Inspection on 07/07/09 for West Street Home

This inspection was carried out on 7th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Street Home 08/07/08

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: West Street Home 198/200 West Street Dunstable Bedfordshire LU6 1NX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: West Street Home 198/200 West Street Dunstable Bedfordshire LU6 1NX 01582477794 01582471684 audrey@benslow.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Benslow Management Company Limited care home 36 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 36 The maximum number of service users who can be accommodated is 36 The registered person may provide the following categories of service: Care Home Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Date of last inspection Brief description of the care home West Street home is situated on a busy road close to the centre of Dunstable within a short walk of the towns many amenities. The home provides personal care for up to thirty-six people over the age of 65 years who have dementia. The accommodation is distributed over four floors that are accessed by staircases and/or a shaft lift. Twenty-six rooms have an en-suite toilet and wash hand basin, one has en-suite shower facilities and the remaining nine rooms do not have en-suite facilities. The dining and lounge facilities are located on the ground floor together with the kitchen, laundry, bathrooms, WCs and some bedrooms. To the rear of the property is a garden with seating areas. Care Homes for Older People Page 4 of 27 Brief description of the care home A copy of the homes statement of purpose and service user guide are available in the front hall. Copies are available to prospective people who may wish to move into the home. The weekly fees range from £457.00 to £716.00 per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection was carried out on 7th July 2009. The home has been registered since February 2008. The care of three people was looked at in detail. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who Care Homes for Older People Page 6 of 27 use a service. During the visit the communal areas of the home were seen alongside three of the individual rooms. Time was spent with many of the people who live at the home in the sitting and dining area. Observations of care practise and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 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. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The system in place for staff to assess the needs of prospective people remains sufficient to ensure that they would have the information to know if they would be able to meet their needs. Evidence: Documents seen as at the previous inspection within the records of a person recently admitted to the home, showed several assessments of their needs. Representatives of, Social Services and staff of the service had completed documents. Each representative had completed their own assessment documentation and further evidence was seen to show all had been involved in the decision for the person to move to the home. Documents described in detail the needs of the person; this included any diagnosis that had previously been made, the behaviors of the person and their individual aspirations alongside any risks. People that live in the home and entries within the daily notes confirmed that they had also had the opportunity to visit, prior to moving Care Homes for Older People Page 11 of 27 Evidence: in. This evidenced consistency in the admission process. Of the people spoken to that were able to respond, all confirmed that they had been involved in their assessment and decision on whether to move into the home. The statement of purpose was seen to be displayed in the home. The document provided information on the staffing, accommodation and services available at the home. Information had been added within this document on rooms available including the fact that two of the rooms did not have natural ventilation. People able to indicate stated that they felt they had been given enough information, before they decided to move into the home. Intermediate care is not provided at the home. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication systems are good so people receive the support they need in this area to maintain a satisfactory level of well being. Evidence: Files examined contained many completed documents for each person; files were set out in a logical way with an index at the front to guide the reader. Included were assessment of needs, risk assessments relating to moving and handling, tissue viability and falls. Entries were also seen to show that regular reviews had been made relating to the assessment of risks. At the previous inspection we made a requirement as there had been no actual care plans in place. This had been met as there were new documents in place. However there needs to be further development of these documents, one person had been assessed as being partially deaf, had memory loss and was at high risk of falling. The only plans in place were for mobility, personal care and continence. Observation of interaction between the staff on duty at this inspection and the people Care Homes for Older People Page 13 of 27 Evidence: living at the home demonstrated that staff had a good level of understanding of the needs of the people living at the home. The manner and the way in which staff interacted with them showed a consistent support that was both encouraging and respectful. Through further observation of the people living at the home it was noted as previously reported that their clothes, hairstyle and makeup reflected their individual personalities. Guidance and support regarding personal hygiene was offered and the level offered by staff was seen to be very good by the people in the home as they responded positively to the staff. At the previous inspection there had been no locks on the communal toilets or bathrooms, this was now noted to have been carried out. Within the individual care files, documentary evidence was in place to show that people had received medical support when needed. One person had become unwell during the night, the daily notes indicated that the night staff had increased the level of observation throughout the night, the persons condition was reassessed again in the morning and staff felt that it had not improved so called for a Doctor. The Doctor visited, prescribed treatment and then the persons health improved. The storage, receipt and administration of medication was examined. The medication administration sheets were noted to be correct, and all balances matched the entries on the medication sheets. The system for recording balances was now sufficient to enable an audit to be carried out. Staff confirmed that they did receive regular updates in the administration of medicines and certification of training was seen in staff files and observations were made of medication and noted to be appropriate and follow safe practice guidelines. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home still feel that the choice of meals provided are sufficient to meet their tastes and preferences. Evidence: People spoken with confirmed that they enjoyed the food at the home. At this inspection the main hot meal of the day was being served late afternoon. This had been changed as a large number of residents were out on a trip during the day. Sandwiches were served to those that remained in the home. Staff were seen to offer people the opportunity to remain in their armchairs or to sit at one of the dining room tables.The most recent environmental health inspection found that there were sufficient standards in this area being maintained. In addition nutritional risk assessments were seen to have been undertaken for the people living at the home. Policies examined and activities advertised suggested that there were no fixed rules or regulations on how people occupied their day as previously reported. The individual interests for people were recorded in their personal files. Several changes had taken place since the previous inspection, there are now wall hangings throughout the home for example, these are bright in color and use different textures to encourage touch. Care Homes for Older People Page 15 of 27 Evidence: A significant increase to the level of activities had also taken place. People at this home have an opportunity to go out frequently. Activities form a part of the daily life in the home and is seen as of vital importance by the manager and her Deputy. Unfortunately we were not able to speak to any relatives as none were visiting at the time of this visit, however surveys had been sent out in June 2009 by the home and the following are some of the comments within the returned surveys. We liked it from the off, sunny, bright, open and the staff are were very friendly, Good, always feel welcome and happy for visitors to come in, homely feel, Welcoming, clean and relaxed. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The training of staff is sufficient to ensure they have a satisfactory level of understanding of the safeguarding protocols to protect the people living at the home. Evidence: The homes complaints procedure was examined. It advised the reader on how they could complain and information on how to complain was also detailed within the homes service user guide. Two complaints had been received by the service since the previous inspection. The documents showed clearly the investigation of the concerns or the outcome, and also demonstrated that a thorough investigation had been carried out. One complaint had been made to us, we passed this onto the provider to investigate. The response from this was within timescale and responded to each area of the complaint. The home had a copy of the local protocols and reporting procedure in safeguarding. Staff when interviewed demonstrated that they were aware of what they should do in the event of an alleged/suspicion of abuse. Training records and staff also confirmed that staff had received training in this area. A safeguarding issue in November 2008 was not upheld, feedback from Social Services was that the manager had acted and assisted them in their investigation in a willing and professional manner. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general standard of the environment is good and provides a homely environment for everyone living at the home. Evidence: The furnishings, fittings and decor in the communal areas of the home is of a good standard. Individual rooms contained personal items of the person to assist in creating a homely atmosphere. All areas visited on this day were tidy and free of odours. The rear garden accessed from the large lounge contained seating, flowerbeds and ornaments. Feedback from people living at and visiting the home was positive. The lighting however in the lounge/dining area is not domestic; it is a strip light and does not assist in creating a homely environment as reported previously. In addition three of the bedrooms have either no natural ventilation or very limited ventilation. For two of the rooms you need to open the en-suite toilet door and open the window in this area for fresh air. The other room had no window, however this is now explained within the statement of purpose, people are advised of this prior to using one of these rooms so therefore the decision to move into one of them is theirs. In addition the manager has added additional items throughout the home to assist in creating a homely environment, these include pictures and ornaments. Care Homes for Older People Page 19 of 27 Evidence: Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner and clinical waste contracts are in place. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for the recruitment of staff are good and protects the people living at the home. Evidence: On examination of staff records to inspect the recruitment practises at the home, three staff files were chosen. It was noted that all three staff had information in place relating to the checks required before they had been allowed to work with people who use the service. In addition the manager had secured additional assistance from a governing body to audit work permits, as a result of this several staff in December 2008 had their employment terminated. Staff training information seen at this visit showed that staff had attended a variety of courses and workshops including health and safety, food hygiene and safeguarding adults. 95 of staff have a National Vocational Qualification at level 2 or above in care. The induction and training of staff was recorded in the individual records of all employees. Staff through interviewing confirmed that they had undertaken a variety of courses these included health and safety, moving and handling and national vocational qualifications in care. Care Homes for Older People Page 21 of 27 Evidence: A manager, Deputy manager care assistants, catering and housekeeping staff are employed at the home. The rotas supplied by the home show that there are sufficient numbers of staff on duty throughout the day and night to meet the needs of the residents at this time. People living at the home again confirmed as previously that staff were available to help and assist them when they need help.Staff were questioned on the individual needs of some of the people who live at the home, through this they demonstrated a good level of understanding of the needs of the person. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems remain sufficient to reduce the risks associated with this area for the people living at the home. Evidence: Health and safety policies were noted to be clear in its guidance to staff and comprehensive. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Approved contractors had undertaken servicing of equipment. Staff carried out the regular checks relating to water temperature checks for example and recorded the temperature on charts. Stocks of aprons and gloves were noted to be available for staff to use, in relation to infection control. No staff at this visit were seen to use these items inappropriately, their use was only seen to be made in the area where they were needed. LOLER was carried out in June 2009. Small amounts of money are held on behalf of people living at the home to help assist Care Homes for Older People Page 23 of 27 Evidence: them in paying for additional services such as hairdressing. A sample check of the records confirmed that receipts are kept which confirm the transactions made on behalf of people helping to protect them. All balances checked were noted to be correct as previously reported. There are quality assurance systems in place, which include sending questionnaires to relatives and visiting professionals to ascertain their views on the quality of care provided. Surveys were viewed that had been returned to the manager. Comments received in June 2009 are detailed within the Daily life and Social Activities section. All comments received about the management in the home were positive. A new Deputy had been appointed since the last inspection. Significant improvements had been made in recruitment, medication systems and activities and credit is given to the manager for her commitment to making these improvements. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be a care plan in 11/09/2009 place for each assessed need, so people receive continuity of care and staff have sufficient guidance on how to support the person. Staff need to have written guidance on how a need should be met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!