Inspection on 08/12/09 for West House

This inspection was carried out on 8th December 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

West House 30/06/09

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 15/03/2010.

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 8th December 2009 09:00 DS0000015565.V378755.R01.S.do c Version 5.3 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.V378755.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.V378755.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.V378755.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 7th July 2009 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.V378755.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 second unannounced inspection carried, which included a visit made to the home out in line with out enforcement pathway for managing services which provide poor outcomes for people. The last inspection was carried out on 7th July 2009. 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 two residents living in the home. We received two surveys from staff members. During the inspection we spoke with nine residents, one relative, two members of staff and the manager. As part of the inspection process we employed the use of an Expert by Experience. This is an individual who has experience of using a social care service. An Expert by Experience is one of the resources we use as part of our methodology for engaging with people who use social care services. This person accompanied us on the inspection and spent tie speaking with residents to obtain their views about their experience of living in the home. The views and comments made by residents were used in this report and to help us make judgements about outcomes for people living in the home. 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. West House DS0000015565.V378755.R01.S.doc Version 5.2 Page 6 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. What the service does well: The home is clean and comfortable and well maintained. Staff are recruited according to a thorough and robust system for checking each person’s suitability to work in the home. Checks such as references and Criminal Records Bureau disclosures are obtained before a person is offered employment. The home has a comprehensive training and development plan, which staff complete. What has improved since the last inspection? What they could do better: A more detailed assessment of each person’s needs must be carried out before they are offered a place in the home. This would help to ensure that the home is suited to the person’s needs. From the assessment a person centred care plan must be developed, which accurately reflects the needs and wishes of West House DS0000015565.V378755.R01.S.doc Version 5.2 Page 7 each person. This will help to ensure that people are supported according to their needs and their expectations. Where risks are identified to the health and safety of people living in the home these must be managed better so that injuries to residents are minimised. Nursing staff More needs to be done so as to provide opportunities for activities and exercises for people living in the home. Some residents told us that they were they could not always make choices about the things the liked to do and the meals they receive. One person said it was sometimes ‘boring’. Two people told us that they were fed up watching television. Two other people said that they would ‘like to go out more’. Staff should spend more time engaging with residents and paying more attention to them. Residents told us that staff were busy and not always available when they needed them. The home could be managed better and the manager could do more so as to ensure that staff support residents according to their needs and wishes and that they minimise risks of harm and injury to people living in the home. 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.V378755.R01.S.doc Version 5.3 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.V378755.R01.S.doc Version 5.3 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): 1,2,3 & 6 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 moving into the home cannot always be assured that their needs will be met because the assessment process is not always thorough. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that there was information available about the home and the services provided in a document and on the internet. One of the two residents who completed surveys told us that they had received enough information about the home to help them decide if it would suitable for them and that they had received a contract of terms and conditions. The other person said that they had not received either. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 10 The manager told us that an assessment of each person’s needs would be carried out before the individual was offered a place in the home. When we visited the home we looked at the arrangements for assessing the needs of people before they were offered a place in the home. We looked at the assessments carried out for two people who had recently moved into the home. The manager had visited both people in hospital and completed an assessment of their needs prior to them moving into the home. However both assessments were basic and did not include details of each resident’s wishes or capabilities in some cases. Important information about one person’s mental health needs was not recorded within their assessment, however it was included within the information providing by the placing authority. We looked at information, which staff recorded about the experiences of people when they first moved into the home. We saw that staff introduced new residents to people living in the home and staff and showed them round the home. We saw information about how residents were supported in settling into the home. One person who was anxious when they moved in requested that their relative stay with them and arrangements were put in place to accommodate their wishes. At the time of the home accepted people from Southend Hospital for short term placements while they waited for a permanent place in a care home or to return to their own homes. There was no information recorded in assessments or care plans for these people as to the plan for their discharge. The manager said that staff from the ‘step down’ team visit these residents each week but that they do not record outcomes in their care notes. This means that staff may not be aware of the plan and progress with this. Following the inspection we spoke with the discharge co-ordinator for Southend Hospital and they told us that while they were no longer placing people at West House (due to the poor quality rating) that they had no issues with short term placements at the home. West House DS0000015565.V378755.R01.S.doc Version 5.3 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 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 do not always supported according to their assessed 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. At the time of the last inspection we told the manager that care plans should be developed so that they were more person centred and reflected the needs and wishes of individuals. Two members of staff who completed surveys told us that they ways in which information about residents needs was shared usually worked well. Of the two West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 12 residents who completed surveys, one person told us that they always received the care and treatment (including medical treatment) that they needed. The other person said that they usually did. When we visited the home we the home we looked at how care was planned and delivered to residents and how risks to the health and safety of people were identified and minimised. We looked at the care plans for four people. Care plans identified each person’s needs around activities of daily living such as washing and dressing, eating and drinking and mobilising. There were care plans in place around how staff were to support resident’s health and medical needs. However care plans did not reflect individual’s wishes for how they would like to be supported. Care plans did not include details of how each person’s needs affected their daily lives. Care plans included the sentence ‘to encourage family participation’. However how this was achieved was not clear and there was no evidence of family involvement in care plans we looked at. Staff reviewed care plans each month. However they did not indicate in the review whether the planned care and treatment had been effective or whether there had been any changes needed. For example where there were care plans in place around managing a person’s pain. Reviews did not indicate when the person had complained of pain or whether medication prescribed had provided relief. We saw that the manager spent some considerable time re-writing care plans. We discussed this with him and he told us that this was to ensure that they were easier to read and understand. However we saw that in the process of rewriting the care plans he regularly changed or omitted information, which would be useful to staff in supporting residents. We looked at how risks to people were identified and the measure staff took to minimise these. We saw that while there were risk assessment documents and a process to identify these that staff did not do so consistently. We saw that where specific risks to some residents’ health and safety had been identified that a plan to minimise these risks had not been completed. One person who required the use of bedrails so as to minimise risk of falling from their bed had no risk assessment in place to consider the risks around use of bedrails. We saw from accident records completed by staff that this person had on one occasion been found by staff on the floor by their bed during the night. Staff recorded that it appeared that ‘It appears that (resident) may have climbed over bedrails or got out of bed at foot of bed and fell’. Following this incident staff did not assess risks around the use of bedrails for this person. We observed that there was no risk assessment in place for two other people where bedrails were used as a method to minimise risk of falling from bed. One person who spoke to us said that she hated going in the hoist. They said ‘I hate going in it. They (staff) don’t seem to know how to use it properly and it’s made my shoulder bleed’. We observed how staff transferred the person using the lifting hoist. Two members of staff assisted the resident. We observed that West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 13 they were chatting with each other and did not act appropriately when the resident complained that the hoist was causing them some pain. With the person’s permission we examined their arm and found a skin tear consistent with what they told us. The injury had not been observed by staff despite the fact that they supported the person with personal care and dressing. We spoke with the manager about our concerns. They told us that all staff had undertaken training around safe moving and handling of people. We looked at the arrangements for ensuring that people living in the home received the medicines prescribed for them. We saw that staff had appropriate training around the receipt, safe storage and administration of medicines. We looked at the medication administration records and saw that usually residents received medicines as prescribed. However we saw that staff had not acted appropriately to ensure that there were sufficient medicines available for one person. This meant that the person did not receive a prescribed medication for a period of three days. We discussed this with the manager who assured us that once it was noticed that the medicines were finished that staff acted promptly to ensure that they were received as soon as possible. We discussed our concerns that staff had not acted to ensure that medicines were received before the last batch had run out. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 14 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 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 do not enjoy a lifestyle, which reflects their wishes. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the home provided an external entertainer each week. They told us that staff undertook 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. Before we visited the home we received surveys from two residents. One person said that there were activities arranged which they could participate in and that they usually enjoyed the meals provided. The other person did not West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 15 respond. One member of staff commented that a room for activities would be good. On the day of the inspection the expert by experience spoke with nine residents. They told us that they would like more opportunities to go out, more choice in activities and food. A number of residents told us that they got fed up watching television. One person said ‘It is on every day from morning to night, and look around, most of us are not watching it’. During the inspection we observed that the television was on during the day and that the majority of residents took no interest in it. We observed that staff spent very little time with residents and tended only to approach individuals when supporting them with activities such as assisting them to mobilise or to serve drinks or meals. The expert by experience spoke with one gentleman who commented how lovely nice it was’ ‘to have somebody to chat with’. One person told us that they ‘were quite happy living at the home, though it could be a bit boring’. They told us that they had been a keen gardener The expert spoke with two residents who spent their time in the smaller of the two communal lounge areas. They told us that we’d like more freedom and choice about what we do’. They also stated that they would like to go out occasionally, as ‘we feel we have no contact with the outside world’. However, when asked them about activities were available, they said that they have craft afternoons. They said they enjoyed these. One person said ‘We make cards or do embroidery once a week’. They also told us that they had regular entertainers who visited the home, which they also appreciated, saying they were very good. They expressed a wish for ‘more fun’ saying ‘we just wish someone would give us a good laugh every now and then’. During the morning of the inspection we observed that no opportunities for activities were provided and while staff were available, they spent very little time engaging with residents. In the afternoon some staff set about dressing the Christmas tree and played some festive music. However they carried out this activity in a part of the room where residents could not observe or participate in the activity. We made a comment to the manager to this affect and staff were then instructed to move to where residents could observe. However residents were still not encouraged or supported to be involved in this activity. Some residents expressed a desire for more choice of meals. One person said that they would like ‘less processed foods such as burgers and the like’. Three residents told the expert by experience that they had to eat what was offered or just leave it. During the inspection we observed how people were supported during the lunchtime meal. Some of the more physically able and mobile residents were seated at the small dining room table. None of the other residents were offered the choice to do so and were served their meals while seated in their armchairs. Some residents may benefit from sitting at the dining room table and engage in social interaction with others. Staff served the West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 16 meal of beef, roast potatoes and vegetables. Staff did not offer to cut the beef for residents and two people we observed clearly struggled to do this. While staff were available in the lounge during the meal, we saw that they spent their time completing records rather than being available to observe and support people. Residents were not offered drinks with their meal and two residents needed some assistance but staff did not appear to notice this until it was pointed out to them by the expert by experience. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 17 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 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 not always safeguarded from unnecessary harm due to poor staff practices. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that the home had a robust complaints and safeguarding policy and procedure. Before we visited the home we sent surveys to residents and staff to complete and tell us how they felt the home dealt with complaints. Two residents returned surveys. They both told us that they knew who to speak to informally if they were unhappy and how to make a complaint. Two members of staff completed surveys and both told us that they knew what to do if someone made a complaint. When we visited the home we looked at the arrangements for dealing with complaints and safeguarding people in the home from harm or abuse. We saw that there was a policy and procedure in place for receiving and dealing with complaints. We saw that one complaint had been received since the last inspection. We saw that this had been dealt with and responded to in line with the homes policy. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 18 During the inspection the expert by experience spoke with nine residents. One resident said ‘I don’t like to complain’. They told us that staff did their best but that they were not always available when they needed them. They also commented that they ‘got fed up with television’ saying ‘why can’t we have some peace and quiet sometimes?’ Another person told us ‘We have no real complaints though, we don’t have a lot to moan about.’ They did say that they would like more choice of meals and told us ‘You just have to eat what you are given or just leave it’. From speaking with residents it appeared that while they did not have complaints about the home that there were issues that they were unhappy about. These were mainly around lack of choice in how they spent their time, food etc and lack of staff support. We looked at the arrangements for safeguarding people from harm, abuse or neglect. We saw that staff had undertaken training around safeguarding and their responsibilities. At the time of the last key inspection there had been a number of safeguarding alerts made about the home. We had identified at that time that there were a high number of incidents of minor injuries to residents caused by how staff handed them when transferring from chairs and beds etc. The local safeguarding team had worked with the home’s manager to address these issues and the alerts had been closed down at the time of this inspection However during the inspection we observed poor moving and handling practices when staff supported a resident who required assistance being transferred from their chair with the use of a lifting hoist. Staff failed to act appropriately when the resident complained of pain during the procedure. Similar concerns were raised by a social worker who visited the home some time prior to the inspection. They told us that they witnessed staff moving residents ‘without due care and attention to the individual’. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. West House provides a clean, safe and comfortable environment for residents; however the layout of communal areas is not always suited to the needs of residents. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment that 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. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 20 Both residents who completed surveys told us that the home was usually fresh and clean. When we visited the home we carried out a brief tour of the premises. We saw that resident’s bedrooms, bathrooms and communal areas were clean and free from unpleasant odours. Staff were employed to keep the home clean and tidy. The manager ensured that checks were carried out regularly so as to ensure systems and equipment were maintained in good working order. Regular checks were carried out to ensure that hot water temperatures were maintained at safe levels, gas and electrical equipment and that fire detection and fight equipment were working effectively. During the inspection we noted that the layout of the communal area was not conducive to good interaction and engagement between staff and residents. The majority of residents were seated facing the television. The arrangement of chairs created a division in the room. We observed that staff spent most of their time in the other part of the room, where they could not easily observe residents. Since the last inspection some residents now took their meals at the dining room table. However this was limited to those people who were physically capable of doing so unaided. Staff did not offer other residents the opportunity to do so with assistance. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 21 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 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 supported by staff as expected according to their assessed needs. 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. At the time of the last inspection we identified issues around staff working excessive hours without appropriate time off, which may impact on the care and support provided. The manager told us in the improvement plan submitted following the last inspection that staff only worked in this way on rare occasions where it was not possible to provide staff cover for the home. They told us that this would be monitored closely and that staff would have appropriate time off from. Prior to visiting the home we sent surveys to staff and residents to complete. Two residents completed and West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 22 returned surveys. One person told us that staff were always available when they needed them and the other told us the sometimes were. Three members of staff told us that they received training, which was relevant to their roles, helped them to understand the needs of the people they cared for and kept them up to date with new ways of working. When we visited the home the expert by experience spoke with nine residents. Of the nine people five commented that staff were often rushed and did not have time to spend with them. One person commented ‘They always seem to be busy, that when you need help they don’t always come very quickly’. Another person told us ‘They (staff) do their best but we are always rushed. I don’t like that’. Two other residents told us that staff ‘always appeared to be too busy’ and one person said ‘They don’t take their time with us’. During the inspection we observed how staff supported residents. We saw that while staff were available in the lounge area that they spent most of the time completing records and engaged very little with residents. On two occasions we observed residents who needed support. Staff were unavailable and the expert intervened to assist a resident who appeared to be choking on their food and another person who asked for a tissue. Throughout the day the expert noted that on numerous occasions when residents requested help staff responded by saying ‘hold on’, ‘wait a minute’ or ‘five minutes’. One resident commented ‘They never do anything first time of asking’. We looked at the arrangements for recruiting, training and supporting staff. We looked at the recruitment files for two people who had been employed to work in the home since the last key inspection. We saw that appropriate checks including references from previous employers, PoVA First checks and Criminal Records Bureau disclosures had been obtained as part of the process for determining the suitability of people before they were offered employment. Staff received job specifications and undertook a period of induction so as to familiarise themselves with the homes policies and procedures. We looked at the arrangements for training staff so that they could best meet the needs of people living in the home. We saw that there was a comprehensive training plan in place and that staff undertook regular training. Following the concerns raised at the last inspection extra training was provided for staff around safe moving and handling of people. However we still observed staff to transfer a resident using a lifting hoist without paying due care and attention or responding appropriately when the person complained that this was causing them pain. West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 23 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 & 38 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 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.V378755.R01.S.doc Version 5.3 Page 24 When we visited the home earlier this year we identified shortfalls in how the home was managed. We saw that the staff rota did not indicate how often the manager was present in the home. When we visited on this occasion we saw that the manager had devised a timetable which reflected when they were in the home. We saw from this that he spent a lot of his time re writing care plans, which nursing staff had completed. This took him away from overseeing the management of the home and ensuring that staff supported residents appropriately. We looked at the arrangements for safe storage and handling of resident’s monies, where these were handed in for safekeeping. We saw that there were stringent process in place for checking money and receipts and that monies were stored securely. Residents had access to their money when they wished to purchase items or services such as hairdressing. 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 been collated so as to show where the home provided good outcomes and where improvements were needed. We were provided with a copy of the analysis of outcomes from the surveys. This was in the form of graphs and it was not easy to determine where residents had suggested improvements or what action had been taken in respect of this. 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.V378755.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 2 3 3 West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 28/02/10 2. OP8 13 3. OP9 13 (2) 4. OP12 16 (2) m &n Each person living in the home must have a care plan, which reflects their individual needs and how they are to be supported. Care plans must be reviewed regularly and amended / updated so that they accurately reflect the person’s needs Where risks to individuals health 28/02/10 and safety are identified these must be managed so that risks of harm and injury are minimised. Staff must ensure that so far as 28/02/10 it is practical that residents receive medicines which are prescribed for them. Appropriate activities and 30/03/10 exercise must be made available to meet the needs of people living in the home so as to keep them occupied. 5. OP31 4 The manager must ensure that the home is managed in the best interests of the people who live there. DS0000015565.V378755.R01.S.doc 30/03/10 West House Version 5.3 Page 27 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 More could be done so as to ensure that people living in the home have the opportunity to express if they are unhappy and that they feel confident that their comments will be taken seriously. The layout of the main communal area should be reviewed so that it provides a more conducive environment where staff can more easily interact and engage with residents. Staff routines and practices should be monitored so that staff support and engage with residents according to their assessed needs. 2. 3. OP19 OP27 West House DS0000015565.V378755.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@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). 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. 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