Inspection on 08/03/07 for Westacre Nursing Home

This inspection was carried out on 8th March 2007.

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

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

Other inspections for this house

Westacre Nursing Home 26/09/07

Westacre Nursing Home 27/02/06

Westacre Nursing Home 08/06/05

Westacre Nursing Home 12/01/05

Westacre Nursing Home 19/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Westacre Nursing Home Sleepers Hill Winchester Hampshire SO22 4NE Lead Inspector Gina Pickering Unannounced Inspection 8th March 2007 10:00 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 Westacre Nursing Home DS0000011657.V327672.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. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westacre Nursing Home Address Sleepers Hill Winchester Hampshire SO22 4NE 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) 01962 855188 01962 866284 watson.sue@btconnect.com Nursing Home Services Position vacant. Care Home 53 Category(ies) of Dementia - over 65 years of age (53), Old age, registration, with number not falling within any other category (53) of places Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Westacre Nursing Home is located in a quiet residential area, within easy reach of the centre of Winchester. The home offers nursing care for older people over the age of 65 years. The house has many original features and has been altered in order that the needs of older people can be met. Extension work has now been completed which has increased the communal space and the number of bedrooms. Fees for residency and care at the home currently range form £750 to £800 per week. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the service was undertaken as part of the inspection on the 8th March 2007. The process included a tour of the service where a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. As part of case tracking 5 staff and 5 residents and two relatives views were sought and care records were looked at. Information gathered by the commission since the last inspection contributed in assessing judgements in this report. Positive comments were received from the residents and relatives about the service provided by the home. Comments from relatives include this home ‘knocks spots off other homes’ and ‘they always keep me informed about my mothers welfare’. What the service does well: Pre admission assessments assures the prospective resident that the service will be able to meet their needs when moving into the home. The service supports residents well to access health care professionals. Activities and stimulation are considered very important; activities and resources are continually being developed to meet resident’s own interests and hobbies. The home provides residents with nutritious meals. Residents are able to receive visitors whenever they wish. Resident’s and relatives are confident that any complaints made to the hoe will be handled in an effective and responsive manner. Good recruitment procedures protect the welfare of those living at the home, the service meets relevant health and safety requirements and legalisation. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Westacre Nursing Home DS0000011657.V327672.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 Westacre Nursing Home DS0000011657.V327672.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents move into the home confident that their needs can be met by the service and with an understanding of the running of the home. The home does not offer intermediate care. EVIDENCE: Prospective residents have their needs assessed by the manager and another staff member prior to the decision being made whether the home can meet the needs of the person. The manager said that each prospective resident users needs will be discussed with the staff tam during the decision making process as to whether the home is able to meet that persons needs. Information about the running of the home and the services provided by the fees are provided in the form of a statement of purpose and in conversations during the assessment process. The manager said that she intends to develop the Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 9 assessment document so that more comprehensive details about the persons needs are documented. Staff at the home said that they have sufficient details when a person is admitted to the home to provide care. Westacre Nursing Home DS0000011657.V327672.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning does not always assure that a person’s personal and mental health needs will be met by the service. The service supports resident’s to have good access to health care professionals. Medications are generally well managed promoting the welfare of residents. A few practices at the home do not consider the dignity of residents. EVIDENCE: All residents have a plan of care that is reviewed monthly. Details included within this document include risk assessments some of which are moving and handing and the risk of falls. But the care plans and the risk assessments do not always clearly detail the actions needed to meet that person needs or reduce the effects of an assessed risk. One such example is that a moving and handling care plan stated that a person needed assistance to mobilise but did Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 11 not give clear guidance of how that person needs to be assisted. Some care plans detail the person’s mental health but does not give clear guidelines of how to support that person with regard to their mental health needs. This could result in staff not knowing how to manage the resident’s mental health care needs. Evidence of the possibility of this include a member of staff talking about as resident’s behaviour “can be spiteful” and a comment on a care plan that the resident might wander aimlessly for which medication should be given to stop the person wandering. There was no evidence that the reasons for resident’s behaviours had been considered in the care planning process. There was little evidence that care plans were being changed as a result of reviewing process. There was no consistency in the completion of care plans throughout the home; some were very detailed where as others were sparse in details. Carers in discussion and in the staff survey forms returned to the commission indicated that although they knew about the care plans and where they are located, they generally do not use them as a working tool, but will discuss any concerns about a resident with the nurse in charge. Discussion with staff, residents and visitors indicated that although care plans are not always consulted the care staff are aware of and understand what care a person needs. But some entries in the care plan documents gave concerns about the respect and dignity given to service users. For example one continence care plan referred to a continence aid as a ‘nappy’. A record of health care professionals input is documented in each service users care plan. The manager spoke about the close working relationship the service has with the local GP surgery through which the service users access the multidisciplinary health care team. Discussion with visitors and service users evidenced that the home is responsive to health care needs, contacting the relevant health care professionals when the service user needs them. Medication policies and procedures are in place that provided details about the ordering, storing, administration, documentation, and disposal of medications. A sample of medication administration record sheets were looked at. A record is kept of all medication received into the home. It is clearly documented when a service user has not take the medication and the reason why the medication has not been taken. On checking the medications of one service user there was a discrepancy in the amount of a certain medication in the home for that person. The home, after being made aware of this, concluded that either there had been an error in the recoding of medications received by the home for that person or a certain times the person had not been receiving the full dose of medication required. This was only noted for one of the five medication records looked at. This was discussed with the manager and deputy manager who addressed the issue in a staff meeting held on the day of the inspectors visit to the home. Staff were generally observed being courteous and respectful to the residents and were observed knocking on resident’s doors prior to entering their bedrooms. However incidents such as the one described above referring to a Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 12 continence aid as a ‘nappy’ and the practice observed of having staff handover with a service user asleep in a wheelchair in the same room suggests that certain practices might not always consider the dignity of the resident. However visitors and resident’s commented that staff respected the resident’s dignity and right to make choices. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a service that provides a variety of meaningful activities that is developed from their interests and wishes. Residents are able to received visitors when they wish. It is unclear whether resident’s wishes about daily routines and activities are consistently considered. The provision of healthy, nutritious meals taken in pleasant surroundings contribute to the wellbeing of those living at the home. EVIDENCE: The home employs two activity coordinators that are in the home most days of the week. They spend time with individual residents, finding out about their past interests and hobbies, their social and working life. From this information they plan an activity programme that they hope will interest the residents. They are in the process of establishing a library of information books that will be used to stimulate the interests of those living at the home. An assessment Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 14 has been made that the social interests are the gentlemen at the home are not been met in he same manner as the ladies. Ways of incorporating activities such woodwork/ carpentry are being looked into. It is concluded that the activities of the residents is considered very important and this part of the service is continually being reviewed and developed to improve the wellbeing of those living at the home. The home has a policy of open visiting. During the course of the visit to the home there were several visitors in the building. Visitors were made welcome staff at the home. Visitors confirmed that they are made welcome at all times and that they can visit their relative or friend in their bedroom or in one of the communal areas. The spiritual needs of residents is met by visiting clergy who offer communion. Residents are able to have their own church/spiritual leaders visit them at the home. Residents were observed making choices about their daily activities such as whether to join in with arranged activities, whether to sit in the communal areas of the home or spend time on their private bedrooms. But it was noted that several residents after lunch were falling asleep in their armchairs or wheelchairs inn the communal areas. With no clear documentation of their wishes in the care planning system it is unclear as to whether this was their wish or whether they would have preferred to have a sleep in the privacy of their own bedrooms. The service provided meals for the residents that are cooked on the premises. Discussion with the residents evidenced that they enjoy the meals provided. A menu is on display for residents to view, though none were observed doing so during the visit to he home. The menu allows for choices at all meal times. Staff were observed to assist residents at lunch time with sensitivity. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and others associated with the home are confident that complaints will be handled effectively and efficiently. Residents are protected from the effects of abuse by a work force that has a good understanding of adult protection procedures. EVIDENCE: Visitors spoken with were aware of whom to address their concerns and complaints to and indicated that they are confident that they will be responded to appropriately. The new manager has commenced a new complaints logbook, but no complaints have been received by the home since her appointment. Polices and procedures are in place about the protection of vulnerable adults and the action to take if there is a case of suspected abuse. There has been one referral for adult protection investigation since the last inspection. This involved the theft of money from a service user. The service promptly contacted the police regarding this. But there was delay in invoking the full adult protection procedure. Discussion with the administrator and the present manager evidenced that learning and development had followed from this incident. They have good understanding adult protection procedures. The manager told the inspectors that as part of the induction process for all new staff whistle blowing and adult protection procedures are covered; this was Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 16 confirmed in conversation with staff members. However for those staff that have not recently been employed they have not received any recent training specifically about the protection of vulnerable adults, but the manager informed the inspectors that she was in the process of ensuring that all staff were made aware of these procedures. Discussion with staff evidenced that they have understanding of abuse and will know the correct action to take if they suspect abusive practices have happened. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is a maintained in a safe and homely manner and has the aids and adaptations to meet their needs. Good hygiene and infection control practices protect the wellbeing of those living at the home. EVIDENCE: Refurbishment and building works at the home have been completed. The home now provides accommodation and care for up to fifty-three residents. The home is decorated and furnished in a homely manner, with some of the owner’s art collection being displayed on the walls. Two shaft lifts enable residents to access all communal areas of the home. The home has sufficient equipment such as moving and handling equipment to meet the resident’s Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 18 needs. Risk assessments of the environment ensure that residents are protected from risks associated with the building and environment of the home. A variety of communal areas are available for residents to make use of, many of them being smaller areas where a few residents can meet for a chat. Sufficient assisted bathing and toileting facilities are available to meet the needs of those living at the home. A programme of regular maintenance is in place; all rooms when vacated are redecorated and carpeted. Two rooms on the day of the visit to the home were in the process of being redecorated and carpeted. Effective reporting procedures ensure that maintenance problems are dealt with promptly. The organisation’s maintence manager coordinates larger maintenance issues. Staff records indicate that they receive training about infection control. Suitable protective equipment is made available to staff and sufficient hand washing facilities are available. A team of cleaning staff are responsible for maintaining the cleanliness of the home that was clean and free form offensive odours on the day of the visit. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a staff team that generally have the skills and knowledge to care for them. But that support to residents will be improved if staff had a greater understanding about the effects of dementia. Good recruitment procedures protect the wellbeing of those living at the home. EVIDENCE: A staff rota clearly indicates the number of staff and what capacity they are working at any time of the day. Discussion with residents, visitors and staff members indicate that there are no concerns with staffing levels. The staffing numbers have been increased to reflect the increase number of residents that the home provides care for. The manager, in consultation with all staff members, is introducing a fixed two week rota so all staff will have advance notice of the shifts they are working. Staff records indicate that they receive training to equip them with the skills to care and support the residents living at Westacre. Many staff have received training about caring for people with dementia, but it is recommended that this subject is revisited. Care plans and some comments throughout the visit, as previously mentioned, suggest that not all staff have an understanding the Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 20 actions of resident’s with dementia and thus the best way to support these people. Care staff are encouraged and supported to undertake NVQ training in care. Recruitment polices and procedures are in place. Staff records evidenced that these procedures were followed, including all the checks required for the protection of the residents. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a new manager who has expressed a commitment to improving outcomes for those living at the home by seeking the views of those associated with the home. Practices are in place to protect resident’s finances. The service is meeting relevant health and safety requirements and legislation. EVIDENCE: The service has undergone a period of change of management. The new manager had been in position for a month when the visit to the home took Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 22 place. The manager is in the process of submitting her application to the commission to be registered as manager of the service. The manager expressed that support systems from the owners of the home are in place to enable her to fulfil her role. She was able to clearly discuss her role as manager of the home and the accountability she has in this role. Discussion with staff members indicated that the new manager has assured them that she will give them help, support and guidance to fulfil their roles. The manager discussed with the inspectors her plans for quality assurance for the service. The previous manager had put a quality assurance programme in place and the present manager discussed that she was going to develop this to ensure that that the service is being audited continually. Included within these developments is the formation of family groups of resident’s relatives that could be involved in auditing the service. Systems in place at the present time include the use of Reg. 26 reports where the owners report on the quality of service provided by then home, and a service users survey preformed last year that resulted in a change in the menu plan. Procedures are in place that protect residents finances. Small amounts of money can be held by the home for which accurate records if income and expenditure are kept. Since the last inspection there has been an incident where a resident had money stolen. The service acknowledges that residents have the choice to keep control of their money, but the administrator and manager discussed actions they are taking to ensure that this resident and other residents finances are protected. Health and safety policies and procedures are in place. Staff have received training about health and safety practices and these are updated annually. Records indicate that all services and equipment are services at to the manufacturers recommended guidelines. An Environmental Health Food Hygiene inspection of the kitchen has been carried you since the last inspection; the service has acted on all recommendations made as a result of this inspection. Fire records detail that all fire safety checks and training are done to the fire and rescue services recommendations. A comprehensive fire risk assessment is in place. Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 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 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 24 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 Timescale for action 30/05/07 2. OP9 13 (2) 3. OP10 12(4(a)) 4 OP30 18(1a & c (i)) All residents must have a clear care plans that details the action needed to meet their personal, physical and mental health needs. A process must be in place that 31/05/07 ensures the stock of medications for each resident is checked at regular intervals. All practices and routines at the 30/04/07 home must protect the dignity and respect the wishes of all residents. Staff should have further training 30/05/07 about the care of people with dementia so they can understand the actions of such residents and provide the resident with the appropriate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011657.V327672.R01.S.doc Version 5.2 Page 25 Westacre Nursing Home Standard Westacre Nursing Home DS0000011657.V327672.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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