Inspection on 12/04/06 for Westbrook House

This inspection was carried out on 12th April 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westbrook House 11/04/07

Westbrook House 09/11/05

Westbrook House 25/04/05

Westbrook House 18/11/04

Westbrook House 03/06/04

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Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

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Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Westbrook House Cupid Green Lane Hemel Hempstead Hertfordshire HP2 7GH Lead Inspector Hazel Wynn Key Unannounced Inspection 12th April 2006 2:00 Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 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 DS0000019613.V288155.R01.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 Adults 18-65. 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 DS0000019613.V288155.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Westbrook House Address Cupid Green Lane Hemel Hempstead Hertfordshire HP2 7GH 01442 264965 01442 264965 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) Caretech Community Service Limited Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 8 people with a learning disability (aged 1865 years and over 65 years) or a physical disability 9th November 2005 Date of last inspection Brief Description of the Service: Westbrook House is situated between the Grovehill and the Woodland Farm areas of Hemel Hempstead and is within five minutes from the local shops, Health Centre and General Practitioners. The property is a conversion of a listed, two-storey farm building. It has been refurbished to a very high standard to provide for the needs of a highly dependent group of service users. The ground floor contains eight single bedrooms; each designed with the potential care needs of the service users in mind, 2 assisted bathrooms, 2 toilets and a laundry room. The lift provides access to the first floor, which consists of a lounge, dining area, kitchen, shower and toilet facilities. The fee range is from £1,242.67 to £1,428.78 with variance depending on assessed needs. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been drawn up following an inspection carried out by one regulation inspector representing CSCI on 12th April 2006 using available evidence gathered during the inspection including observation, discussion with service users, care staff and the manager (who is not yet registered) and examination of records maintained in the home. What the service does well: What has improved since the last inspection? A sign (in a service user’s room) instructing staff has been more discreetly displayed to protect the dignity of the service user. Medication is stored at the correct temperature and temperatures recorded daily. All medication charts had been recorded by the pharmacy; there were no handwritten recordings requiring signature and medication was being audited regularly. The new manager ensured that a full employment history was obtained for all job applicants and that references corresponded to previous employment with adequate checks conducted. Extension leads are tested as part of the homes Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 6 safety checks. Hot water was being delivered within guideline temperatures close to 43°C. 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. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in the outcome of this inspection visit is good; this judgement has been made using all available evidence including a visit to this service. Information is provided to prospective service users about the home to enable and support them to make a choice. Prospective service users’ individual aspirations and needs are assessed. EVIDENCE: The service users guide was seen at this inspection to have been updated in January 2006 and a copy maintained in each service users individual file. Service users are supported by their relatives, professionals who contribute appropriately to the individual’s assessment and review and evidence of this was seen in individual files. The evidence perused in the files provided assurance that service users know that the home can meet their needs; observation of the meeting of needs during this inspection provided further evidence. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in the outcome of this inspection visit is good; this judgement has been made using all available evidence including a visit to this service. Service users know their care plans contain their assessed and changing needs as well as their personal goals (or their advocates do so on their behalf). Services users are supported to make decisions about their lives. Service users are safely supported to take risks as part of an independent lifestyle. EVIDENCE: A sample of care plans was examination at this inspection and found to contain copies of assessments, which have ongoing regular reviews, the service users are present at assessment and reviews and this was evidenced in the records. The service users are fully involved in care planning and had signed their documents. Service users were going through the process of choosing a holiday and some had already made a choice and were making bookings. Service users choose what they would like to eat using picture menus where this is a better form of communication. Leisure choices have been increased as part of the new Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 10 managers service user focus and service users were benefiting greatly from this. Individual risk assessments had been carried out and guidelines written to support service users to take appropriate risks as part of an individual lifestyle. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17 Quality in the outcome of this inspection visit is good; this judgement has been made using all available evidence including a visit to this service. Opportunities for personal development are provided as are age, peer and culturally appropriate activities. Personal relationships are fully supported. The rights and responsibilities of service users are recognised in their daily lives. EVIDENCE: A sample of service users care plans and records were examined at this inspection and these contained evidence that opportunities for personal development are provided and that appropriate leisure activities are enjoyed. These have increased as part of the new manager’s agenda for positive change. The range of activities enjoyed were seen to be age, peer and culturally appropriate and the records showed that many of the activities take place in the local community thereby supporting service users to be part of their local community. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 12 Two family members confirmed, during conversation with the inspector, that personal relationships are well supported and the records further supported this. Relationships with family members were seen to be well maintained by telephone communication and visits. A number of families who live nearby make regular visits and two residents are able to make visits (both day and staying visits) to their families with support from staff where appropriate for transport. Families and friends are invited to the home for parties and seasonal activities and are also regularly consulted by means of quality questionnaires for their views about the running of the home. Policies and procedures are in place to support service users to benefit from all relationships they have with their families and friends. Policies and procedures are in place in respect of the rights and responsibilities of the service users. Terms and conditions of placement also set out the service users rights and responsibilities in a user-friendly format. Service users enjoyed their evening meal in a relaxed and jovial atmosphere. Service users menus are put together with the aid of picture menus, which help them to voice their choices. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 20 Quality in the outcome of this inspection visit is good; this judgement has been made using all available evidence including a visit to this service. Personal support is provided to service users according to their wishes. The physical and emotional health needs of service users are met. Medication is administered appropriately and the homes policies and procedures were being adhered to affording protection to the service users. EVIDENCE: The care plans examined showed an individual approach is afforded to service users in providing personal care (see environment, where a need for a shower room to better meet bathing needs for service users who have changing needs has been required). Staff were observed to be meeting the physical and emotional needs of the service users with a warm and caring approach. The care plans examined at this inspection provided guidance to staff in how to meet the physical and emotional needs of individual service users. The service users require full support with the administration of medication. The records were well maintained and medication was appropriately stored and Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 14 at the correct temperature. Requirements made at the last inspection had now been met. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 - 23 Quality in the outcome of this inspection visit is good; this judgement has been made using all available evidence including a visit to this service. Service users views are actively sought, listened to and acted upon. Services users are protected from abuse, self-harm or neglect. EVIDENCE: The manager explained how the views of service users are obtained on a regular basis using various forms of communication and surveys. A pictorial formatted complaints policy is provided to enable service users to understand the document and this is updated annually. Some staff were planning to attend the Hertfordshire County Council Adult Protection training in the week post inspection; whilst awaiting this staff had received in house training in adult abuse awareness. All other staff are on the waiting list for the limited places provided by Hertfordshire County Council for Adult Protection training. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 Quality in the outcome of this inspection visit is poor; this judgement has been made using all available evidence including a visit to this service. The easily stained carpeting in the lounge area and the lack of a shower room mars the quality outcome in this area. Otherwise the service offers a comfortable and safe environment and the home is otherwise clean and hygienic. EVIDENCE: The records showed that the carpets had been thoroughly cleaned following the last inspection but had quickly become stained again. It would be advisable to replace the flooring with a suitable impermeable flooring. The carpet in the lounge was stained as observed at this inspection and was such that it cannot be addressed by daily cleaning. Otherwise the home was clean, odour free and hygienic. The bathrooms are failing to comfortably meet the changing needs of some of the service users who find bathing uncomfortable due to their physical conditions worsening. The service needs to provide a shower room to meet changing needs of service users. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in the outcome of this inspection visit is good; this judgement has been made using all available evidence including a visit to this service. Service users are supported by competent and qualified staff. Recruitment procedures are now robust. Staff are appropriately trained to meet the needs of the service users. EVIDENCE: The training programme was seen to provide adequate on going training to meet the needs of the service users. Some staff were scheduled to attend Hertfordshire County Council’s Adult Protection training in the week post inspection. Other staff would attend the same training course as limited places become available; in the meantime all staff had attended in house training on adult abuse awareness. Moving and handling training had been provided on March 24th 2006. The manager provided evidence on how meticulously she recruits staff and carries out appropriate checks to protect service users. Three new staff had been recruited and were awaiting a start date on receipt of CRB. CRB’s and references for recruitment since the last inspection were made available at this inspection. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in the outcome of this inspection visit although good is marred by the fact that the manager is not yet registered; this judgement has been made using all available evidence including a visit to this service. The home is well run and the service users benefit from this. Service users can be confident that their views underpin the all self-monitoring, review and development by the home. The health, safety and welfare of the service users is promoted and protected. EVIDENCE: The new manager stated that she is in the process of applying for registration but the application remains awaited, therefore a requirement is made. A requirement was made for the previous manager who has since left. Various records were examined during this inspection visit, including medication, service user finance, fire safety records, accidents and incidents and various health and safety records; all records were well managed; this in part provided evidence that the home is well run. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 19 Staff stated that the new manager had made positive changes focused on benefiting the quality of life of the service users and staff stated they felt well supported. Records showed an increase in leisure activities. The service has a staff member employed solely to provide structured day activities to meet the needs of service users where day services are not suitable. Some service users had chosen a holiday and booked and others were still in the process of doing so. Two relatives, with whom the inspector consulted for feedback praised the care staff team and stated that they were confident that their respective relatives were well care for and happy in the home. Evidence has been provided earlier in this report that the health, welfare and safety of the service users is promoted and protected. Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 1 28 x 29 x 30 1 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 1 x 3 x x 3 x Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 21 yes 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 YA30 Regulation 23(2)(d) Requirement Stained carpet in the lounge must be cleaned (preferably by professionals). It may be advisable to consider an alternative impermeable floor covering to overcome the problem of constant heavy duty cleaning of carpeting. The manager must submit a Registration Application to the Commission for Social Care Inspection. This requirement was previously made in relation to a manager who has since left and a new manager is now in place. The provision of bathing facilities must suit the needs of individuals. Timescale for action 30/06/06 2. YA37 8(1)(a) 05/06/06 3 YA27 23 30/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 22 Westbrook House DS0000019613.V288155.R01.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 Westbrook House DS0000019613.V288155.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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