Inspection on 27/07/06 for West View

This inspection was carried out on 27th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

West View 20/02/08

West View 03/01/06

West View 19/07/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE West View Plummers Lane Tenterden Kent Lead Inspector Lisbeth Scoones Unannounced Inspection 27th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West View Address Plummers Lane Tenterden Kent 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) 01580 261500 Kent County Council Mrs Caroline Joan Heffernan Care Home 60 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (45) of places West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 30 of occupied beds can be used at any one time for service users who are under the age of 65 years old but are over the age of 55 years. Additional service users with a diagnosis of DE(E) are restricted to two (2) whose DOBs are 22/05/1918 and 24/08/1913. 3rd January 2006 Date of last inspection Brief Description of the Service: West View is an innovative service, registered in April 2005, and aims to provide a range of services to meet both the health and social care needs of 60 male and female residents aged 55 and over. Accommodation is on two floors each providing care for 30 residents. Nursing care and recuperative care is provided in the 15-bedded Benenden East and 15-bedded Benenden West units on the first floor accessed by two passenger lifts. The ground floor comprises two units: The Lindens and Wittersham. Long term residential care for 15 residents and up to 2 of places for short stay respite care is provided in the Lindens. Wittersham provides long term dementia care for 15 residents and up to 2 of these may be used for short-term respite care. West View Integrated Care Centre is newly built and situated in Plummer Lane. It offers magnificent views of rural countryside and provides ample car parking. There is a secure garden as well as other gardens, walkways and a pond to the front of the building. The market town of Tenterden with bus services, railway station and other amenities is nearby. The town of Ashford is approximately 15 miles away. The maximum current weekly fee is £351,91. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place between 9.20 and 17.00 and was carried out by three inspectors one of whom a pharmacist inspector. During that time a full medication audit was undertaken and Benenden West, the Lindens and Wittersham units visited. The inspectors met with a number of residents and had discussions with the deputy manager, who assisted the inspectors throughout the day, senior nurse, senior team leader, an agency nurse on duty, other staff and members of the rehabilitation team. Documentation was examined in respect of care planning and risk assessments, staff recruitment and training files, menus and duty rotas. Prior to the visit, ten residents, three GP’s and two care managers returned completed comment cards. In general these contained favourable comments about the services provided. What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User Guide have been updated and now include a summary of residents’ views. Care plans are now integrated and a new format has recently been introduced. Nearly all staff have now had adult protection update training. Liquid soap and paper towel dispensers were seen in those toilets and ensuites visited. Staffing levels have been reviewed and job descriptions completed. Staff training has been reviewed following appraisal. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 6 Health and safety issues have been addressed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. The Statement of Purpose and Service User Guide provide residents with the information they need to make an informed decision about the services the home provides. All residents move into the home having had their needs assessed and been assured that these needs will be met. Residents assessed and referred as requiring intermediate (recuperative) care are assisted to maximise their independence and return home. EVIDENCE: The Statement of Purpose and Service User Guide have recently been updated and provide residents with the information they need to make an informed choice of the services provided. Copies of the Guide were seen in those rooms visited and now include a summary of the outcome of satisfaction surveys regularly undertaken. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 9 The centre has procedures for admission covering the various types of care on offer. For intermediate care, a flow chart identifies the process. For those residents requiring long term residential or dementia care, the process would include an assessment by the care manager and pre-admission assessment by the manager of the centre. For those residents requiring nursing care, admission criteria would be determined through a joint assessment process. Not all referrals made result in an admission to the centre. It was evident from discussions with the deputy manager that every referral is carefully considered on the basis whether the centre can meet the residents’ needs. The centre has dedicated rehabilitation facilities, which include equipment for therapy and treatment. Specialist services from relevant professions including physiotherapists and occupational therapists are provided to meet the assessed need of those residents admitted for rehabilitation. A recently admitted resident said that he noted an improvement and “yesterday I walked 17 steps.” West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome group is adequate. This judgement is based on information available at the time, which includes a visit to the service. Not all care plans provide staff with the information they need to satisfactorily meet the residents’ needs. Residents’ health care needs are well met with evidence of good multidisciplinary working but the evaluation of nutritional care needs should be more robustly recorded. There was evidence that medication practices are poor and potentially place residents at risk. Residents are treated with dignity, kindness and respect. EVIDENCE: Since the previous inspection, a new integrated care planning format has been introduced. Staff said they like the new format. The deputy manager praised West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 11 the staff for their hard work in adopting the new format. The centre is in the process of computerising the care plans. The inspectors viewed a sample of care plans. In the Linden and Wittersham units, these contained much information and were regularly reviewed. A sample examined in one of the high dependency-nursing units lacked detail in respect of nutrition and mobility and had not recently been reviewed. Whilst the centre provides adequate equipment, staff said they had requested an additional means of weighing highly dependent residents. It was recommended that pain charts be used as an audit for residents prescribed regular analgesia. The Core Intermediate Care Team (amalgamation of CART and Adult Rapid Response Team) comprises physiotherapists, occupational therapists and community district nurse and provides care and support to those residents admitted for recuperative care. The centre employs its own physiotherapist. All staff are trained to treat and prevent the development of pressure ulcers and to promote continence. Residents have access to dental and chiropody services. GP visits are recorded in the care plan. The home has two differing medication policies and procedures and two forms for recording receipts. Four medicines were found that were not recorded on the medication administration records. Records of unwanted medicines were seen, with separate records of collection by the disposal company. Lockable drawers are provided for service users, who are assessed as able to self-administer medicines. Supply of medicines for self-administration was not recorded. For one resident ten MAR charts were in use, with 24 entries some of which were for the same medicines. Two nurses expressed concerns about so many MAR charts with duplicate information, being in use for one resident. It was discussed that this should be reviewed. For two days a medicine had been recorded as not available and another as out of stock. A medicine had not been administered for three days after admission as the home had been waiting for confirmation of a dose. It was noted that staff interacted with the residents in a kind, patient and dignified manner. A resident said, “ everyone has been very kind and given me all the help I’ve needed.” West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Residents are provided with choices in relation to their chosen lifestyle and are encouraged to maintain contact with family and friends Residents receive a wholesome, balanced and varied diet. EVIDENCE: Residents spoken to said that they have a choice in relation to leisure and social activities, food and routines of daily living. A life history is included in residents’ care plans providing staff with information about their interests and activities. Leisure facilities for those residents receiving long-term care currently include bingo, daily newspapers, dominoes, arts and craft (making birthday cards), word games, beauty therapy and the shop. Residents are accompanied for walks. A recent planned visit to the Tenterden railway was postponed due to the hot weather. Residents meetings are held regularly. A reminiscence room has been set up in 1930’s style, the contents of which many residents and their relatives have contributed to. The inspector was shown a fully operational sensory room with a variety of “snoezelen” equipment. The latter has been purchased with monies raised through charity West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 13 fundraising. Residents’ response to the relaxation offered is monitored using a “well-being” chart. It was suggested that more detail be recorded to reflect residents’ experience. It is the manager’s intention that a sensory garden be developed. Residents are enabled to practice their religion. Communion services are organised as well as a Baptist service every month. Each unit has a calendar on display with religious ceremonies. Shaw Health Care provides the catering arrangements at West View and the kitchen is well equipped and staffed. Residents complete menu cards and choose what they wish to eat. The majority of residents spoken to said they enjoy the meals. Three meals a day are provided as well as a snack meal in the evening if required. The inspectors did not visit the kitchen at this visit. Meals served were well presented. Menus have recently been reviewed. In one unit, the menu on display was out of date and in small print. It was suggested that a current menu be readily available and in larger print. Colourful cups and saucers are used throughout the Lindens and Wittersham units but it was noted that these are no longer used in the nursing units and replaced with white mugs. Every unit has a kitchen from which the meals are served. Additional kitchens are available to be used by residents and their relatives. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Residents know that their complaints will be listened to. Staff are trained in adult protection issues thus ensuring that residents are protected from abuse. EVIDENCE: There is a complaint procedure, which is included in the Service user Guide. The Commission has been made aware of one complaint, which is being investigated by the registered provider. The deputy manager is the centre’s adult protection trainer and confirmed that the great majority of staff have been provided with adult protection training updates. See also standard 30 in respect of a training matrix. Since the previous inspection three incidents were investigated under adult protection procedures. These investigations are now completed. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. The centre provides a safe, well-maintained, clean, pleasant and hygienic environment. EVIDENCE: The centre provides a pleasant environment for its residents with single ensuite facilities. It was noted that fans and air conditioning units were made available during the hot weather spell. Shaw Health care is responsible for maintaining the building both in respect of routine maintenance and renewal of fabric and decoration. The grounds and gardens are attractive and accessible to residents. The responsibility of the domestic and laundry provision is with Shaw Health Care. The centre was clean with no unpleasant odours. A resident commented, “ My room is always cleaned. I watch the cleaners.” West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 16 An infection control policy and procedures are in place and staff training provided. Some concern was expressed about the standard of cleaning and efficiency of the laundry service at weekends. The manager said this would be addressed. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Staff are provided in sufficient numbers and skills mix to meet the needs of the residents. The residents are protected by the centre’s recruitment policy and practices. Residents are in safe hands at all times and cared for by staff who are trained and competent to do their job. EVIDENCE: Staff spoken to said that in general, staffing levels were adequate but that Benenden West was a particularly busy unit. Whilst the units have a stable staff team who work well together, the centre employs regular relief staff (agency). Some residents said they preferred “their own staff”. The inspector spoke with an experienced agency nurse who is well liked and works regularly at the nursing units. Duty rotas examined would indicate that for each shift, sufficient senior and unit staff is provided. Staff at the Lindens and Wittersham units said they enjoy doing games with the residents but that there was “not always sufficient time to fit it all in.” A resident, when asked “are staff available when you need them” said “ There can be times when staff are really busy and staff are not available.” West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 18 The centre offers day care and is registered to provide residential, dementia and nursing care. In respect of nursing care, registered nurses and health care workers are employed on a secondment basis by the local PCT. The centre has been accredited to provide placements for student nurses. A community nurse (as part of the intermediate team) oversees the nursing needs of “residential” residents receiving recuperative care. It was said that nurses employed at the centre would undertake a delegated role for residential clients on occasions. A sample of staff files was examined and demonstrated in general sound employment practices. For auditing purposes, it was suggested that a list of PIN numbers/expiry dates and evidence of completed CRB checks (currently held at head office) be available at the centre. Since the previous inspection, the process of reviewing job descriptions has been completed. The deputy manager has delegated responsibility for induction and other training. Since the previous inspection, the induction programme has been reviewed to comply with the Skills for Care standards. Following appraisal, every PCT seconded member of staff now has an individual training profile and development programme. The manager confirmed that the same standard applies to KCC employed staff. Planned and undertaken statutory and specialist training (e.g. Dementia care) is recorded on a training matrix and monitored every two weeks. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. The manager is supported by senior staff in providing leadership throughout the home. Residents live in a home that provides an open and positive management approach. Monitoring systems ensure that residents’ views are included in establishing whether the home meets its aims and objectives and Statement of Purpose. A number of audit tools are used that ensure consistent and compliant practices and record keeping. Staff are appropriately supervised. Residents’ health, safety and welfare are promoted and protected. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Caroline Heffernan, a registered nurse, is the registered manager and an experienced care home manager. She has a management qualification and is supported by a Head of Service, Operational Manager and a Business Officer. The deputy manager is a registered nurse, responsible for training, recruitment and audit. A senior sister heads the nursing units and senior team leader the residential and dementia units. All staff have been provided with recently reviewed job descriptions relevant to their role and responsibility. In respect of quality monitoring, through staff and residents meetings, the manager ensures involvement from staff and feedback from residents and their relatives. The centre uses a number of audit tools to ensure consistency and compliance as e.g. in respect of care plans, medication, moving and handling and the servicing of equipment. Identified at this inspection, those audits pertaining to care plans, moving and handling records and medication need tightening up. The registered provider carries out formal monthly monitoring visits. These visits include discussions with residents and staff and details of staff training. At the previous inspection, the centre’s arrangement for dealing with residents’ personal finances was discussed. Some residents make use of the centre’s Personal Property Accounts (PPA’s), which feeds into and out of a KCC account set up with a major bank. Whilst this system does not appear to comply with the national minimum standard (35), it has been introduced for residents’ convenience and the amounts banked and withdrawn are small. All staff have 4 to 6 weekly formal supervision as confirmed by staff spoken to. A sample of records pertaining to supervision sessions was seen at this inspection. Arrangements are in place for clinical supervision for nurses and health care staff. As already discussed in standard 30, all staff are provided with statutory training identified on a training matrix. Fire training is provided monthly and during every shift, a nominated Fire Officer and First Aider are on duty. The centre has three moving and handling trainers. Environmental risk assessments are undertaken. At the previous inspection it was noted that accident records were well maintained and stored in accordance with the Data Protection legislation. West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 21 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 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1) Requirement That the registered person shall prepare a plan as to how the service users needs in respect of health and welfare are to be met. Previous timescale 07/02/06 A complete and accurate record must be kept of all medicines received into the home. The home must ensure adequate supply of medicines and knowledge of the prescribed dose. Timescale for action 31/08/06 2. 3 OP9 OP9 13 (2) 13 (2) 31/08/06 31/08/06 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 2 3 Refer to Standard OP8 OP9 OP9 Good Practice Recommendations That nutritional assessments are used effectively A record should be kept of the supply of medicines for selfadministration. Action should be taken to ensure that the medicines fridge is kept within the correct temperature range. DS0000063680.V299729.R01.S.doc Version 5.2 Page 23 West View Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI West View DS0000063680.V299729.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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