areas. It could not be established if the same opportunities took place for those with dementia or confusion. The menus provided by the home were good and varied and comprised a fourweek rolling menu. One service user said “the food is good ”. One relative also stated that the meals provided are of good quality and plentiful. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 18 Service users can have a cooked breakfast on a Sunday, and alternatives are provided at each mealtime. The cook talks directly with service users about food and as a result of this the menus are made up. Drinks are freely available to service users, one said “staff bring you drinks when you need them”. The record of food consumed needs to improve for those who are being monitored. It is important for service users who require monitoring of intake to ensure that a record of food eaten is maintained, and whether or not other nutritional foods or drinks have been explored via the G.P. This information must be in their care plan to show what measures are being taken to address these needs. The mealtime occasion was relaxed and sociable with assistance from staff on hand. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 16&18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives were confident that their concerns would be taken seriously, and most have access to the complaints procedure should they need to make a complaint. The home showed that they are able to protect vulnerable service users in their care. EVIDENCE: The home and the Commission have received no formal complaints since the last inspection. Residents spoken to were clear that they would speak to the manager if there were a problem. Relatives were generally happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. One relative did not have a copy of the complaint procedure, or know how to contact the Commission should they wish to register a concern. Relatives who lived a distance from the home and were unable to visit regularly, did not have the opportunity to see the notice board with contact numbers on it. The manager should review which families this may apply to in order that all have access to the complaints procedure and process, particularly where the service user has dementia and possibly could not advocate for themselves. There is a complaints procedure and those service users case tracked had a copy of this in their bedroom. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 20 The complaints records were viewed and showed that a record of the investigation and outcome is maintained. However the outcome should be made known to the complainant, preferably in writing so that they have the opportunity to say whether they are satisfied or not with the action taken. A compliments book is maintained which enables visitors to comment on the care delivered, the entries were positive. The monthly regulation 26 visits showed that compliments and complaints are audited, this is a good means of quality assurance and another means of the service being able to obtain the views of people in order to make any improvements. The pre inspection questionnaire completed by the manager prior to the inspection visit stated that Adult Protection Procedures and Whistle Blowing procedures were available, but there was no date to show when these were last reviewed, to ensure they are in line with current good practice. These were not examined at this visit. Staff training records showed that most staff had received training in how to recognise abusive situations and how to respond to them in order to safeguard service users. Staff interviewed during the visit had a good awareness of what to do in such circumstances. The service history showed that a potential adult protection matter had been recognised by staff and protection procedures had been followed to ensure the safety of the service user. The financial records of three service users were seen. The records showed that a record is maintained of incoming money, and expenditures. Receipts are maintained and a running total kept. No discrepancies were found. The service user had signed to say they had received some of their money. One service user said they had access to their money as required. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 21 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 the following standard(s): 19,20,21,23,&26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Recent investment has significantly improved both the appearance and facilities of this home creating a comfortable and safe environment for those living there. EVIDENCE: The location of the home is lovely, set at the top of the road overlooking the church and local shops with pleasant views from all aspects. West heath House is a well-maintained comfortable and pleasant environment, which meets with the needs of the service users. There is level access to and from the home. The rear garden is mainly laid to lawn and fairly level, service users were observed to access this without difficulty. Service users with an interest in gardening have been supported in planting up container pots for the patio, these were beautiful, and several of the service users proudly pointed these out. A tour of building found that the home was clean and fresh. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 22 A number of improvements had been made since the last inspection. All three lounges and the dining room have been redecorated, fitted with new lighting of domestic type, and new curtains. The upstairs carpet in the corridor has been replaced, as have two bedroom carpets. Service users bedrooms have all been redecorated. Bedrooms were very pleasant and had a lot of personal touches and possessions, it was evident that staff support service users, in this area, to ensure they are comfortable and have nice surroundings. Those service users spoken with were very happy with their bedrooms and said they met with their needs. It was positive to see that two of the service users who needed to use mobility aids such as the hoist and zimmer frames had benefited by moving to one of the larger rooms that offered more space. These rooms also had raised chair legs to enable more independence by the service user. The layout of the room was thoughtful, ensuring that no items of furniture could potentially be an obstacle. The space in the rooms allowed furniture to be placed in a manner that would minimise the risk of the service user falling against it. Fire doors have been replaced in line with improving fire safety within the home. The toilet areas have been partitioned to improve the privacy for service users, and modernised to improve accessibility for those who require assistance or the use of aids. There were adequate bathing and toilet facilities in the home to meet the current needs of service users. Corridor areas were spacious and it was observed that staff had sufficient room to support service users moving around the home with zimmer frames. The smoke room has recently been redecorated and service users using this facility said they were very happy at these improvements, informing the inspector that they were fully involved in the choices made. There are separate smoke free lounges for the comfort of service users. There have been improvements to the exterior of the property to include repainting and replaced guttering. On the day of the inspection new kitchen appliances were being fitted. There are domestic staff who are responsible for the general cleaning, and all areas viewed on the day of the visit were clean, and hygienic. The arrangements in place for infection control were good staff were observed using protective clothing, and lidded waste bins were in toilet areas. A contract for the collection of clinical waste was in place. Systems were in place to deal with soiled linen, lessening the risk of cross infection. West Heath House DS0000033605.V306730.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,&30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Staffing levels and competencies were such that the immediate physical needs of service users are met safely during the majority of the time. However the levels of service user dependency have not been fully assessed and staffing numbers may compromise how well the needs of service users can be met. Recruitment records showed that not all the checks necessary for the safety of service users were undertaken, and this could place service users at risk. EVIDENCE: Rotas showed that minimum staffing levels of three care staff throughout the working day plus senior support are maintained. At the previous inspection a requirement was made to ensure the dependency levels of service users were met with sufficient staff numbers. The manager said that referrals have since been made to some social workers for service users needs to be reassessed. There has been no change in the allocation of staffing levels. Staff and the manager and relatives spoken with, raised concerns at the level of service user dependency and how this impacted upon the availability of staff to meet needs. This requirement remains outstanding, and the Commissions’ concerns regarding service users support needs, remains. Of the 16 care staff 13 had attained NVQ Level 2 or 3 and this was to be commended. Six staff hold a current first aid certificate. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 24 Staff appeared to be able to meet the immediate physical needs of the service users ensuring they are in safe hands at all times. The recruitment files of two staff were sampled. One evidenced two references and CRB clearance. There was an application form and a record of induction and supervision. The other file sampled did not have CRB clearance. The Pre-inspection Questionnaire completed by the manager stated that CRB had been applied for in May 2004, October 2005 and July 2006, but the check was not undertaken because the appropriate identification papers had not been submitted. The Pre-Inspection questionnaire stated the start date for this employee as September 2000. In discussion with the manager it transpired that this person was already working for the department and had been re-deployed to West Heath House. Normally the Personnel department carry out the necessary recruitment checks but in this case these are long over due. The Commission considers this a worrying situation and the outcome judgement in the area of recruitment, to be poor. In the absence of a POVA 1st and CRB check, this person should not be in post. The manager was able to show that this information had been requested on several occasions. However the staff member was still working in the home. A decision had not been taken to stop the person working until all the checks necessary for the safety of service users are undertaken. This must be resolved with urgency, and the Commission informed of the action taken. There was a training record that indicated that some staff had undertaken training in Dementia Awareness, Infection control, Food Hygiene, First Aid, Fire Awareness, Adult Protection, and Falls Awareness. A plan of future training was submitted on the pre inspection questionnaire, which covered all the mandatory training needed by care staff. There was no service user specific training included on this, except for manual handling. The training done in the last 12 months did not include continence management, or pressure care, which is relevant to one service user currently being cared for in bed. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,&38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are aspects of the home that are managed well. Systems for service user consultation are good ensuring they can put their views forward. Systems to monitor the service being delivered should include relatives and visiting professionals so that problems with the service can be identified and acted upon and run in the best interests of service users. There is a robust system for the safekeeping of service users; money and valuables, should they choose to use this facility. Staff are trained in health and safety issues and their practice was observed to be good, however the management plans for identified risks need to improve to ensure the overall safety of service users. EVIDENCE: West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 26 The manager is experienced in the conditions that affect older service users. She holds the NVQ level 4 in management and care and the Registered Managers Award. She has several years of experience in caring for older persons, and managing a staff team, this ensures she has the relevant skills to manage the care home. Service users speak positively about their inclusion in events within the home, regular service user meetings are held, and an example of service users complaining of the ongoing building works causing disruption was acted upon. Relatives spoken with felt that their concerns are listened to and that they are made welcome and kept involved. There is evidence that quality assurance initiatives are carried out, this consisted of audits and monthly visits by the providers’ representative which involved seeking the views of service users, a compliments book has also been introduced. There was little evidence of feedback from other stakeholders such as professionals visiting the home being actively sought. The inspection report was not on display, however this is not the normal practice, and having discussed this with the manager, the inspector was happy that the usual practice is that all reports are displayed to enable service users and the families access to them. Some relatives were unaware that they could have access to this to read. Records of service users’ finances held at the home meet the standard and safeguard service users. Records relating to the depositing of valuables in the home for safekeeping are robust. All the records seen balanced with the amount of money held. The home kept individual receipts for all spending of money. Regular financial audits are carried out in order to safeguard service users’ money. The manager has begun to implement planned supervision for all staff. This is an improvement since the last inspection. However from staff interviews it is evident that there had been some long gaps in between, it is anticipated that once this is re established staff will have a regular platform in which to review their practice. There are appropriate arrangements to ensure the health and safety of both service users and staff. Appropriate maintenance and inspection certificates for all appliances were seen. The inspector saw evidence of the Gas Landlords certificate and the maintenance of appliances, the certificate of electrical wiring safety and fire safety checks. Visits are taking place by the Registered provider’s representative on a monthly basis copies of these reports were available at the home. There was evidence that audits were being undertaken on a regular basis to monitor the quality of the service and seek the views of service users this included service user meetings, a comments book and attendance at reviews. The arrangements for ensuring safe working practices are relatively good, staff have received appropriate training in these areas but this could be compromised by the lack of including the outcome of risk assessments in care plans. This could potentially place service users at risk. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 27 The inspector spoke with some service users, one of whom described the assistance she required. She was happy with the arrangements for her personal care, which included the use of manual handling techniques, she said she felt safe with the arrangements in place. One service users care plan (I.S.S.) did not show how her wheelchair was to be charged and on the day of inspection she used a manual chair because the battery was not charged. This could be easily avoided with clear instructions in her care plan for staff to follow. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 28 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 2 West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 14.(1)(a)( b) 14.(a) (d) Requirement Timescale for action 30/10/06 2 OP3 3 OP7 15(1) 4. OP8 OP8 17(1a)S3( m) The Registered Person must ensure that all new referrals have a full and complete assessment of need. The Registered Person must 30/10/06 ensure that confirmation in writing to the service user that having regard to his assessment the care home is suitable for the purpose of meeting the service users needs. The Registered Person must 30/10/06 ensure that the service users plan clearly sets out in detail the actions, which need to be taken by care staff to meet the needs of the service user. This is a previous requirement. The Registered Person must 30/10/06 ensure that appropriate action is recorded in the service users’ care plan relating to tissue viability and the risk of pressure sores. The plan must specify how these are being managed and should relate to the tissue viability risk assessment. The care plan must specify DS0000033605.V306730.R01.S.doc 5. West Heath House 17(1a) 30/10/06 Version 5.2 Page 30 OP8 S3(m) appropriate action relating to those service users who are on food monitoring and how this is being managed and any clinical guidance included. The results from manual handling risk assessments must be incorporated into the service user care plan. The plan must demonstrate how service users are moved or handled safely. Service users who for reasons of dementia are unable to join in activities must have an activity care plan to determine how they will receive one to one staff time. The Registered Person must review the staffing levels to ensure these are appropriate to the assessed dependency levels of current service users. The Registered Person must not employ a person to work at the care home before all the necessary checks have been completed including; 30/10/06 6. OP8 13.(5)&17 (1)(a) S3(m) 7 OP12 16(2)(n) 30/10/06 8 OP27 18(1)(a) 30/10/06 9. OP29 19(1)b Sch(2)1-7 30/10/06 10 OP30 18.(1)© 11. OP33 24.(1) &(3) A PoVA check must be completed and be clear and a CRB enhanced disclosure applied for before employing any staff. Service user specific training 30/10/06 must be included in the proposed training for the staff team, specifically the management of continence and pressure care. The views of family, friends and 01/12/06 visiting professionals should be sought as to how the home is achieving its aims. The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties. The manager must ensure there DS0000033605.V306730.R01.S.doc 7. OP38 17(1a) 30/10/06 Page 31 West Heath House Version 5.2 S3(m) is a system whereby the significant findings of risk assessments are specified in service users care plans. 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 OP16 Good Practice Recommendations It is recommended that the outcome of the complaint be confirmed in writing to the complainant. This will ensure they have an opportunity to state their satisfaction with the investigation results. West Heath House DS0000033605.V306730.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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