Inspection on 13/09/05 for Westbrook House

This inspection was carried out on 13th September 2005.

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 11/01/07

Westbrook House 16/05/06

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 Canterbury Road Westbrook Margate Kent Lead Inspector Clair Brown Announced 13,14,15/09/2005 at 10:00hrs 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 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 H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Westbrook House Address Canterbury Rd, Westbrook, Margate, Kent. Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01843 860000 Kent County Council Mrs Sarah Elizabeth Khamsoda Registered Care Home - Nursing. 60 Category(ies) of DE(E) 25, MD(E) 15, Older persons (30) registration, with number of places Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 30 of occupied beds under 65 years old but above 55 years. Date of last inspection N/A 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 daycentre has not been opened). 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. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s first announced inspection since being registered in April. The inspection was conducted by two inspectors and the pharmacist inspector. The duration of the inspection was 18 hours over three days plus 5 pharmacy inspection hours. The Homes representative was the registered manager. Additional time was spent in planning the inspection and report writing. The pharmacist inspector also assessed the progress being made following an unannounced medication inspection by her earlier in the year, which led to a serious concerns letter with requirements being issued. The inspectors spent time talking to 3 service users and 7 staff to gain their views. Twelve service users and four relatives completed inspection comment cards. A full tour of the premises was conducted, documents and records were examined and service users files were case tracked. Medication procedures were inspected by the CSCI pharmacist. What the service does well: What has improved since the last inspection? What they could do better: The home and the manager needs to be supported by a junior level of management, these positions are currently vacant. The transition for staff from the health sector has not been easy, those spoken to feel they have had little information regarding the differences of working in a care home. The differences in working practices and culture between those from health and social sectors have created inter-disciplinary tension to the detriment of the service users. This is a key issue as this is having a negative impact on the care being provided and there is now an uneasy atmosphere within the Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 6 intermediate wing of the home. The production and implementation of clear practices and procedures which are adhered to and “owned” by care staff should start to address this. The home needs to resolve staffing issues and the excessive use of agency staff to cover vacancies and the high staff sickness levels. The service users records/ care plans need to be more detailed and completed properly. Those receiving intermediate care files need to have assessments and treatment programmes completed by the therapists. Confidential records need to be stored securely. There needs to be an activity programme implemented, especially in the intermediate care unit. Health & safety procedures need to be improved and adhered to. Medication practices need to be greatly improved to ensure they are handled and administered safely. The registered persons must comply with the regulations by applying for a variation to the homes registration for the service user admitted out of category. 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 H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5,6 The statement of purpose does not provide up to date information to enable prospective service users to make an informed decision. EVIDENCE: The statement of purpose has not been completed and the draft copy provided showed evidence that there is insufficient information and inaccurate information within the document. One service user has been admitted who is not within the homes registration, this is an offence. The registered manager stated that she was instructed to admit the service user by senior management in the local authority even though she had reservation about admission. Pre-admission assessments have not been completed on prospective service users. Care managers assessments have been obtained. There is a designated area for the intermediate care, however it is difficult to find evidence of intermediate care being provided as therapist’s assessment and treatment programmes have not been completed. The home does benefit from having the occupational therapists and physiotherapists in offices within the same building. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10, The care planning system within the intermediate care unit is inconsistent and does not adequately provide staff with the information they need to satisfactorily meet service users needs. There is a failure to ensure that health needs are met. A review of medication handling was undertaken by a CSCI pharmacist inspector who concluded that medicines were not being handled or managed effectively and that this could potentially place service users at risk. EVIDENCE: Intermediate care wing with nursing/social - five care plans were case tracked. The care plan for a recently admitted service user had not been written. The care plans did not identify all of the service users needs and these had not been regularly reviewed for those service users who had become long stay. None of the intermediate care plan paperwork had been completed by the healthcare professionals (occupational therapists and physiotherapists) therefore there was no information regarding the service users rehabilitation programme and it’s implementation. Healthcare assessments such as skin integrity were either not completed or found to be completed incorrectly with those reviewed showing considerable fluctuations in results. Although there Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 10 was some evidence of general practitioners being accessed promptly when required. There was also documentary evidence that one service user waited a week before seeing the doctor when prompt action was required. The local doctors visit three times a week on a routine basis. Health and personal needs are not easily identified by the nursing staff and when they are identified the nurses inability to work autonomously hinders the effective management of the care. A service user stated that they were told off for using the call bell and this was evidenced by entries made in two service users files. Interaction between staff and service users was limited with staff preferring to stand in the kitchen area rather than sit and interact with service users. There is a failure by nursing staff and care staff to acknowledge service users psychological welfare and the impact of recent events on their emotions and behaviour. Staff do not appear to understand the underlying reasons for service users outbursts, viewing them as aggressive. This “labelling” determines staff responses, which are defensive rather than empathetic. Wing for those with dementia – Five service users files / care plans were assessed. The care plans provide information and instructions on how to meet basic care needs. However, care plans failed to acknowledge dementia, behavioural needs and communications in sufficient detail. Many of the service users do have challenging behaviour and needs, specific individual details of how to manage these needs are not provided. Dependency score assessments and some health assessments have been completed. Interactions between the staff and the service users were observed, these were relaxed and natural. Staff sat with service users during lunch and some ate their own meal with them. Time and support was offered to enable service users to achieve their maximum potential. The member of staff administering the medication ensured every service user actually took their medication and demonstrated that they had the skills to know how to approach and manage those who are likely to refuse or need encouragement. Medications There is a lack of detailed procedure for staff to follow particularly when the home has been so reliant on agency staff and this has resulted in different methods being employed. Record keeping is so poor and haphazard; it is difficult to obtain a clear picture of service users’ current medication. Findings such as medicine not being given as prescribed, medicine being out of stock and medicine being given at incorrect times must question staff competency in medicine handling. An additional visit letter has been sent to the home to provide more detail. This is available on request. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 There are no leisure activities provided in the intermediate unit. The meals provided are to a high standard with multiple choices and variety available. Visitors are made welcome and encouraged to visit at all times. EVIDENCE: Intermediate wing with nursing – although service users undertake sessions of physiotherapy and occupational therapy there are no other activities organized for this group of services. Wing for those with dementia – staff were seen to positively interact with service users. During one visit to this wing staff and service users were sitting around a table whilst a staff member was reading out aloud and talking about what was being read. Seven of the inspection comment cards completed by service users said the home does not provide suitable activities. Catering service are provided by a company who are based at the home. There are three to four choices for the main meal and several options for the dessert, everyday. Relatives said the food looked inviting and was always hot. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 12 Good-sized portions were served and individual choices were provided. Multiple hot options of meals were available and service users enjoyed having the choice. The food was to a good standard and quality. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The complaints procedure does not promote awareness and confidence. EVIDENCE: There is a folder placed at the reception desk with complaint forms for people to complete. The complaints procedure does not include the receipt and acknowledgement of verbal complaints. Staff are not aware of the complaints procedure and their role when in receipt of a complaint. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The building is a well-maintained purpose built care home. There are faults with the design and layout of the building relating to everyday practical uses. Some infection control procedures are inadequate. 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 maintenance programme for 2006 has already been produced. The home opened in April and since then and during the course of the inspection some issues have been identified which relate to the practicalities of using the building. The air is stuffy and oppressive with no means of ventilating the building. Staff stated that this makes them feel unwell and they get frequent headaches. The location of medical equipment and linen storage outside of the wings means care and safety is compromised as staff are required to leave the wing to access these. Already it has been identified that there is insufficient storage facilities within the wings. Office areas again are sited outside of the wings with no provision to manage the wings from within. Staff confirmed that these Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 15 practical issues are impacting on their ability to provide care effectively and efficiently. 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; ADL kitchens and bathrooms. There are two secured gardens allocated to those residing on the ground floor, however the recent hot weather has brought it to light that there is no designated garden area that is safe and easily accessible for those residing on the first floor. Also there is no ventilated smoking room for the first floor. These issues have encouraged unsafe practices breaching health & safety. For example the inspectors observed that the fire exit / escapes on both units of the top floor were obstructed with chairs used by service users for smoking, the used ashtrays were also evident and this was confirmed by staff when spoken to. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staff morale is low with high levels of sickness and turnover of staff. This situation is having a detrimental impact on the standard and consistency of care offered within the home. Recruitment procedures do not protect the welfare of the service users. EVIDENCE: Staff sickness is high with five permanent staff off sick each day of the inspection. The home relies heavily on employing agency staff, this promotes unease with the permanent staff and resentment against agency workers due to their lack of knowledge of the needs of the service users and what responsibilities are required of them. There are a significant number of vacancies resulting in a lack of senior staff (upper grades of qualified nurses) and remaining staff feel under pressure and express they are not able to undertake their role properly. Although many of the staff have previously completed training and a number of training days have been planned since the opening of the home staff continue to lack the ability to be autonomous and work as part of a team. Insufficient numbers of staff have completed courses such as dementia training. However those staff working in the dementia area that have completed the training have already implemented knowledge and skills gained from the training course. There are insufficient numbers of qualified nurses employed, especially above grade D. At night there are only two registered nurses employed working a total of five nights between them. The two remaining nights, annual leave and training are covered by agency. There are complexities and delays in the procedures for recruiting staff to vacant health positions. Ten staff files were Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 17 assessed. Not all of the required safety checks have been conducted for newly employed staff prior to their start date. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38 There is a lack of cohesion at senior management level, which is having a detrimental affect on the management of the home. The lack of a supportive management structure seriously affects the registered managers ability to create an open, positive and inclusive atmosphere. This has resulted in a breakdown in communication between staff groups and there is a lack of awareness of their roles and responsibilities. The conflicts between staffing groups is having a negative impact on the effective management of the home and the welfare of the service users. Health care staff are very resistant to the changes that have occurred with moving to the new development. EVIDENCE: The registered manager, registered nurses, healthcare assistants and care workers were spoken to as well as service users. The inspectors directly witnessed the conflicts between the two disciplines; health and social. Those staff previously from the local authority have an understanding of what is expected of a care home however those staff from health have no Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 19 understanding of the regulatory role of the commission. Combining the two areas of working practices is causing conflict and confusion for staff. The supportive management posts (deputy managers) have recently become vacant leaving a major short fall in the management structure. The registered manager has the skills and knowledge required for running the home but the lack of support from the supporting management structure. This has resulted in a workload that is too much for any one person to deal with. Currently there is no one with the responsibility and time to take on task such as writing new working practices procedures. The NHS PCT and KCC are continuing to develop working relationships. The negative atmosphere is very apparent, with the inspectors, staff and service users being aware of it. Incidents of attempts to undermine the management of the home have been discussed. Currently there are no procedures for quality monitoring of the care provided. There are insufficient storage facilities for COSHH items in appropriate areas. At weekends and evenings there is no receptionist to enable visitors and other professionals using the building to gain entry. Currently care staff are required to leave the area of care to use the entry system. There are inadequate secured storage facilities for confidential files. Office space is limited and staff do not have an area to complete paperwork within each wing. Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 1 2 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 2 3 2 3 2 2 2 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 3 1 1 x x 1 1 2 Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 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 OP1 Regulation 4,5, schedule 1 5,14 14,15 Requirement The statement of purpose must be completed and contain all of the required information. The registered manager must ensure the information is accurate. The contract / terms and conditions must have details of the trial period. A suitably trained staff member from the home visits prospective service users prior to admission to confirm their suitability and ability to meet their assessed needs. Care plan must clearly identify all care needs; physical, medical, rehabilitation and psycological. Care plans and health assessments must be reviewed at a maximum of monthly intervals or when a change in needs is identified. Health assessments must be completed by staff with the skills to do so, ensuring accurate results. Appropriate action must be taken when assessments identify a need and/or potential risk. Prompt appropriate action must be taken to access healthcare Timescale for action 31.01.06 2. 3. OP2,5 OP3 31.01.06 31.10.05 4. OP7,8 12,13,14, 15,16,17 schedule 3 31.10.05 Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 22 5. OP7,37 12,13,14, 15,16,17, schedule 3 6. OP10 12,16,18 7. 8. OP12 OP16 4,12,14,1 5,16,23 17,22 schedule 4 16,23 9. OP20 10. OP25 13,23 11. OP26 12,13,16, 23 12. OP27,29 7,9,18,19 schedule 2 professionals (e.g. GP) when a need is identified. Daily reports must be made on a daily basis for every service user. Daily records must clearly and accurately record all care provided. All staff must refrain from making inappropriate entries in service users records. All service users must be treated with respect and dignity. The use of communal clothes must be stopped. A programme of activities must be planned and implemented. To review the complaints procedure to acknowledge and record all complaints, including those made verbally. The registered manager must clarify the details of the land/gardens owned by the home. To identify an area of outdoor space that service users on the first floor can use and access safely. To resolve the lack of air circulation / ventilation of the building. Send an action plan to CSCI relating to this requirement. Handwashing equipment must be correctly located above handwashbasins. Handwash basins must not be used for the washing of dishes. Infection control procedures in the laundry room, soiled linen must not be placed on the floor, containers must be provided. Ancillary cleaning staff must wear protective clothing. The management team (i.e. the deputy managers) vacant posts must be recruited to. Additional permanent registered 31.10.05 31.10.05 31.03.06 31.01.06 31.01.06 31.01.06 31.10.05 31.01.06 Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 23 13. OP29 7,9,19 schedule 2 14. OP33 10,12,15, 24 15. OP36 18,19 16. OP37 15,17 17. OP38 18. OP38 4,12,13, 16,17,23, 37 schedules 1,3,4 4,12,13, 16,17,23, 37 schedules 1,3,4 nurses for the night duty must be employed. Sufficient numbers of registered nurses must be employed to meet the needs of the home. Duty rotas must record all staff shifts, including agency. New staff must not start work prior to the receipt of the CRB except in exceptional circumstances. Evidence of a POVA first must be available prior to the start date. The homes quality monitoring process is insufficient. The registered persons must ensure that there is a system for reviewing and monitoring the quality of care provided , including the quality of nursing and this must be done at appropriate intervals. Staff must be competant for 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 competance and the quality of care provided. Confidential records must be stored in a secured facility. The use of communal records (e.g. doctors books) must be stopped. Food hygiene training must be given to all staff who serve food to service users. COSHH items must be stored in a locked facility (e.g. dishwasher powder in beverage area) and appropriately labelled. Fire exits routes must be kept clear at all times. 31.10.05 31.03.06 31.03.06 31.10.05 31.01.06 31.10.05 Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 24 19. OP38 4,12,13, 16,17,23, 37 schedules 1,3,4 20. OP33,38 21. OP22,38 22. 23. OP30,32 OP9 24. OP9 4,10,12, 13, 15,16,17, 23,24, 37 schedules 1,3,4 4,12,13, 14 16,17,23, 37 schedules 1,3,4 5,10,12, 13,18,21, 24 12,13,14, 16,17, schedule 3 12,13,14, 16,17, schedule 3 12,13,14, 16,17, schedule 3 12,13,14, 16,17, schedule 3 12,13,14, 16,17, To identify an area on the first floor for service users to use when they wish to smoke with appropriate extractors fitted. The kitchen must not be accessible to the general public. The need to maintain the security of the building and the welfare of those within must be reviewed for when the receptionist is off duty. Nursing and care staff time must not be used for this purpose. The registered persons needs to develop and implement internal procedures for combining working practices and the practical elements of the home. Adequate storage facilities must be provided for equipment and laundry/linen on each unit. 31.10.05 31.03.06 31.03.06 25. OP9 26. OP9 All staff must be made aware of the role of the CSCI and the National Minimum Standards. There are detailed user friendly procedures for all medicine handling and all staff can easily access them. There are clear, accurate records of all medicines received, administered and leaving the home as well as a record of nonadministration to ensure an audit trail. Sufficient lockable storage for medicine is provided in the upstairs clinical room and the room is kept neat and tidy. The temperature of drug fridge be maintained between 2ºand 8ºC. Nurses follow the NMC Guidelines for the Administration 31.01.06 15.12.05 31.10.05 31.12.05 31.10.05 27. OP9 31.10.05 Page 25 Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 28. OP9 schedule 3 12,13,14, 16,17, schedule 3 12,13,14, 16,17, schedule 3 12,13,14, 16,17, schedule 3 4,12,14, 18 of Medicine. All medicine is administered as intended by the prescriber by following the directions on the label of the medicine or on a signed authorisation. All staff administering medicine are competent. The home sets up a contract for the disposal of pharmaceutical waste. Service users must not be admitted to the home whose needs cannot be met. The registered persons must ensure that only service users who are within the categories of the homes registration are admitted. The registered persons must apply for a variation to its registration for the service user identified during the inspection. 31.10.05 29. OP9 30.11.05 30. OP9 31.10.05 31. OP4 30.11.05 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. Refer to Standard OP9 OP9 OP9 Good Practice Recommendations The temperature of the upstairs clinical room is kept at a more ambient temperature Prescribed creams and ointments are stored in a locked cupboard in the clinical room unless required for selfadministration All hand transcriptions are written in plain English and clearly detail the directions on the label of the dispensed medicine Westbrook House H56-H05 S64161 Westbrook House V243511 130905 stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU 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. 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