Inspection on 11/01/07 for Westbrook House

This inspection was carried out on 11th January 2007.

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

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

Other inspections for this house

Westbrook House 04/08/08

Westbrook House 24/09/07

Westbrook House 16/05/06

Westbrook House 13/09/05

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Westbrook House 150 Canterbury Road Westbrook Margate Kent CT9 5DD Lead Inspector Clair Brown Key Unannounced Inspection 11th &12th January 2007 10:05 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 Westbrook House DS0000064161.V307059.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. Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbrook House Address 150 Canterbury Road Westbrook Margate Kent CT9 5DD 01843 254117 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) Kent County Council Mrs Sarah Elizabeth Khamsoda Care Home 60 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (15), Old age, not falling within any other category (30) Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 30 of occupied beds can be used at any one time for service users who are under the age of 65 years old but are over the age of 55 years. 16th May 2006 Date of last inspection Brief Description of the Service: The home is a large new purpose built care home which is a joint project between the local authority (KCC) and the NHS PCT. The home has the facilities to provide intermediate care. Physiotherapists and occupational therapists are based in offices within the building. The home is laid out in four wings and has day centre facilities. The wings are used to provide separate areas of care according to the needs of the service user for example intermediate care with nursing and dementia. The home employs a team of registered nurses and care assistants. The ancillary & catering services are contracted. The home is situated close to local amenities and is on a main bus route. The grounds have two enclosed garden areas and a car park. The current scale of fees are: free for 6 weeks intermediate care then a scale of £303.25 to £367.82 for both dementia and intermediate care. Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of an unannounced key inspection visit to the home on 11th & 12th January 2007 by two inspectors, duration approximately 17 hours. The inspection takes account of information received from a variety of sources including written information from the registered provider and registered manager, service users and staff. The previously made requirements and recommendation from other inspections were inspected and all key standards. The inspectors spent time talking with service users and the staff to gain their views. A partial tour of the premises was conducted. Documents and records were seen and service users files were case tracked. What the service does well: What has improved since the last inspection? In the Appleton (dementia) wing a basic sensory room has been created for service users to use as a relaxation and therapeutic area. The procedures used to recruit new staff have improved with all staff being fully vetted before they start work. The home is recruiting further qualified nurses and care staff. A new service user contract has been produced for those receiving intermediate care. COSHH items are now kept in a secure cupboard and staff no longer use the hand wash basin for washing dishes. Medication practices by staff have improved. Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Westbrook House DS0000064161.V307059.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 Westbrook House DS0000064161.V307059.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): 2346 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receiving intermediate care now have a contract for their stay at the home. The staff feel that the pre-admissions procedure and assessment process does not ensure service users are admitted inline with the homes original admission criteria. The provision of intermediate care fails to clarify individuals’ goals and that these are achieved. EVIDENCE: The CSCI has received an anonymous complaint, part of this which relates to service users being inappropriately admitted that do not always meet the criteria for rehabilitation. During the inspection visit, staff and therapists were meet, who also expressed the same concerns. Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 9 The statement of purpose contains the admission criteria for the intermediate care unit, however this is vague and doesn’t provide staff and those making the referrals with a clear description of the type of prospective service user whose needs the home can meet. Some service users are referred directly from the hospital and others by care managers in the community. None of the service users files contained preadmission assessments. At the end of the inspection visit the inspectors were informed that these documents were held separately. The inspectors were offered these documents but did not have the opportunity to view them. However, the registered manager stated that the home cannot always conduct a pre-admission visits before admitting an intermediate care service user, but does obtain copies of appropriate professionals assessments. The home provides two areas of care, there is a wing for those with dementia and the top floor provides intermediate care with nursing. There is a team of therapists (occupational and physiotherapists), some of whom are employed by Social Services and others by the PCT. When meeting the therapists it was stated that there were problems with the responsibility for writing individuals assessments and rehabilitation plans in the service users files / care plan. The therapists stated that they remove their documentation from the service users file, once they have completed their course of treatment. This continues to provide evidence that the home needs in house policies and procedures. The files of those receiving intermediate care fail to identify the individuals personal rehabilitation goals and then record if they have been achieved. Although the files assessed did contain the therapists assessments of ability and some therapist had written brief details of the service users programme in the care plan. Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system is inconsistent and does not adequately provide staff with the information they need to satisfactorily meet service users needs. Intermediate goals are not identified in the care plan. Medications practices are improving but service users are not supported or encouraged to manage their own medication. EVIDENCE: An audit of the medications on the intermediate unit was conducted. This showed that overall practices have improved, the records for the controlled drugs corresponded with the actual medication held in the home. Staff continue to place medication in the fridge inappropriately, the mediation fridge was running too cold at –1’. One service users medication brought in from home was dispensed in 2005 and the label was partially removed and the name was not that of the service user, despite this the staff had administered Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 11 tablets from this box. Pain charts were being used for some service users to justify the administration of analgesia, however one service users chart showed they were in a lot of pain and taking regular pain relief, there was no evidence of this being followed up, did the medication work and did it need reviewing. Service users file who were case-tracked were met and the inspectors discussed their stay at the home with them. Although the service users in the intermediate unit were there for rehabilitation to regain their confidence and independence to return to their own home, not one service user selfadministers their own medication. One service user stated that they don’t do it because the nurses look after their tablets and give out the medication. When talking about their tablets it was apparent that service users medication had been changed when in hospital and the service user no longer knew what they took, despite having managed their medication when they had been in their own home. One service user was admitted suffering a great deal of pain in her leg and was unable to mobilise initially, but did not have a pain chart, yet her care plan stated to monitor her pain but there was no evidence of monitoring in any of the documentation. In both units the care plans had improved in the quality of information provided and the format was easier to follow. Four care plans in total were assessed and these were found not to cover all the needs of the service users. In the intermediate care unit the approach is very medical based and fails to take a more holistic approach. In the Appleton unit (dementia) it was found that the care plans were limited on how to manage and meet the needs relating to dementia. One files stated: Short term memory loss – “needs constant reminding of situation. Objective – to reassure & keep anxiety to minimum.’ Action – staff to keep reminding him of situation & reason for his where abouts. To answer their questions truthfully”. There was no evidence to suggest that this is the right approach for this particular service user. For some this may cause emotional trauma. Action –“Try distraction methods to minimise anxiety” but no details of what they are. There was no evidence of any service user in either unit being involved in the writing of their care plans. Further evidence is included in sections “Choice of Home” and “Daily life and Activities”. Continence pads continue to be left out on display in service users bedroom, this is not promoting dignity and privacy. Westbrook House DS0000064161.V307059.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): 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. There is no leisure activities provided in the intermediate unit and limited stimulation provided in the dementia wing. The meals provided are to a high standard with multiple choices and variety available. There is a failure to promote personal choice & preferences. Visitors are made welcome and encouraged to visit at all times. EVIDENCE: There is no one appointed to arrange and organize a programme of activities in any of the areas of the home. The Occupational therapists run an exercise class in the mornings, but service users stated that these are cancelled if the therapist has to do “home visits”. In the Appleton wing (dementia) there was limited stimulation provided, some of the games and jigsaw puzzle had been brought in by the care staff from their own homes. The registered manager stated that there are occasions when activities do occur, however the recorded evidence confirms that this is rare. One service user was seen to be trying to leave the home via the secured fire exit and was wearing a coat. The senior team leader said that the service user had become unsettled due to the son Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 13 having visited and now believes they are going home. Asked if they could go in the enclosed garden, the senior team leader stated, they do, however on case –tracking this persons file there was no evidence of the garden being accessed to relieve their anxiety and other staff stated they only used the garden when the weather was warm. Another service user said how unhappy they were at the home and that they would love to go outside for some fresh air. The registered manager stated there is no budget for employing activities staff. A varied and nutritious menu is available however personal choice is not always promoted. In the Appleton wing, staff were asked how they support service users to choose their meal, staff answered that the middle table are still able to choose and that the table nearest the serving area don’t have teeth so they can’t have the gammon and will have to have the chicken casserole because it’s soft. No changes to the entry system to gain access to the home outside office hours has been made despite previous assurances having been made that this was being dealt with. Westbrook House DS0000064161.V307059.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): 16 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is not adhered to when staff raise concerns but the home does have policies in place. Adult protection procedures have been adhered to. EVIDENCE: The CSCI has received an anonymous complaint relating to a variety of issues within the home. The complainant stated they had approached the management about these previously but no action was taken. The registered manager stated that she had not been approached by anyone. The registered manager and deputy manager are investigating the complaint at the request of the CSCI. The home has adult protection procedures, which were last reviewed in January 2005. The home has followed disciplinary procedures and adult protection procedures following the drug errors identified at the last inspection visit. Westbrook House DS0000064161.V307059.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): 19 20 22 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The building is a well-maintained purpose built care home. The furniture and equipment is not appropriate to the needs & rehabilitation of the service users. Some infection control procedures need improving. EVIDENCE: The home is a purpose built care home with a maintenance contract in place to ensure the building is maintained to its original standard. The registered manager confirmed that some of the furniture has been found to have potential health & safety implications for some service users. Despite the furniture being attractive to look at, it is has been found that some chairs tip backwards when service users try to get out of them independently, others cannot be used with the hoists and the height of the chairs also causes Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 16 problems. The dinning tables are too small to properly enable wheelchairs users to access them properly, service users were seen to be eating at arms length, if placed closer to the table they were then encroaching on the leg room of the other service users. All bedrooms have en-suite facilities including assisted walk-in showers. Additional assisted bathrooms are available. For those admitted for rehabilitation there are additional facilities proved; assisted kitchens and bathrooms. There are two secured gardens allocated to those residing on the ground floor. An area of garden has now been allocated to service users on the first floor. Access to the building outside office hours continues to be problematic and relies of care staff leaving their work areas to allow visitors into the building. There are plans to relocate the door entry system in the future, to provide easier access for staff to respond quicker during out of hours periods. The therapists stated that the home has not got the appropriate equipment to enable them to fully implement the service users rehabilitation programme. An example of this is the provision of commodes and perching stools, the commodes are needed to set the bedrooms up as they would be at home (as few have en-suite facilities in their own home) and the perching stools are needed to enable independence with personal care. The registered manager stated that they have drawn up a list of additional equipment required and has applied for funding. In the laundry clean sheets were seen to be piled up on a stool/chair and were dragging on the floor, when discussing this with the laundry staff they explained they didn’t have sufficient work surface to place the folded sheets on. Action was taken the same day to resolve this. Records of the baths temperatures continue to show that they are run at only 38’ despite this being a previous requirement. Clinical rooms/areas were seen to be cleared of clutter and have been organised. Westbrook House DS0000064161.V307059.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): 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. Staffing levels continues to rely on the provision of agency staff, however the staffing is affected by the conflict between the roles & responsibilities of the staff and how these are achieved. Recruitment procedures have improved and are now thorough. Staff are attending some training courses but are not implementing what they have been taught. EVIDENCE: Since the home has opened it has used a significant number of agency staff to fill the gaps in the staffing. Some new staff have been employed and the registered manager stated that they are employing further registered nurses. The recent anonymous complaint raised concerns that some agency staff were working excessive hours, resulting in the agency staff falling asleep on night duty. Also that some of the agency staff are reluctant to help with basic care needs and will only do nursing tasks. The complainant raised concerns that the level of service users needs as increased and that there is insufficient care staff on duty at night. There were a total of 6 service users that required hoisting staying in the intermediate care unit, therefore requiring a minimum of two staff. When the inspector entered the intermediate unit to find a Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 18 member of staff to talk to, no staff could be found on two occasions despite service users being in the unit. According to the pre-inspection questionnaire, staff have completed training in a variety of subjects and a number of training days have been planned for the future. However the training files were not organized and there is no training matrix or individual training programmes. Currently it is impossible to identify if all staff have completed the mandatory training. The deputy manager stated that she was aware of this and had inherited several different formats for recording the training. The pre-inspection questionnaire states that less than 50 of the care staff have achieved NVQ level 2 in care. Staff were observed using the incorrect hoist for a service user, the hoist required the person to be able to weight bear, the senior team leader also observed this but did not intervene, the registered manager had to inform both of the carers and the senior team leader of what they had done, if all of these staff have attended manual handling training then this demonstrates that they are not putting into practice their training. Four staff files were assessed. There was evidence of a recently employed qualified nurse having their registration with the NMC checked. Recruitment procedures have improved with interviews being documented and the safety checks being conducted prior to new staff starting work. The registered manager explained how she has stopped using a particular agency for the provision of agency staff when the registered managers investigation revealed that they had not been CRB checked. There was no evidence in the two new staff files, of them completing the induction programme; the registered manager stated they are provided with the folder to work through. The registered manager also stated they have the “skills for care” induction packs available for new staff. Westbrook House DS0000064161.V307059.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): 31 32 33 35 37 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The overall management of the home is not proactive and fails to ensure the home is run in the best interest of the service users. EVIDENCE: The registered manager has the skills and knowledge required for running the home. Through discussions with staff and the registered manager there continues to be a lack of clear communication between the different teams within the home and the different employment groups (PCT & NHS). There remain difficulties with the internal operations of the home with the different directives, policies, Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 20 practices and employers, resulting in staff not working efficiently together. There remains conflict between the PCT & KCC staff with disputes over roles and responsibilities. This is worsened by the lack of internal policies & procedures therefore staff have no written guidance to follow and adhere to. The registered manager is unable to change corporate policies (either KCC or PCT), this is beyond the scope of her remit. She is able to produce local service specific operational procedures. This has been a requirement for the previous two inspections. An example of this is when talking with the therapists, there were differences between those employed by the PCT & KCC, a lack of understanding of the role of the CSCI and they stated that they needed internal procedures relating to the production of the service users records and who is responsible for writing the programme in the care plan. The registered manager stated that a working group met a year ago to review the current policies but nothing has been formally recorded or amended, even though these are now due for review again. The inspectors acknowledge that the registered manager is constrained by having two different management structures (PCT & KCC) to work with. The registered manager stated that she has done some of the quality assurance work but has not produced a report; there are internal audits and surveys conducted. Confidential records were seen to be stored in an unlocked storage box. Insurance certificates displayed in the main entrance had expired, when the inspector informed the registered manager she was not aware of this, but would take action to rectify it. Environmental certificates for the servicing of equipment, gas & electrical supplies were up to date, however the electrical certificate was about to expire and neither the service manager or the registered manager was aware of this. The Fire log book recorded that safety checks were conducted regularly. Hot water testing records show that the hot water is delivered at approximately 43’, however bath records state that service users are bathed in temperatures of 38’ ( just 1’ degree above body temperature) when this was discussed with staff they believed that this was the temperature they were supposed to bath service users in. Service users money is handled through a none interest making bank account. None of the staff are appointees for service users and records are kept, this information was provided by the pre-inspection questionnaire. Westbrook House DS0000064161.V307059.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 X 2 2 1 X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 3 2 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 2 X 3 X 1 2 Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 12 14 18 Requirement Service users living in the home who have dementia must have these needs acknowledged and met. The home must be able to demonstrate how they meet these needs and that staff implement the training they have received. Documents and information relevant to the service users must be produced in appropriate formats, such as pictorial menus etc. The service users receiving intermediate care must have clearly defined goals identified and records must provide evidence of these being evaluated to determine if these goals have been achieved. Care plan must clearly identify all care needs; physical, medical, rehabilitation and psychological. Health assessments must be completed by staff with the skills to do so, ensuring accurate results. Appropriate action must be taken when assessments identify DS0000064161.V307059.R01.S.doc Timescale for action 28/02/07 2. OP4 12 14 18 28/02/07 3. OP6 12 18 23 28/02/07 4. OP7 12 – 17 sch 3 28/02/07 Westbrook House Version 5.2 Page 23 a need and/or potential risk. Prompt appropriate action must be taken to access healthcare professionals (e.g. GP) when a need is identified. Previous timescale: 31.10.05 & 30/09/06 5. OP7 12,13,14, 15,16,17, schedule 3 12-17 sch 3 Daily records must clearly and accurately record all care provided. Previous timescale: 31.10.05 & 30/09/06 There are detailed user friendly procedures for all medicine handling and all staff can easily access them. Previous timescale: 15.12.05 & 30/11/06 All medicine is administered as intended by the prescriber by following the directions on the label of the medicine or on a signed authorisation. Previous timescale: 31.10.05 & 30/09/06 Service users receiving intermediate care must be fully assessed and supported to selfmedicate the own medicines when assessed as capable. All service users must be treated with respect and dignity. Including the storage of feeding equipment and continence aids discreetly in bedrooms. Previous timescale: 31.10.05 & 30/09/06 A programme of activities must be planned and implemented. Previous timescale: 31.03.06 & 30/11/06 The registered manager must formerly acknowledge and act upon concerns raised by the staff. The home must provide DS0000064161.V307059.R01.S.doc 28/02/07 6. OP9 28/02/07 7. OP9 12-17 sch 3 14/02/07 8. OP9 12-17 sch 3 28/02/07 9. OP10 12 16 18 14/02/07 10. OP12 4 12 14 16 23 01/05/07 11. OP16 17 22 sch 4 14 16 23 14/02/07 12. OP22 28/02/07 Page 24 Westbrook House Version 5.2 13. OP25 12 23 14. 15. OP28 OP30 18 12 18 appropriate equipment to enable service users to complete their rehabilitation programme such as perching stools, commodes etc. Bath water / hot water must be delivered at the tap at the appropriate temperature 43’. Staff must be made aware of the appropriate water temperature to run the bath. Previous timescale: 30/09/06 50 of care staff must have the NVQ level 2 in care qualification. All new staff must complete the homes induction programme. Individual staff training programmes must be produced and implemented as well as a training matrix to manage the provision of training and to ensure that all staff attend the mandatory subjects as well as additional relevant training. The registered manager must be supported to take a strong management lead in the home, ensuring that requirements are met and the overall standards and practices within the home improve. Previous timescale: 30/09/06 The registered manager and the staff team must make available all of the relevant documents for the inspection process. For example when inspectors are case-tracking service users files all of the appropriate information must be produced and not to wait to the end of the inspection to produce additional evidence. The homes quality monitoring process is insufficient. The registered persons must ensure that there is a system for reviewing and monitoring the DS0000064161.V307059.R01.S.doc 14/02/07 01/05/07 01/05/07 16. OP32 10 12 15 24 01/05/07 17. OP32 10 12 17 24 14/02/07 18. OP33 10,12,15, 24 01/05/07 Westbrook House Version 5.2 Page 25 quality of care provided , including the quality of nursing and this must be done at appropriate intervals. Previous timescale: 31.03.06 & 30/11/06 19. OP36 18,19 Staff must be competent for 01/05/07 their roles and must be appropriately supervised. Formal supervision must occur at appropriate intervals and action must be taken to address attitudes identified at this inspection which affects staffs competence and the quality of care provided. Previous timescale: 31.03.06 & 30/11/06 01/05/07 20. OP37 21. OP37 22. OP38 Confidential records must be stored in a secured facility. Previous timescale: 31.10.05 & 30/09/06 4 10 12 The registered persons needs to 13 15-17 develop and implement internal procedures for combining 23 24 37 sch 1 3 4 working practices and the practical elements of the home. Previous timescale: 31.03.06 & 30/11/06 4 12 13 The need to maintain the 16 17 23 security of the building and the 37 sch 1 3 welfare of those within must be 4 reviewed for when the receptionist is off duty (the door entry system). Nursing and care staff time must not be used for this purpose. Previous timescale: 31.10.05 & 30/11/06 4 12 13 16 17 23 37 sch 1 3 4 The registered manager must ensure the home has all of the required insurance cover. Copies of the new certificates to be sent to the local CSCI office. 15,17 01/05/07 01/06/07 23. OP38 14/02/07 Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP9 OP12 OP38 Good Practice Recommendations To define the prospective service users criteria for admission to both the intermediate care unit and the dementia care unit. That the balance is written as zero when controlled drugs are returned to the service user to take home. To employ a team of activities persons to implement an activities programme. That the registered manager should develop clear lines of communication between all the staffing groups. This may take the form of a news letter. Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Westbrook House DS0000064161.V307059.R01.S.doc Version 5.2 Page 28 - 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. 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