Inspection on 16/05/06 for Westbrook House

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 09:30 16 ,26 May & 16th June 2006 th th 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.V291935.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 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.V291935.R01.S.doc Version 5.1 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.V291935.R01.S.doc Version 5.1 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. 13th September 2005 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 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. 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.V291935.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of an unannounced key visit to the home on 16th, 26th May & 16th June 2006 by two inspectors on the last day and a pharmacist inspector on the second day. The inspection takes account of information received from a variety of sources including written information from the registered providers, relatives, care managers and general practitioners. The previously made requirements and recommendation from other inspections were inspected and all key standards. Comment cards were completed by 11 service users. The inspectors spent time talking to service users and the care staff to gain their views. A 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? The statement of purpose has been amended. Service users no longer wear communal clothing. Complaints are now acknowledged and investigated. An area of outdoor space has been allocated to the service users on the first floor to enjoy and the homes ventilation system has been repaired. Procedures for handling soiled linen in the laundry room have improved. A new deputy manager has been employed to support the registered manager. All new staff have had the required security checks before starting work. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1236 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users to the intermediate care unit receive limited information prior to admission. Only some service users receive a contract and the contract fails to provide full details of services provided for the fee. The provision of intermediate care fails to ensure individuals’ goals are achieved. EVIDENCE: The statement of purpose has been revised. The service user contract is produced for the elderly dementia care unit and has not been fully implemented for those in the Intermediate care unit, the home is registered for providing nursing care but this service is not included under “Fees”. Service users surveys showed that some did and some didn’t receive a copy of the contract. Five service users files were assessed for pre-admission assessments, some are referred direct from the hospital, some have care managers assessments, some assessments are conducted by the home and in Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 9 some files there was no evidence available of the assessment being completed. The registered manager stated that she would do some of these assessments and so will the deputy manager or a physiotherapist. The quality of information gathered varied according to the assessor however; details in some were vague and insufficient. One was quite detailed but was completed after admission to the home. The home is purpose built for providing intermediate care on the first floor; it has assessment kitchens and physiotherapy rooms. There are physiotherapist and occupational therapists employed to work with these service users. The quality of these professionals paperwork varies considerably; some were seen to be blank, whilst others provided quite a clear indication of the service users progress or decline. There was no evidence of cross referencing or information sharing between the therapists and nursing/care staff. Changes in service users abilities, identified in therapists records was not transferred to the nursing/care plan. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is 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 recorded in the care plan. There is a failure to ensure that health needs are met. Medications practices could potentially place service users at risk. EVIDENCE: Intermediate care wing with nursing/social - three care plans were case tracked. The care plan of a service user due for discharge showed that the majority of the records and entries are made by the physiotherapists and occupational therapists. Records by the nursing staff are brief and vague. The care plan was reviewed but the information provided was limited and inaccurate; the physiotherapist had clearly recorded the deterioration in the service users balance, was having further falls and needed someone near by when mobilizing, this was not included in the care plan. The care plans did not identify all of the service users needs and the reviews where found to be Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 11 inaccurate when cross referenced. The information regarding the service users rehabilitation programme and it’s implementation is not included in the care plan and for one service user the O.T & physio assessments were blank. Healthcare assessments such as skin integrity, nutritional status, movement & handling were either not completed or found to be completed incorrectly. The local doctors visit three times a week on a routine basis. Records indicated that a service user was suspected of having a urine infection, however there was no evidence in the records of any action being taken relating to this matter. Two care managers comment cards stated that staff did not demonstrate a clear understanding of their clients needs and that the number of agency staff was greater than the permanent staff. Three out of the four care managers said they were able to speak with a senior member of staff when they visited. Wing for those with dementia (Appleton) – two service users files / care plans were assessed. The care plans have declined in the level of information they provide since the last inspection; often just a few words are used to describe the individuals’ needs. All of the service users have dementia and many have challenging behaviour and needs, specific individual details of how to manage these needs are not provided. Health assessments such as nutritional and skin integrity were blank. The care plans were discussed with senior staff on duty who explained they are short staffed, especially for team leaders and this has impacted on their time for completing the care plans and chosen to prioritise giving their time to the service users. Interactions between the staff and the service users were observed these were relaxed and natural. The inspection was unannounced and yet the service users were dressed smartly and care staff had taken the time to ensure the ladies were wearing their jewellery and make up and the gentlemen had shaved. Medications Intermediate care unit - medication is administered by qualified nursing staff. There were a significant number of errors identified in the handling, recording and administration of medicines. Serious concerns have been raised in relation to the recording and administration of controlled drugs and multiple errors were identified with the records and the quantities of medicines. On the second day of the visit an entry made in the CD register raised questions regarding the practices of a member of staff. The entry was made since the first day of the inspection, the date entered was for a month earlier. The medication for the service user had been discontinued 3 months earlier. The packaging was damaged and the tablet returned to the packaging. Before this entry there had been a tablet missing. The PCT and KCC have undertaken an investigation and suspended the members of staff. In service users bedrooms prescribed items were seen to be left out on top of dressing tables etc. Prescribed supplement drinks are held in large quantities, the failure to rotate these on delivery has meant many of them have expired and staff were not aware the these were now out of date. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 12 Appleton unit – medication practices were satisfactory, although some errors identified. There is limited storage available in the medication room which will decrease further when the final wing of the home has opened. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 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. Cultural needs are not acknowledged and met. 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. One service user did not speak English, the care plan stated to “speak slowly and clearly”. There were records of using translators, communication cards or other any other means of communication. Wing for those with dementia – staff were seen to positively interact with service users. Evidence of craft and reminiscence activities taking place where displayed on the walls and available in the communal rooms. The registered manager confirmed there is no budget to employ an activities person within the home. A care manager survey stated they are not always able to see their client in private. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 14 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. Multiple hot options of meals were available and service users enjoyed having the choice. The food was to a good standard and quality. The care staff were seen to be liquidizing the food for those requiring a soft diet, on asking the staff why they were doing this they stated “the kitchen does not provide soft/pureed meals”. Therefore the food was all blended together in one pot to form an unappealing bowl of food. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is now implemented. EVIDENCE: There remains a folder placed at the reception desk with complaint forms for people to complete. The pre-inspection questionnaire shows that the home has received 5 complaints, all of which have been investigated, 1 substantiated and the others partially substantiated. The service user surveys stated that only 1 was not aware of the complaints procedure the other 7 said they knew how to make a complaint. The home has adult protection procedures, which were last reviewed in January 2005. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 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. There are faults with the design and layout of the building relating to everyday practical uses. Some infection control procedures need improving. Clinical areas of the home are disorganized and untidy. 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 2006/07 has already been implemented and work was being carried during the inspection visit. The registered manager confirmed that some of the furniture has been replaced as it had already broken. Some of the dinning table where not suitable for those using wheelchairs. The problems with air circulation system has been resolved. No changes have been made to the environment. All bedrooms have en-suite facilities including assisted walkWestbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 17 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. 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. A door entry system is planned to be installed in the future. During the course of the inspection records were found that the lack of provision of specialist equipment for movement & handling was having an impact on being able to meet service users needs and comply with health & safety requirements. A service user was not able to use the toilet because there was no hoist available. Clinical rooms/areas were found to be cluttered and full of inappropriate supplies, therefore stock was out of date and some items were no longer sterile. This issue had been raised at the last inspection. Hot water temperature records show that the hot water is not very warm averaging at 38’. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff morale remains low due to the shortfalls in staffing numbers. Service users are not always able to receive the care they need at the desired time due to low staffing numbers. Recruitment procedures have improved but the staff records are inadequate. Staff are now attending some training courses. EVIDENCE: There are insufficient numbers of qualified nurses and care staff employed. For over a year the home has used agency staff to cover the shortfalls in staffing, long term this is problematic due to their lack of knowledge of the needs of the service users and what responsibilities are required of them. This is supported by comments made by 3 care managers. There remains a significant number of vacancies and shortages of staff, resulting in a lack of senior staff (upper grades of qualified nurses and team leaders) and remaining staff feel under pressure and expressed they are not able to undertake their role properly. During the inspection the weekly review meeting was taking place, during this time two or more staff attend the reviews, no additional staff are rostered on duty despite this being a regular occurrence and the remaining staff were overwhelmed with meeting the needs of service users, call bells rang for a long time and several of the service users required at least two carers at a time to provide care. 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 near future. However there Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 19 was limited evidence in staff files of mandatory training being completed. Less than 50 of the care staff have achieved NVQ level 2 in care. There remains complexities and delays in the procedures for recruiting staff to vacant health positions. Three staff files were assessed. There was no evidence of a recently employed qualified nurse having their registration with the NMC checked. Recruitment procedures have improved with the safety checks being conducted prior to new staff starting work. However staff files do not contain all of the required documents as detailed in the amended schedule 2 of the regulations. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 37 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is affected by the differences in procedures between KCC & PCT. There is no quality assurance systems in place and the day to day management of the home lacks a consistent leadership within the home. EVIDENCE: Twenty of the previously made requirements have not been met or only partly met. The areas of conflict and confusion relating to the different practices and procedures between to two different groups of staff (PCT & KCC) identified at the last inspection is gradually improving, however staff spoken to expressed the need for clarification and the production of written procedures. The registered manager confirmed that to date only two new procedures have produced in relation to this joint working. There remains managerial difficulties due to the different policies and working practices of the two Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 21 employers. For example the registered manager cannot take disciplinary action against a member of staff employed by the PCT. Those staff previously from the local authority have an understanding of what is expected of a care home however those staff from health have limited understanding of the regulatory role of the commission, the registered manager confirmed they are working with staff at meetings to increase their awareness. Staff involved in the inspection were co-operative and helpful. A deputy manager has recently been employed and has completed her induction. The managers were not aware of some of the practices and problems within the home, the registered managers rota show she spends a significant amount of her time attending meetings, often accompanied by the deputy manager. The registered manager has the skills and knowledge required for running the home. There are no procedures for quality monitoring of the care provided, regulation 26 reports have been completed. The storage facilities for COSHH items in the wings were left unlocked and the key in the door. The environmental certificates were up to date, however the fire extinguisher were overdue their servicing and the fire log book provided evidence of weekly tests and checks not always being done. 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 remains inappropriate storage facilities for confidential files, service user files continue to be stored in “doctors round” trolleys, even those that have locks fitted, were left open. 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.V291935.R01.S.doc Version 5.1 Page 22 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 3 2 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 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 3 17 X 18 3 3 2 3 2 3 2 3 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 1 X 3 2 1 2 Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 23 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 OP2 Regulation 5 14 Requirement The contract / terms and conditions must have details of the trial period and nursing care provision. Previous timescale:31.01.06 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. Previous timescale: 31.10.05 Care plan must clearly identify all care needs; physical, medical, rehabilitation and psychological. 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 professionals (e.g. GP) when a DS0000064161.V291935.R01.S.doc Timescale for action 30/11/06 2 OP3 14,15 30/09/06 3 OP7 12 - 17 sch 3 30/09/06 Westbrook House Version 5.1 Page 24 4 OP7 12,13,14, 15,16,17, schedule 3 5 OP8 12-17 sch 3 12 16 18 6 OP10 7 8 9 10 OP12 OP25 OP26 OP27 4 12 14 – 16 23 12 23 12,13,16, 23 7,9,18,19 schedule 2 11 OP29 7,9,19 schedule 2 need is identified. Previous timescale: 31.10.05 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. Previous timescale: 31.10.05 The registered manager must investigate the incident relating to staff assisting a service user to evacuate their bowels. 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 A programme of activities must be planned and implemented. Previous timescale: 31.03.06 Hot water must be delivered at the tap at the appropriate temperature 43’ Hand-wash basins must not be used for the washing of dishes. Previous timescale: 31.10.05 Additional permanent registered nurses for the night duty must be employed. Sufficient numbers of registered nurses and care staff must be employed to meet the needs of the home. Duty rotas must record all staff shifts, including agency. Previous timescale: 31.01.06 All staff files must contain all of the required documentation as detailed in the amended schedule 2. When prospective staff are interviewed, records must be kept and evidence of investigating gaps in DS0000064161.V291935.R01.S.doc 30/09/06 30/09/06 30/09/06 30/11/06 30/09/06 30/09/06 30/11/06 30/09/06 Westbrook House Version 5.1 Page 25 12 OP32 13 OP33 14 OP36 15 16 OP37 OP38 17 OP38 18 OP37 employment history recorded. 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. 10,12,15, The homes quality monitoring 24 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. Previous timescale: 31.03.06 18,19 Staff must be competent 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 competence and the quality of care provided. Previous timescale: 31.03.06 15,17 Confidential records must be stored in a secured facility. Previous timescale: 31.10.05 4 12 13 COSHH items must be stored in 16 17 23 a locked facility (e.g. dishwasher 37 sch 1 3 powder in beverage area) and 4 appropriately labelled. Previous timescale: 31.10.05 Fire checks must be completed at the correct time intervals. 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. Nursing and care staff time must not be used for this purpose. Previous timescale: 31.10.05 4 10 12 The registered persons needs to 10 12 15 24 DS0000064161.V291935.R01.S.doc 30/09/06 30/11/06 30/11/06 30/09/06 30/09/06 30/11/06 30/11/06 Page 26 Westbrook House Version 5.1 13 15-17 23 24 37 sch 1 3 4 19 OP9 12-17 sch 3 20 OP9 12-17 sch 3 21 OP9 12-17 sch 3 22 OP9 12-17 sch 3 12-17 sch 3 23 OP9 24 OP9 12 - 17 sch 3 25 OP9 12-17 sch 3 develop and implement internal procedures for combining working practices and the practical elements of the home. Previous timescale: 31.03.06 There are detailed user friendly procedures for all medicine handling and all staff can easily access them. Previous timescale: 15.12.05 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. Previous timescale: 31.10.05 Sufficient lockable storage for medicine is provided in both clinical room and the room is kept neat and tidy. Previous timescale: 31.12.05 Nurses follow the NMC Guidelines for the Administration of Medicine. Previous timescale: 31.10.05 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 Immediate requirement made: to ensure that medications are recorded, handled and administered correctly and safely. For an action plan to be sent to the CSCI by the 1st June 2006, resolving medication problems identified at the inspection. Regular audits to be conducted. All staff administering medicine are competent. Previous timescale: 30.11.05 30/11/06 30/09/06 30/11/06 30/09/06 30/09/06 26/05/06 30/09/06 Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 27 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 OP2 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 To produce two versions of the service user contract, those receiving long term care and those receiving intermediate care. Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Kent and Medway Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Westbrook House DS0000064161.V291935.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!