Inspection on 30/06/09 for West House

This inspection was carried out on 30th June 2009.

CQC found this care home to be providing an Poor service.

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 House 08/12/09

West House 22/09/08

West House 25/09/07

West House 03/10/06

West House 06/03/06

West House 06/10/05

West House 30/03/05

West House 23/11/04

West House 31/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE West House 11 St Vincents Road Westcliff On Sea Essex SS0 7PP Lead Inspector Carolyn Delaney Key Unannounced Inspection 10:30 7th July 2009 DS0000015565.V376484.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West House Address 11 St Vincents Road Westcliff On Sea Essex SS0 7PP 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) 01702 339883 01702 346518 www.westhousenursinghome.co.uk Rootcroft Limited Barry Gelfand Barry Gelfand Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N To service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accomodated is 25 2. Date of last inspection 22nd September 2008 Brief Description of the Service: West house is an established care home providing nursing care for up to a maximum of twenty-five older people. Although the home predominantly accommodates residents of the Jewish faith, this is not exclusively the case and residents of other faiths (or no faith) are also accommodated. The home consists of a traditional residential property, which has been modified and extended to meet the needs of older people. The shaft lift and stair lift gives access to all three floors where accommodation and communal areas are situated. The home is situated close to local shops and amenities and is within easy reach of the main shopping area; the seafront and local theatre are also nearby. There is a limited amount of parking to the front of the home. At the time of this report the fees for a place at the home range between £388.01 and £750.75 per week. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a routine unannounced inspection, which included a visit made to the home between the hours of 10.45 and 17.30 on 7th July 2009. The last inspection was carried out on 22nd September 2008. As part of the inspection process we reviewed information we had received about the service over the last twelve months including notifications sent to us by the manager of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment, which the registered provider or owner is required by law to complete and tell us what they do well, how they evidence this and the improvements made within the previous twelve months. We also looked at the improvement plan that we asked the manager to send us following the last inspection. This plan described how the manager was to address the issues as identified at the last inspection. We sent surveys each to the home to distribute to residents and staff and to complete and tell us what they think about the home. At the time of writing this report we had received surveys from six residents living in the home. We received six surveys from staff members. During the inspection we spoke with three residents, three relatives, two members of staff and the manager. When we visited the home we looked at residents care plans and information available to staff to help them support residents. We looked at how staff were recruited to work in the home and how they were trained to support residents. We looked at how the home was managed and how residents were involved in this. We also observed how staff interacted with residents when supporting them with activities such as meals and providing recreation and stimulation. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 6 What the service does well: People’s needs are fully assessed before they are offered a place and they are provided with information about the home to help them decide if it will be suitable for them. Each person has a detailed plan of care based upon their assessed needs. Staff support residents in line with their care plans, ensuring that they receive the medical attention they need. Residents enjoy the meals provided and any special dietary needs are catered for. The home is clean and comfortable and suits the needs of people living there Staff are recruited robustly and all the necessary checks to ensure that they are suitable to work in the home are carried out before they commence work. Staff receive training to help them understand and meet the needs of people living in the home. What has improved since the last inspection? What they could do better: More opportunities for activities, socialising and exercise could be provided for residents living in the home. More must be done so as to safeguard people living in the home from harm. There have been a number of serious incidents affecting the welfare of people living in the home within the previous twelve months. Staff could exercise more care and attention when supporting and moving residents so as to minimise injuries. Some staff work back to back duties without a break and this may impact upon the support provided to residents. Some staff are expected to attend training following night duty and this may impact on how they receive information during the training session. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 People using the 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 move into the home can be assured that their assessed needs will be met. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that information about the home, including recent inspection reports are readily available and that when assessments were carried out before a person moved into the home, people were given a brochure about the home. Three of the four people who completed surveys said that they had received enough information to help them decide if the home would be the right place for them. Two of the four said that they had been given information about the homes terms and conditions (contract). Residents we spoke with during the inspection West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 10 had been living at the home for some time and could not remember what information they had received. One person told us that their relative had made the arrangements for them to come into the home. We spoke with relatives for three residents. They told us that they had visited the home before the decision had been taken for their loved one to move in. Two people told us that they had spoken with staff and the manager about the home to help them make their decision. We saw that information about the home was available in each person’s bedroom. We looked at the arrangements for assessing a person’s needs before they were offered a place in the home. We looked at the pre- admission assessment for two people. One person had recently moved into the home and the other was due to move in later that day. We saw that a detailed assessment of both people’s needs had been carried out by either the manager or nursing staff before the person was offered a place in the home. The assessment covered activities of daily living such as washing and dressing, eating and drinking, mobilising and sleeping. The support or assistance, if any, each individual needed with these activities was recorded in their assessment. There was information about person’s health as well as any medical conditions and the treatment the person received. Risks to the person’s health and safety were identified such as risks of falls etc. On the basis of the information gathered the manager or nurse then made a decision as to whether the home would be able to meet the individual’s needs. The home was one of a number of homes used by Southend Hospital for ‘step down’ places. This was where people who were medically fit for discharge stay temporarily in a care home until such time as proper arrangements could be made for them to return to their own home or to move into a care home. We spoke with one of the coordinators involved in placing people at the home and they told us that there were no issues and that ‘so far the placements worked well’. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 People using the 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 in the home are well cared for and receive the support they need for their health and personal care needs. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the home had a very good team of nurses who provided a high standard of care to residents. They told us that residents or their families were actively encouraged to participate in the completion of care plans. Staff who completed surveys told us that they received support from the manager to help them meet the needs of people living in the home. They also told us that the ways in which information about residents needs was shared worked well. Residents who completed surveys told us that they always received the care support and medical attention they needed. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 12 Residents told us that they received the medical care and support that they needed. When we visited the home we looked at how residents were supported for their needs and how care was planned and delivered. We looked at the care plans for two people. Care plans were detailed and covered health, personal care, social and cultural needs. We saw that both person’s health and personal care needs were recorded such as what assistance they needed with washing and dressing, eating and drinking or mobilising. There was information recorded as to how staff were to support each person to carry out these daily activities. However there was little information recorded as to what each person could do independently, for example choosing when to wash or bath, choosing clothing etc. This would help to promote independence for the person for as long as possible. Care plans were reviewed regularly by staff and amended where there were changes to the person’s needs or general condition. There was a system in place for assessing risks to residents of developing pressure sores, injuries from falls and malnutrition. Generally these were completed and reviewed regularly so as to monitor and minimise risks to people. We looked at accident records and there had been a high number of incidents where residents sustained minor injuries such as skin tears when staff were supporting them to transfer using hoists. Two relatives raised concerns about how staff handled residents when assisting them to transfer and when using lifting equipment such as hoist. Risks around use of equipment and handling residents had not been recorded or monitored and we discussed this with the homes manager. We looked at the arrangements for ensuring that residents received medicines which were prescribed for them. We saw that when residents moved into the home that they were asked if they would wish to keep their medicines and administer them independently. Staff received training in the safe storage and administration of medicines and storage facilities were appropriate. We looked and medication administration records and these were completed by staff to indicate that each person had received medicines prescribed for them. We looked at records around doctors and other health care professionals and we saw that where residents required medical treatment that this was sought promptly. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the 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 who live in the home do not always have opportunities for stimulation and activities which suit their needs and reflect their interests. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that that they home provided an external entertainer each week. They told us that staff undertake a variety of activities each day, some of which were made up of small groups while others may involve one to ones. They told us that residents who were able were encouraged to go out to local shows of the seafront. They told us those residents families were encouraged to have tea in the garden (weather permitting). We were told that a member of staff had been employed to assist with arranging the delivery of activities. Of the five residents who completed surveys two told us that there were always activities that they could participate in. Two people told us that there usually were and one person said there sometimes were. Three relatives we West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 14 spoke with commented that there could be more activities for residents and more stimulation provided. When we visited the home we looked at the arrangements for providing activities and opportunities for social stimulation for residents. The manager told us that there had been a lot of improvements made and that more activities were provided. They showed us some photographs of parties and external music entertainers. During the day of the inspection we observed that there were no opportunities for activities provided. The manager told us that the person who was responsible for activities was not on duty that day. Throughout the day the majority of people remained in the lounge seated in their chairs with no provision for exercise other than when staff assisted them to use the toilet. The television was on but there was no other form of stimulation available for many residents. We looked at records, which staff kept as evidence of the range and frequency of activities provided. There was very little information about the activities or opportunities provided for stimulation or occupation. There was very little information in residents care plans about they types of things they enjoyed doing or how they liked to spend their time. Residents we spoke with during the inspection and those who completed surveys told us that they enjoyed the meals at the home. One person told us ‘We always have plenty of food that’s for sure.’ Another person said ‘I always enjoy my food, I had sausages today and they were very nice.’ A cook was employed at the home to cook meals and residents had a choice of breakfast, lunch and evening meals from a menu which was displayed in the lounge each day. Residents were offered a soup course, main meal and dessert course. On the day of the inspection we observed staff serve and support residents with their lunch time meal. Staff were available to assist and support people who needed help. The meals looked well presented and appetising. We saw that where residents had particular dietary needs such as diabetes etc that appropriate foods were provided. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are not always safeguarded from harm. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the home had a robust complaints and safeguarding policy and procedure. Since the last inspection there had been a number of safeguarding alerts raised about the home. There was no reference in this assessment as to how the risks to people living in the home were to be minimised in light of recent safeguarding allegations. Each of the three residents who completed surveys told us that they knew who to speak to informally if they were unhappy or if they wished to make a complaint. Six staff members completed surveys and told us that they knew what to do if someone had concerns about the home. One relative who completed a survey said that they knew how to complain and that the home usually responded appropriately to concerns raised. When we visited the home we looked at the arrangements for receiving and dealing with complaints. The manager told us that there had been no complaints made since the last inspection. During the inspection we spoke with the relatives of four residents and they told us that they generally had no West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 16 complaints about the home. Two people said that communication between staff could be better. One person contacted us after the inspection. They told us that ‘things never seem to move on when I make a complaint’. Since the last inspection there had been a number of serious safeguarding alerts raised. Three of these were around staff failure to monitor residents who were at risk of developing pressure sores appropriately or to communicate effectively with the local district nursing team. One related to staff’s failure to check hot water temperatures before bathing a resident, this resulting in the resident’s feet being scalded. This incident was being investigated by the local Health and Safety Executive at the time of this inspection. When we last visited the home we had identified that hot water temperatures were excessively high in one area and we made a regulatory requirement that the measures be taken to minimise the risks to residents. While the provider had thermostatic valves fitted to the area in question they failed to ensure that hot water in other areas was delivered at a safe temperature. They also failed to ensure that staff minimised risks of scalding to residents. When we visited the home we looked at the arrangements in place for minimising risks of abuse or harm to residents. We saw that following the recent incidents in the home that most staff had undertaken safeguarding training. Regular meetings were held with district nurses so as to ensure that information about residents who were at risk of developing pressure sores was communicated more effectively. We saw that most staff had received training to help minimise risks to residents of developing pressure sores. Other measures had been implemented including more rigorous recording procedures and checking hot water temperatures before using baths and showers. We looked at records staff kept in respect of accidents and incidents affecting people living in the home. We saw that there were numerous occasions where residents sustained skin tears when being moved and handled by staff. One person who completed a survey told us that they had concerns about the way in which some staff handled residents when assisting them to move. We discussed our concerns with the manager at the time of the inspection. Similar concerns were raised by a relative who contacted us following the inspection. They raised concerns about an injury which their relative sustained some time last year. As a result of these concerns another safeguarding alert was raised at the time of writing this report. This was not accepted by the safeguarding team however information was shared with the local contracts and commissioning team (who purchase places for people). West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy clean and comfortable accommodation. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that new communal and bedroom furniture such as wardrobes and flat screen televisions had been provided for residents. They also told us that they had introduced the role of a housekeeper so as to ensure that resident’s clothes were returned to them. Each of the people who completed surveys and those we spoke with during the inspection told us that the home was always fresh and clean. We saw that a cleaner was employed in the home and that all areas, including communal bathrooms and residents bedrooms were cleaned regularly and there were no West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 18 unpleasant odours in the home. There was information about minimising the spread of infection available in key areas. There was hand washing soap and towels in areas such as kitchen and bathrooms so as to enable staff to wash their hands and promote good infection control practices. We saw that measures had been taken so as to ensure tat hot water was delivered at an appropriate temperature and that staff carried out regular checks. There was a programme in place for the ongoing routine maintenance of equipment necessary for the running of the home such as heating and hot water systems, gas and electrical equipment and installations and fire detecting and fighting equipment. Many residents spent the majority of the day sitting in chairs in the lounge. They were served their meals on over lap style tables. Two relatives commented that they would like to see residents eat their meals at dining room tables. There was space within the communal lounge to be able to provide this facility for residents should they wish to do so and we discussed this possibility with the manager. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While staff are recruited robustly and receive training residents are not always supported appropriately. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that they had a good stable staff team who were caring and who provided a high standard of care to residents. They also told us that the process for staff recruitment had been improved so that it was more robust. They told us of the improvements planned for the future including actively encouraging new staff to undertake National Vocational Qualifications in care so as to maintain and improve the standard of care provided. When we last visited the home we were concerned that some staff worked long hours without appropriate off duty time. We made a regulatory requirement that the manager ensure that staff were employed in appropriate numbers so that they did not need to work excessive hours. The manager told us in their improvement plan that this only happened in exceptional circumstances and that the nurse in charge would monitor this to ensure that the practice did not impact on residents. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 20 When we visited the home we looked at the arrangements for recruiting and training staff and the way in which staff were employed to work in the home. The manager told us that the staffing levels were one registered nurse supported by five care staff during the morning, four care staff in the afternoon and two carers at night. In addition a cook, cleaner and maintenance person were employed in the home. We looked at the staff duty rotas for a period of eight weeks. During this period we saw that some staff worked late duties followed by waking night duty or night duty followed by a late duty. We also saw that staff were expected to attend planned training days following night duty worked at the home. This practice may impact adversely on the level of care and support that residents receive. Each of the six members of staff who completed surveys said that their employer had carried out checks such as Criminal Records Bureau disclosures and references before they started work and generally staff felt that their induction when they started work covered everything they needed to know about the job. We looked at how people were recruited to work in the home. We looked at the recruitment files for two people who had been employed since the last inspection. We saw that before each person commenced work at the home that checks including references from previous employers and Criminal Records Bureau disclosures were obtained so as to help ensure that only people who were suitable were employed. We saw that once a person commenced work at the home that they completed a period of induction which included ‘shadowing’ more experienced staff to help them become familiar with the home’s policies, procedures, routines and the needs of residents. The home had a programme for staff training and development which included training in the safe moving and handling of people, health and safety, infection control etc. Extra training had been provided following the serious issues and concerns around staff practices. People we spoke with and those who completed surveys were generally complimentary about staff. One person said ‘I am generally satisfied with the care’. Another person told us ‘staff are very good’. Residents who completed surveys told us that staff were available when they needed them. However two people we spoke with and one relative who completed a survey commented that staff did not always communicate effectively. One person told us that some of the care staff were ‘inexperienced who sometimes do not give whole hearted attention when moving residents using hoists and wheelchairs’. They told us that they had witnessed injuries to residents ‘through lack of attention and idle chatter’. We also saw from records that there were a high number of injuries to residents when being supported by staff and when being transferred using the hoist. There were policies and procedures in place for staff to follow including policies around minimising risks to residents. However staff’s failure to follow these led in part to one resident sustaining scalds to their feet. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 21 West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 28 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always managed in the interests of the people who live there. EVIDENCE: The homes manager is a competent person who has managed the home for a number of years. They told us in the Annual Quality Assurance Assessment of the improvements made within the past twelve months such as improving how staff record information about residents needs, planning more activities and training for staff to help them understand how to support and provide suitable activities for residents. They told us that met regularly with residents, their families and people who commission (purchase) places in the home. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 23 The manager had completed their National Vocational Qualification level 4 in care and management since the last key inspection was carried out. The manager told us that they spend about three days in the home. We looked at duty rotas for a period of eight weeks and there was no record of the time spent by the manager at the home. The rest of the time the day to day running of the home is carried out by the nurse in charge of each duty. However there have been a number of issues for concern raised since the last key inspection as indicated throughout the report. We discussed the seriousness of the safeguarding incidents and outcomes for people who live in the home; however they did not appear to appreciate how this may impact upon the outcomes for people living at the home. In particular we were concerned that the manager considered one of the serious incidents as ‘human error’ rather than neglect (of staff to follow the home’s policy and procedure for bathing people and checking hot water temperatures, and the manager’s failure to ensure that hot water in the home were maintained at a safe temperature). There was a system in place for obtaining the views of people who live in the home, their families and people who were important to them and people who commission places in the home, as part of a quality assurance system for monitoring and improving the service. At the time of the inspection we saw that surveys had been given to people to complete so as to comment on the home and the services provided. The results of the survey had not been collated so as to show where the home provided good outcomes and where improvements were needed. We looked at a sample of records and certificates and saw that the home’s equipment was checked regularly so as to ensure that it was in good working order. We saw that repairs were carried out promptly where needed and that equipment and installations necessary for heating, hot water and fire detection etc were checked and service regularly. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 2 3 x 2 West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 25 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 OP12 Regulation 16 (2) m &n Requirement Appropriate activities and exercise must be made available to meet the needs of people living in the home so as to keep them occupied. Arrangements must be made so as to safeguard residents from harm and to minimise risks of injury. Sufficient staff must be employed in the home so that staff do not work excessive hours without a break as this may impact upon the care of residents. Timescale for action 30/09/09 2. OP18 13 30/09/09 3. OP27 18(1) (a) 30/10/09 4. OP30 18 (1) Staff must have appropriate time 30/09/09 off for training. This is to ensure that they receive and retain information to help them understand and meet the needs of people living in the home. West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations West House DS0000015565.V376484.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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