Inspection on 17/10/08 for Westbridge House

This inspection was carried out on 17th October 2008.

CSCI found this care home to be providing an Excellent service.

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

Other inspections for this house

Westbridge House 20/10/06

Westbridge House 22/02/06

Westbridge House 01/09/05

Westbridge House 22/11/04

Westbridge House 25/05/04

Westbridge House 01/03/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Westbridge House 1 Westfield Road Barton On Humber North Lincolnshire DN18 5AA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kate Emmerson     Date: 1 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Westbridge House 1 Westfield Road Barton On Humber North Lincolnshire DN18 5AA 01652632437 01652637977 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sandra Cox Type of registration: Number of places registered: Mr Kumar Thakerar,Mr Nilesh Lukka care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Westbridge House is registered for 22 service users in the category of mental disorder. The accommodation is over four levels, and would not be appropriate for individuals using wheelchairs. The home does not provide nursing care, but it works closely with the community health teams especially the community mental health team, to meet the specific needs of individual service users. The current fee for the services can be obtained by contacting the manager of the home. 22 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was unannounced and took place on the 17 October 2008. The last key inspection was conducted on 20 October 2006. We examined the written documentation in the home including care plans, medication records, staff recruitment and training and health and safety records. We spoke to some of the people living at the home to see if it was helping them to meet their needs and provided them with a happy and comfortable environment to live in. Surveys were also sent to the home and we received nine completed surveys form people who live in the home and eight from the staff group. These were all very positive about the quality of the service provided. Care Homes for Adults (18-65 years) Page 5 of 28 We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes procedures enabled people to make an informed choice about the service and ensured that peoples needs were identified prior to admission. Evidence: The information provided by the manager prior to the inspection stated that they had reviewed assessment formats. They also stated that they had improved peoples experience on admission to the home by encouraging and arranging a number of half day visits to allow people to familiarise themselves with the home. In surveys most people said that they had enough information about the service before moving in and one person said ‘they were very friendly and helpful’. The care files for four people living at the home including the person most recently admitted to the home were examined. All of these files included a full assessment of peoples individual needs that had been completed before they were admitted in to the Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: home. The assessments were a combination of the home’s pre-admission assessments and assessments completed by the persons care management or specailist health care team where appropriate. In surveys staff stated that they had up to date information about peoples needs. There was evidence from people living in the home, discussions with staff and records that Westbridge House does have the capacity to meet peoples assessed needs. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home were encouraged to live independant lives and their care needs were well met. Evidence: Four care plans were examined. Overall care plans were detailed and evaluated regularly and had been updated when needs had changed and there was evidence that people were involved in the development of their care plans. The care plans supported people to maintain their independance and improve their skills. Where able, people assited in the home as part of their care plan. For example one person assited with the homes weekly shopping and monitoring of supplies. He said he enjoyed this role and was observed undertaking this task with the support of the staff. Whilst the care plans had been evaluated and updated where needs had changed Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: evaluation records would benefit from more detailed account and in some cases the updates had not always been dated and signed. Whilst the staff were able to give a good account of how one person had deteriorated and the intervention required to keep them safe this was not always evidenced in the daily diary reords and monitoring records for incidents of challenging behaiour. The care plans were supported with risk assessments where appropriate although these had not always been updated. For example one person was given luch time medicaiton to take out with them. Whilst it was observed that the staff checked the person had understanding of the medication and when they were to take it, the risk assessment had not been updated to support this. People spoken with and comments on surveys confirmed that they are able to make decisions for themselves in relation to their daily lives. This included the times to rise from and retire to bed, what to eat and where to eat it and whether or not to become involved in any activities in the home or in the community. Notices were also seen in the home in relation to access to advocacy services. Comments included although I can do what I want, I do receive encouragement and guidance on what is considered best for me, extra staff are laid on to cope with all sort of activities and also all sort of problems, the staff have been picked very well to help with all of the residents. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported through individual care plans to make choices and lead independant lives. Evidence: Observation of people during their daily lives at the home, discussions with them and written documents evidenced that people who live in the home are provided with opportunities to maintain and develop their social, emotional, communication and independent living skills. Detailed care plans and risk assessments were in place which identified peoples interests in this area and the support people required to participate. Care plans evidenced that people were supported and encouraged to take part in in valued and fulfilling activities at the home and in the community. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: Varied activities were provided at the home and staff were involved in promoting activites that were available. Outings were arranged and there were regular trips into the local town shopping area with staff. The home had organised its own olympic games and people had been given medals for their performances. The residents had enjoyed this activity and wore their medals with pride. Some enjoyed showing us the photographs of events and outings that had taken place over the past year. A large percentage of the people living in the home smoke and so one of the lounges has been set-aside for people to smoke in. An extraction fan had been fitted to this room together with a mobile air purifier. Monitoring of peoples nutritonal needs had improved. An assessment of peoples nutritional needs and dietry preferences had been completed and care plans had been developed to identify how needs were to be met in this area. Peoples likes and dislikes in respect of food were recorded and peoples weight had been monitiored by the deputy manager every week. Menus showed that specific dietary needs were met. People spoken with said that they enjoyed the meals provided and that the quality of the meals that they received was good. They said if they wanted something different then this would be provided for them. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received individualised personal support and were encouraged to maintain their Independence and develop their skills. Health care needs were met. There were some deficiencies and inconsistencies in record keeping relating to medication which may increase the risk of errors. Evidence: People received individualised personal support and were encouraged to maintain their independence and develop their skills. This was evidenced by the way people were involved in all aspects of the home within their own limits. The staff were pleased with their successes in people being able to return to live in the community. Care files included records of all of the contact that staff and people living in the home had with outside health care professionals.This included GP’s, psychiatrists and community nurses. Staff training records showed that they receive specialist training in relation to mental health problems. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Direct observations and discussions with people living in the home evidenced that peoples privacy and dignity were upheld at all times. All of the staff that administered prescribed medication had received accredited medication training and had had competency reviews in this area. It was the homes policy that at all times two staff were responsible for the administration and record keeping of the prescribed medication and the records were audited on a regular basis. One session of administration of medication was observed. The staff were knowledgeable about the medications they were administering however there was a lack of clarification of roles/responsibilities in two person administration. Where people were going out and taking their medications with them the resident signed to say they had taken the medication. The records showed some inconsistency as to how this was recorded and it was recommended that staff have some clarification of this procedure. Homely remedies had not always been signed and dated when given. There was no controlled medication prescribed for people in the home at the time of the inspection. Where people required medication on an as required basis to modify their behaviour, management plans stating in what circumstances this should be administered had not been developed to ensure consistency of approach to managing challenging behaviour. This is recommended. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were protected from abusive situations at the home and there were clear and easy complaints procedures in place. Evidence: The home had a clear and effective complaints procedure. The procedure was available on the homes notice board and in peoples bedrooms. Comments on surveys and discussions with people living in the home indicated that they were aware of the how to make complaints in relation to the services provided however they all stated that they had no call to make any complaints. The home also had a niggles and concerns book for people to raise smaller issues. The home had not received any complaints about the service. bservation of staff personnel files and interviews with staff showed that they had all received appropriate safety vetting before they had been employed. This helps to protect the people from abuse at the home. Staff interviews and observation of their training records showed that they receive training specific to the protection of vulnerable adults. This was a combination of internal training, elements of NVQ and Induction training and protection training Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: provided through the local authority. The staff and management were aware of the multi-agency protocols for the protection of vulnerable adults and a copy of the protocols were available in the office of the home. The home also has a clear whistle blowing policy and procedure. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment can meet the needs of the service users and appearance had been enhanced by redecoration. Evidence: The home was suitable for its stated purpose. The grounds of the home were limited but in some ways this encouraged people to make more use of the local community. There had been work completed to meet the requirements from the last inspection. The outside of the home was in need of decoration and some of the windowsills required attention as they were beginning to corrode. The manager stated that quotes have been sought for this work. A window on the second floor of the staircase which was badly cracked has been repaired. There had been redecoration of bedrooms and communal areas since the last inspection. The bathrooms are maintained clean and tidy and free of any offensive odours but the equipment was very dated and the home would benefit from updating the present bathrooms and some of the toilets. The bathrooms and toilets were well spaced throughout the home and were in close proximity to the communal areas and individuals rooms. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Smoking was limited to a specified lounge at the home. Air purifiers had been provided in this area. The home employed a ‘handyman’ who was also shared between the company’s other services. Time at the home depended on prioritising his workload. Records of work completed and planned were held. There were adequate areas for people to relax in and to take part in activities. The dining area also doubled as an activity area when meals were not being eaten there. The people living at the home were independently mobile so there were very few pieces of mobility aids in the home. Hoists were available in the bathrooms. Infection control standards were well maintained in the home. The home was very clean and tidy through out. The washing machines at Westbridge House were programmable to disinfection and sluicing standards. The washing machines had automated feeds to minimise the risk of injury to the staff from coming in to contact with the cleaning materials. All of the equipment in the home including the fire safety systems were regularly reviewed, serviced and maintained. A health and safety risk assessment had been completed for the home. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff working at Westbridge House had the necessary skills and knowledge and were provided in sufficient numbers to care for peoples individual needs. Evidence: A random selection of the staff training and personnel files were examined. The duty rota was also examined. There was evidence from staff files, discussions with staff and surveys that the staff received appropriate safety vetting before they were employed. There was evidence in files that people living in the home were involved in the recruitment of staff and sat in on interviews. Records were held of the questions they had asked and their stated opinions. The home had achieved the Investors in People award. Comments about the staff group from people living in the home included the staff have been picked very well and extra staff are laid on to cope with all sort of activities and also all sorts of problems. They confirmed that staff treated them well. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Staff confirmed that there were sufficient staff on duty to meet peoples needs. Staff training and development records showed that staff received all of the required mandatory training and that they also received training specific to the needs of the people they were caring for. Staff confirmed that they had received training relevant to their role. The staff have exceeded the requirement for a minimum of 50 of them to have achieved NVQ2 in care or equivalent. Ten of the care staff had completed NVQ 2. Documentation seen identified that the staff attended regular meetings to update them on legislation, training and to give them an opportunity to air their views on the development and delivery of the service provided at the home. The staff personnel files evidenced that the staff received the recommended minimum of six formal recorded supervision periods per year. Staff interviews confirmed that this actually occurred. Staff stated that the management were supportive and they received regular supervison. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a strong commitment to ongoing improvement of the service and good management of health and safety. Evidence: The manager of the home had completed the Registered Managers Award and NVQ 4 in care. Since the homes last inspection the management systems had been maintained and the manager has monitored the quality of the service provided. Questionnaires sent out to people living in the home or who had received respite care at the home showed a high level of satisfaction with the service received. The home had achieved the Local Authorities Gold Award in relation to the quality of care that was provided at Westbridge House. They had also received the Investors in People award and won an award for excellence in care for the involvement of residents in the running of the home. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Regular staff and residents meetings were held at the home to allow them to air their views on the development and delivery of the services at the home. The policies and procedures required by regulation were all in place at the home and were reviewed on an annual basis. Records evidenced that as far as is reasonably practicable the health, safety and welfare of the people living in the home and staff were protected at the home. An external agency had been commissioned to provide a full health and safety inspection of the home. The issues identified had been prioritised and there was evidence that the manager had actioned these. Up to date safety certificates for the fire, gas, and electrical systems at the home were in place and staff training was up to date. There was good management of fire safety in the home, a fire risk assessment was in place and staff had received training. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 17 Records of administration of homely remedies must record the date and time administered and be signed by the person administering the medicaiton. To ensure a full record of medication administered is maintained and to minimise the risk of errors. 01/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The daily diary records, monitoring records, and records relating to evaluations of care plans should be more detailed so that a full record of care provided is maintained. Where people require medication to modify behaviour on an as required basis care plans should identify in what circumstance this should be administered to ensure a consistent approach. The registered person should consider updating the bathrooms in the home in their redevelopment plan. 2 20 3 27 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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