Inspection on 22/05/06 for Westbourne

This inspection was carried out on 22nd May 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 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 17/01/07

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 Key Unannounced Inspection 07:15 22nd May 2006 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.V289628.R02.S.doc Version 5.1 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.V289628.R02.S.doc Version 5.1 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 Mr Balbir Bains Mrs Kulvinder Bains Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only bedrooms 4 and 15, which measure 17.5 square metres, can each be shared by 2 persons through positive choice and mutual agreement. Bedrooms 24, 25, 26 and 27 which are accessible via some steps to accommodate mobile residents only. 21st September 2005 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 newspapers, chiropody, hairdressing and personal toiletries. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous inspection report of September 2005 was disappointing and was followed by a statutory notice issued in respect of the home’s medication practice in December 2005 and an unsatisfactory follow-up inspection of medication practice in February 2006. The current inspection took over eight hours, starting early in the morning and included a further inspection of the home’s medication practice by a pharmacy inspector for the CSCI. The opportunity was taken to speak to service users, staff and visitors to the home, including community health professionals and to inspect records. This was a much more positive inspection and although much remains to be done, proprietors, manager and staff can feel a real sense of achievement in making the progress they have. As noted elsewhere, the important thing now is to maintain this progress and to work with the same commitment to improve those areas of the home’s activity that require further improvement. What the service does well: What has improved since the last inspection? It is acknowledged that very significant progress has been made in key areas of the home’s operation, including medication, where the pharmacy inspector was able to note that; “There have been some significant and notable improvements in the management and use of medicines in the home.” The standard of care planning seen on this occasion was good and the recently introduced care plan format is a very comprehensive and effective one. Further progress is noted throughout this report and this inspection provided an opportunity to have some very frank and hopefully positive and helpful discussions with the new manager and the proprietors. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 6 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. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 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.V289628.R02.S.doc Version 5.1 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): 3 4 5 (Standard 6 does not apply to Westbourne) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the homes’ pre-admission assessments and the care plans drawn up to meet those assessed needs should ensure that someone admitted to the home will have their care needs identified and met appropriately. Prospective service users and those responsible for them are encouraged to visit the home prior to admission. EVIDENCE: Care plans were inspected and the new format, recently introduced, is comprehensive and fit for purpose. Service users were generally very positive about their care and it appears that the home offers prospective service users every opportunity to visit the home to assess its ability to meet their needs before they are admitted. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Provided that recent improvements in the home’s medication practice are maintained and any requirements made in this report are met then service users can be confident that their medication will be administered safely and accurately. EVIDENCE: Records of the receipt and disposal of medicines are maintained to a reasonable standard. Records of medication reviews and contacts with health professionals show some minor deficiencies in that there is still a need to be consistent in the record to indicate the prescriber’s intentions when these are not clear on the dispensing label. There is a dedicated register in use for the recording of controlled drugs. However, there is a need to record the full name and address of the supplier and/or disposer. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 10 There is a record of a date on which staff are deemed to be competent to administer medication but, as yet, no documentary evidence of the basis of this assessment. It was reported that such an assessment will be complete by the college and this evidence of competence must be provided. The new care plan format, provided it is fully completed, reviewed and updated, will provide a very good system of record, providing staff with the information that they need in order to meet the developing care needs of service users. A community nurse spoken to during this inspection indicated that she received appropriate information and support from the home to enable her to effectively provide healthcare for service users. Messages left in the handover file the night before the inspection, requesting GP’s to be called to specific service users, were acted upon promptly. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 11 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The range of activities in the home, whilst improved is still limited and needs further thought as to scope and content. There is insufficient evidence that service users are helped to exercise meaningful choice in the routines of the home. “They just turn it on”, one resident said about the television. The dining experience has been improved although some poor practice was observed during the breakfast period. This outcome area should now be specifically targeted for improvement. EVIDENCE: Very little if any meaningful activity took place during this inspection and service users were not very positive about what and when activities are provided. “Sometimes they find something for you to do, other times you are twiddling your thumbs” was one comment made. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 12 Several service users complained that they are “got up” earlier than they would otherwise choose to and have to wait an unreasonable time before their breakfast is served. One service user was served breakfast in the front lounge only after the Inspector mentioned that she had said she had waited over an hour, and was then left slumped in her chair, with the result that she spilled a quantity of her breakfast down her front. More positively, cooked breakfasts are now regularly served, improved quality provisions are now provided, including fresh milk and fruit, and new pictorial menus are to be introduced. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an adequate complaints policy in place, advocacy is publicised in the home and staff spoken to were aware of what constitutes abuse and how to respond if it is suspected. The lack of structured evidence about choice in the routine of the home, makes a more positive judgement about dignity, rights and “abuse” inappropriate. EVIDENCE: Details of the complaints policy and the availability of Age Concern’s advocacy service were seen displayed in the home. The improved frequency of service user meetings should improve communication within the home. Service users spoke to the inspector about changes they would like to see in the home, which would more properly have been addressed to the staff. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 14 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 21 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This judgement may be generous as it takes into account not only progress made with the provision of new beds, carpets and chairs throughout the home, but also a programme of work on the bathrooms of the home which had only partly been completed at the time of this inspection. The next inspection will focus on the home’s environment in greater detail, in particular those areas where redecoration and repair is overdue. EVIDENCE: New chairs, beds and carpets have been purchased since the last inspection. There is a redecoration programme now in place to deal with refurbishment and repair in a more structured way. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 15 One of the bathrooms has been refitted and is now a pleasant environment which is not surprisingly preferred by service users to the alternative bathrooms available. Some service users were seen to be eating lunch in a smaller, more intimate dining room as an alternative to the larger, communal dining room. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although staff numbers appear adequate, care staff are still required to undertake a range of “domestic” duties which must have the effect of reducing the actual care hours available to service users, or alternatively prejudicing the domestic service they receive. Staff receive the training and supervision required to enable them to provide service users with an appropriate level and quality of care. EVIDENCE: Staff rotas and instructions were seen. The latter include weekly, monthly and quarterly routines to cover an extensive range of domestic tasks such as “Cleaning the dishwasher inside and out and surrounding floor area and tiles to the left of dishwasher” Conversations were held with care staff, who confirmed details of training undertaken and planned and also of supervision and staff meetings taking place regularly. Records are in place to monitor this. A check of recently recruited staff members’ files was made and they were found to include the necessary details and documents. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 17 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 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This judgement reflects the fact that the home’s manager who has only recently been appointed is not yet registered by the CSCI and also a serious lapse in security and health and safety during the course of this inspection. Despite this, the early signs are that, supported appropriately by the proprietors, there is the necessary determination to maintain the improvements that have already taken place and ensure that further progress is made. The proprietors have invested in a recognised quality assurance system, which should support the recently enhanced process of service user and relative consultation. This should help ensure that the home’s routines and management are increasingly focussed on the needs and preferences of service users. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 18 The health and safety of service users was compromised by external access to the home being insecure and by the wedging open of a fire door from the kitchen. EVIDENCE: No application has yet been made to the CSCI for the registration of the manager although it is understood that it will shortly be submitted. The rear door to the kitchen was open at 7.15 am, allowing unrestricted access into the home. The fire door from the kitchen into the main area of the home was propped open with a floor cleaning notice. Senior staff in charge when the home’s intruder alarm went off seemed unsure of what it was and how to react to it. Very positive discussions took place with both the new manager and the proprietors on the steps needed to improve the overall rating of the home and more importantly the care outcomes for service users. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 19 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) 17(1)(a) Sch 3(3)(m) 13(2) Requirement The registered person must ensure that records of professional contact are accurate and up to date. The register person must ensure that medicines controlled under the Misuse of Drugs Act, 1971 are recorded in accordance with the Act and associated Regulations. The register person must ensure that staff adhere to the home’s own procedures for the safe handling and recording of medicines. The registered person must ensure that staff authorised to administer medicines have been assessed as competent to do so. The manager must develop, and record on an individual basis, a programme of activities that meets service users’ assessed needs, making use of information and resources based on current good practice. DS0000019611.V289628.R02.S.doc Timescale for action 30/06/06 2. OP9 30/06/06 3. OP9 13(2) 30/06/06 4. OP9 13(6) 18(1)(a) 30/06/06 5. OP12 16(m)(n) 31/07/06 Westbourne Version 5.1 Page 21 6. OP12 18 7. OP14 12(2)&(3) 8. OP19 23(2) 9. OP27 18 10. 11. OP38 OP38 13 13 The proprietors must ensure that adequate dedicated resources are available to the manager to achieve requirement 5. The manager must demonstrate and record that the routines of the home are, wherever possible, ordered in accordance with the express wishes of individual service users and provide the maximum possible degree of choice for them. The proprietors and manager must draw up, and keep under review, a structured programme of renewal and decoration with a timetable reflecting appropriate priority for those areas most in need of it. The manager and proprietors must keep staffing numbers under constant review, to ensure that care staff, undertaking noncare duties, still have adequate time to fully meet the care needs of service users at all times. The manager must ensure that the home is secure at all times. Fire doors that are not fitted with approved automatic closure devices must never be propped open. 31/07/06 31/08/06 31/07/06 22/05/06 22/05/06 22/05/06 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 Refer to Standard OP9 Good Practice Recommendations The register person should review the procedure for the duplicate use of the receipt record on the medication record forms. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 22 2. OP15 3. OP19 The manager and proprietors should review the mealtime arrangements in the home to ensure that they are as positive as they could be, that there is no unreasonable delay at mealtimes and that mealtimes reflect service user choice. The manager and proprietors should review the bathing and communal areas of the home to ensure that they offer the most positive experience and environment for service users using them. Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Westbourne DS0000019611.V289628.R02.S.doc Version 5.1 Page 24 - 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!