Inspection on 17/01/07 for Westbourne

This inspection was carried out on 17th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Westbourne 15/08/07

Westbourne 22/05/06

Westbourne 21/09/05

Westbourne 09/05/05

Westbourne 02/11/04

Westbourne 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Westbourne 9 Bedford Road Hitchin Hertfordshire SG5 2TP Lead Inspector Jeffrey Orange Unannounced Inspection 17th January 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 Westbourne DS0000019611.V328014.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. Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbourne Address 9 Bedford Road Hitchin Hertfordshire SG5 2TP 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) 01462 459954 01462 459954 b.bains1@ntlworld.com Mr Balbir Bains Mrs Kulvinder Bains Angela Valerie Bowes Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only bedrooms 4 and 15, which measure 17.5 square metres, can each be shared by 2 persons through positive choice and mutual agreement. 20th December 2006 Date of last inspection Brief Description of the Service: Westbourne is a large detached two-storey house, situated close to the centre of Hitchin, which has been converted for use as a care home for elderly people. The original house was built in 1859 and has been extended. It has a total of twenty-five bedrooms, two of which can be shared by two people through positive choice and mutual consent. The ground floor has an entrance lobby, two lounges to the front, one lounge, one dining room and a conservatory to the rear, the main kitchen, an office and eight bedrooms, all of which have ensuite wash hand basins and toilet and two of which also have showers. There is also one assisted bath. The laundry is situated in the basement. A passenger lift serves the first floor. The first floor has seventeen bedrooms, five with wash hand basins only, nine with en-suite wash hand basin and toilet and three with showers in addition. There is a hip- bath and two assisted. There are gardens to the front and rear of the home with parking available at the front of the home. The home has a statement of purpose and service user guide to provide information to prospective service users and copies of the latest inspection report from the Commission for Social Care Inspection (CSCI) are also available in the home. Current charges range from £372 - £550 per week. Additional charges apply for chiropody, dentistry and opticians’ services and for newspapers, hairdressing and personal toiletries. Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection for Westbourne in the period April 2006 to March 2007. Since the previous key inspection in May there have been other inspections in September, November and December. The last of these was a thematic inspection, carried out as part of a national programme of inspections to help inform the Commission’s response to a report from the Office of Fair Trading on Care Homes’ Contracts and the information provided to prospective service users about fees and services. Each of these inspections were unannounced and provided opportunities to speak to service users, relatives, visiting healthcare professionals and staff and also to inspect key records including those for medication and staff recruitment. This report also draws on information received from eleven survey forms received from service users or their representatives since the last key inspection. The period covered by these reports has been one of sustained improvement in performance for Westbourne and this is reflected both in the judgements made about the outcomes for service users in this report and also the overall rating for Westbourne. In order to justify and retain the improved rating that has been achieved by the hard work and commitment of the Proprietors, Manager and her staff team it is imperative that robust quality control and monitoring of all areas of the home’s operations is in place and rigorously maintained. What the service does well: The surveys received from, or on behalf of service users are overwhelmingly positive about the standard of care experienced at Westbourne; “My sister and I have been extremely pleased with the standard of care our Mother has received.” “My husband has only been at Westbourne a short time, but the staff are always cheerful and ready to help. He is happy! …” The care plans now in place are well maintained and contain the information required to enable staff to provide the care that service users require, in a way that reflects their current needs and meets their personal preferences. The physical environment of the home is homely, attractive and well maintained. Westbourne DS0000019611.V328014.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. Westbourne DS0000019611.V328014.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 Westbourne DS0000019611.V328014.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): Standards 1 2 3 (Standard 6 does not apply to this service) Quality in this outcome area is adequate, this judgement has been made using available evidence including a visit to this service. The information about charges that is provided for prospective service users is adequate and provides sufficient detailed information to avoid confusion as to the fees that apply and what is included in them. The contract should be reviewed to address some potential ambiguities and unfair conditions and would benefit from being produced in a more User-friendly format, it also needs reviewing and possible amendment to bring it into line with the new requirements of the Care Homes Regulations in respect of differential charges where fees are paid by someone other than the service user. Whilst the Statement of Purpose and Service User’s Guide meets the basic requirements of the regulations and National Minimum Standards for Older People in terms of content, it must be kept under review to make sure it contains up to date information for service users and consideration should be given to an improvement in the format to make it easier to understand for those that need to. Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 9 The thematic inspection found that the process in place for the assessment of people considering Westbourne as a home, either for themselves or for someone else, is essentially sound and should ensure that only those whose care needs can be met are admitted. EVIDENCE: A copy of the contract was seen and the basic information it contains about fees and what is and isn’t included is essentially adequate. The contract should be reviewed to address some potential ambiguities and unfair conditions, for example in respect of changing a service user’s room and would benefit from being produced in a more user-friendly format. Since the thematic inspection the Statement of Purpose and Service User’s Guide has been reviewed and some out of date and inaccurate information that was found has been updated. The Service User’s Guide and Statement of Purpose are available on an audiocassette for those that would find reading it difficult. Westbourne DS0000019611.V328014.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): Standards 7 8 9 10 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The standard of care planning is good and provides care staff with the information they require in order to provide appropriately for the care of service users. Service users can be confident that their medication will be administered safely and accurately. The healthcare needs of service users are met by care staff and through the appropriate involvement of community healthcare professionals and services. EVIDENCE: A community nurse spoken with during an inspection in November was very positive about their relationship with the home and the quality of care seen. Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 11 Consistent progress and improvement in the standard of medication records and practice has been found in each of the previous three inspections. Spot checks were carried out during this site visit and no errors were found. Care plans have been revised and the format is clear and those seen were well completed. Westbourne DS0000019611.V328014.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 Quality in this outcome area is adequate, this judgement has been made using available evidence including a visit to this service. This rating represents an improvement from the last key inspection in May 2006 and if the current rate of progress is maintained a further improvement in rating could be achieved at the next key inspection. Service users are able to maintain family and community contacts and an improved range of activities is now available although further development is still necessary. There has been a marked improvement in the formal processes undertaken by the home to ascertain and record service users’ choices and preferences about the home and the way that their care is delivered. The standard and choice of food in the home is generally good and meets service users expressed preferences. Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 13 EVIDENCE: An activity session was observed during the morning of the inspection and provided the most lively and well-supported session seen by the inspector in his many visits to Westbourne. It is understood that additional activity resources and personnel are being obtained, this will continue to be monitored during future inspections. One service user survey received specifically asked for additional activities for the less mobile service users to be provided. Meetings are now being held on a regular basis to obtain service users views on the running of the home. This provides additional opportunity for service users to exercise choice and influence the day-to-day activity of the home. Service user and relative feedback following a survey by the home was seen in addition to that received at the CSCI following a survey by the Commission. Surveys indicated that staff almost always listen to and act on what service users say and also indicate that the food is generally well received with just one negative comment about food occasionally being served “cold and hard to chew.” A recent nutritional analysis commissioned out by the local authority Trading Standards Department was satisfactory and this inspection included a discussion with the chef, inspection of menus and records and a sample tasting of the meal at lunchtime. This was well presented, with good flavour and appeared nutritionally well balanced. Westbourne DS0000019611.V328014.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 18 Quality in this outcome area is good, this judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints policy and procedure in place that should ensure that any complaint is dealt with promptly and appropriately. Service users are protected by the training provided to staff and the home’s commitment to the Hertfordshire County Council policy and procedure for the protection of vulnerable adults. EVIDENCE: The recording of complaints has become more realistic since the previous inspection. From the information received during the thematic inspection and by service user survey returns it appears that service users know how to make complaints, are confident that they would do so if they wanted to and that they would be listened to and acted upon. It has previously been established that staff training includes the identification of abuse and what to do if it is suspected, in line with the local policy for the safeguarding of vulnerable adults. One concern raised by a relative about alleged overpayment of fees appears to have been satisfactorily addressed by the proprietors. Westbourne DS0000019611.V328014.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 24 26 Quality in this outcome area is good, this judgement has been made using available evidence including a visit to this service. The environment of the home provides service users with a safe, clean and comfortable place in which to live and includes the necessary facilities and equipment they require to help them to meet their health and daily living needs. EVIDENCE: Several newly decorated rooms were seen and the home was free from odour and clean during each of the recent inspections. Relatives spoken to remarked how clean the home was and on the rare occasions they have had any concerns, these have been promptly and effectively addressed. “We have always found the home to be clean and comfortable” Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 16 Service user’s bedrooms that were seen, at the invitation of the service user, were well personalised. There is a programme of ongoing assessment of the premises and redecoration/refurbishment in place that should, provided it is adhered to, continue the recent improvements in the home’s environment that will benefit all service users. Westbourne DS0000019611.V328014.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 28 29 30 Quality in this outcome area is adequate, this judgement has been made using available evidence including a visit to this service. The staff team including the manager and her newly appointed deputies have worked hard to improve the care standard experienced by service users, and the improvement in the home’s rating is in no small part due to their efforts. Staff receive the training and supervision required to enable them to provide service users with the appropriate level and quality of care to meet their needs. The recruitment process protects service users by making the required pre-employment checks on applicants. Although staff numbers appear adequate, care staff are still required to undertake a range of “domestic” duties, which runs the risk of either reducing the actual care hours available to service users, or of prejudicing the domestic services they receive. Service users have expressed some concern that staff whose first language is not English cannot always be easily understood. This concern is not reflected in comments about the quality of care received by those staff, which is said to be very good, it does however need to be monitored and any support and additional training provided as appropriate. Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 18 EVIDENCE: During recent inspection visits several service users and relatives have spoken very positively about the improvements in the home. It was confirmed at this inspection that the night staff are still required to undertake some routine housekeeping duties although it is stated that the care needs of service users would always have priority. Three members of staff are currently undertaking NVQ level 3 courses, and 80 of the staff team have achieved NVQ2. A new training matrix is being developed to keep track of training needs and how they are to be met. Several of the service user surveys received made mention of difficulties in understanding some members of staff whose first language is not English. These comments were invariably allied with appreciation of the standard of care provided by those carers. It is understood that additional assistance is being provided to those carers identified as being in need of it and that in general it is felt that the problem is reducing as staff and service users become more familiar with one another. Westbourne DS0000019611.V328014.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 32 33 35 38 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. This home is well managed and is increasingly able to demonstrate the involvement of service users in decisions about the way it is run. There are policies and procedures that are being put into practice, which should provide confidence to service users that their health, safety and welfare are protected. EVIDENCE: The manager has recently been registered by the CSCI and already holds the Registered Managers Award and has considerable experience in the management of care services. Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 20 The staff team observed and spoken to during this inspection were well motivated and indicated that they felt well supported by the manager. Supervision records show that this takes place regularly. The atmosphere in the home was very positive and welcoming and staff were seen to be proactive in their care for service users. An improved system of quality assurance is now in place and survey returns from GPs, service users and relatives were seen. There has been an improvement in the frequency of service user meetings. The financial systems within the home have previously been seen to adequately safeguard service users. Westbourne DS0000019611.V328014.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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 6 Requirement Timescale for action 17/03/07 2 OP2 5 3 OP27 18 4 OP27 18 The Home’s Statement of Purpose and Service User’s Guide must be kept under review and where appropriate revised to ensure that it is up to date. The Contract for Residential care 31/03/07 must be reviewed in the light of guidance issued by the Office of Fair Trading to ensure that it does not include any unfair terms or conditions, for example in relation to changes in service user’s room and must also contain a clear indication if there are different fee ranges for privately funded service users and those funded by local authorities. (It is not however necessary to detail what those differences are). 17/03/07 The manager and proprietors must review staffing numbers to confirm that the care needs of service users and the domestic/house-keeping needs of the home are not being compromised by the existing pattern of night care working. The manager must ensure that 17/03/07 DS0000019611.V328014.R01.S.doc Version 5.2 Westbourne Page 23 all staff have the communication skills required to meet the care needs of service users effectively. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The home’s statement of purpose and Service User’s Guide should be reviewed and revised to ensure that it is written in plain English and is in an appropriate format for the home’s principal service user group. Reference should be made to the Office of Fair Trading’ s guidance on fair terms for care and should draw on any examples of good practice available locally. The scope and spread of activities within the home should be kept under active review and development to ensure that they are sufficiently frequent and appropriate for service users at all levels of ability and capacity and reflect individual choices and preferences wherever possible. The process of service user involvement and consultation should continue to be developed to ensure that the day to day running of the home meets their needs in the way that they prefer. 2 OP12 3 OP14 Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Westbourne DS0000019611.V328014.R01.S.doc Version 5.2 Page 25 - 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!