Inspection on 16/05/07 for Westbrook House

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Westbrook House 11/01/06

Westbrook House 06/09/05

Westbrook House 22/10/04

Westbrook House 12/05/04

Westbrook House 22/10/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Westbrook House 21 Cabbell Road Cromer Norfolk NR27 9HY Lead Inspector Mr Jerry Crehan Unannounced Inspection 16th May 2007 09:30 Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 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 DS0000027329.V340540.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000027329.V340540.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbrook House Address 21 Cabbell Road Cromer Norfolk NR27 9HY 01263 512482 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) w.jeesal@virgin.net www.jeesal.org Jeesal Residential Care Services Limited Mrs Heather Rachel Hurn Mrs Shirley Luke Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2006 Brief Description of the Service: Westbrook House is a four storey house situated in a residential street in Cromer. It provides accommodation for up to seven adults with a learning disability. The home has a communal lounge, dining room and kitchen on the ground floor. There are seven single bedrooms in the basement, first and second floors. The home has a patio with seating to the rear of the home and a very small seating area to the front of the home at basement level. The home is situated next to communal gardens and is very close to the seafront and to the town. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 5.5 hours on 16th May 2007. Opportunity was taken to tour the premises, talk to tenants, care staff, the manager, and to look at care records and policies. The inspection report reflects evidence from inspection of Key Standards and other National Minimum Standards. Two comment cards were received from relatives/visitors before the inspection visit and two comment cards from visiting professionals. These reflected positive views about the service and care for tenants, which have been reflected in the report. Four comment cards were received from tenants. These also reflected very positive views about the home, its manager and care staff. The range of weekly fees for the home is £356 to £1,355. What the service does well: • People who use the service are involved in decisions about their lives, and play a role in planning the care and support they receive within their capacities. People who use the service are protected from abuse through very good care guidance for staff and through good training for staff. People who use the service are able to make choices about their lifestyle, and supported to develop their life skills. Well trained staff provide good healthcare support to people who use the service. People who use the service, their relatives and visiting professionals speak very positively and are complimentary about the home and the care it provides. • • • • What has improved since the last inspection? Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 6 • There were no requirements made at the previous inspection. What they could do better: • Visual impairment training for new staff (and repeated for existing staff) will assist in ensuring good care is maintained for people with visual impairment. The ‘medication administration record’ could provide clearer guidance as to the circumstances when PRN (as required) medications may be administered. • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 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 DS0000027329.V340540.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people to use the service have their needs assessed, and access to all of the information they need about the service they may choose. EVIDENCE: The home has an assessment pro-forma and ‘application form’ used by the manager or other senior staff when collecting information. These documents are well designed to ascertain the level of support required by, and aspirations of, any prospective tenant. There has been a recent admission to the home, however, this tenant moved from another of the proprietor’s homes. Consequently an assessment of their needs had already been made. The manager in respect of Westbrook House had undertaken further assessment. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are involved in decisions about their lives, and play a role in planning the care and support they receive within their capacities. EVIDENCE: Several care files were looked at during the site visit. Each contained detailed care plans and risk assessments. There was evidence in care files of tenant participation in their care planning and reviews, and the tenant signs these wherever possible. The care plan for a tenant includes a daily diary and ‘anxiety index’ rated by the tenant themself as a means of planning care to manage this. Tenants communication needs are summarised clearly and in detail in care plans, providing a clear guide for staff to be aware of and to follow. Symbols, sign language and objects of reference are used with different tenants depending on their needs. Financial care plans are in place for every tenant. These set out personal allowance monies, indicate where monies are paid into, support provided by Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 10 staff in accompanying the tenant to the bank if necessary, where cheque books and/or monies are kept, where cheques are recorded, if the tenant holds a lot of money where else this may be kept safely. This is an example of good practice. Risks are recognised and assessed appropriately with clear guidance provided to staff about how to manage the risks. Risk assessments are set out in categories including – activities of living, inappropriate sexual behaviour, absconding and wandering, substance misuse, self injurious behaviour, interacting with others, aggressive or violent behaviours, fire, theft, and mental and physical health. These categories are ranked as serious, moderate or minor, then detailed risk assessments on each area completed. There was evidence of regular monthly review of risk and updates to risk assessments where there have been changes in need. The emphasis in both care plans and risk assessment at the home is on ensuring tenants undertake and participate in any activity as independently as possible, though with the required level of support. There are positive comments about care at the home from tenants, relatives and other visitors to the home. Tenants comments include ‘I like it here’ and ‘everything’s great’. Comments from relatives and professional visitors to the home include ‘family feel to the place’ and ‘Westbrook are probably as near as possible to being the best.’ Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle, and supported to develop their life skills. Social, recreational and educational activities meet the expectations of tenants (and their relatives). EVIDENCE: The home is situated close to the town centre and tenants are able to access local facilities with relative ease. The home has a car for longer journeys, though public transport (including local bus service and the train) is also used for longer journeys. Individual care plans set out tenants interests and a plan of the education and leisure opportunities that they take part in. At the time of the inspection visit two tenants left the home to attend a local adult education music group, while other tenants participated in planned activities at the home. During the afternoon other tenants attended external activities as part of their regular activities programme. There is a daily timetable of activities set out in symbol format, but with ‘Sign along’ signs also that tenants assist in preparing each day, and provides a Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 12 guide for tenants to follow. This is in the hallway of the home and accessible for tenants and staff. It assists tenants in understanding what they are doing each day. The weekly activities available include music, exercise groups, horticulture, computer courses, food and health courses in addition to activities available at the home, and from the home such as trips to the bank or to the library. Each of the four comment cards received from tenants indicated that they have lots of things to do. Tenants own accommodation reflect their own interests. Every room seen contained a television and music centre, and one tenant has their own drum kit in their room. Some tenants have arrangements for maintaining contact with their relatives. These arrangements vary for individuals. Some contact takes place at the home, or from the home. Other tenants are supported by the home in contact at the tenant’s relatives home. The manager indicated that staff have supported tenants care needs in these settings where needed. Comment cards from relatives confirm that the home helps them in maintaining contact with their relative who lives at the home, and that this includes supporting tenants in sending birthday and other cards to mark special occasions. Meals at the home chosen by tenants on a weekly basis at a meeting, and they participate in shopping and in food preparation where possible. Menus seen were very varied, and tenants asked about the quality of meals at the home were very complimentary. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Well trained staff provide good healthcare support to people who use the service. EVIDENCE: Staff spoken with during the inspection visit were knowledgeable and well informed about the health care needs of service users. Staff spoken to are also aware of specialist healthcare needs for tenants with a different ethnicity, and supported by appropriate health and personal care advice in their care plans. They have access to training in health care matters including first aid, medication and epilepsy. Care plans indicate service user individual support needs, and care staff are clear about the most appropriate ways to provide support, including personal and health care advice from a range of professionals. The home has a mixed gender tenant group and an exclusively female staff group. Consequently male tenants that require assistance with personal care received female assistance. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 14 A tenant who is blind is assisted to mobilise safely in certain environments and situations. Staff were seen to offer appropriate support in indoor and outside environments. On discussion with the manager it appeared that several new staff have not yet received specialist training in supporting someone with visual impairment, and that those staff who have received this training found it particularly useful. It is therefore recommended that this specialist training is provided for new staff and repeated for existing staff (see recommendation 1). There is no specialist equipment at the home aside from a tenant’s wheelchair. The home uses a monitored dosage system for medication. Medication seen is stored securely and appropriate records are kept for the receipt of medication into the home, its administration and any medication returned to the pharmacy. There are photographs of tenants with medication administration records to support correct administration. There are very clear instructions in care plans for staff in the administration of ‘PRN’ (when required) medications. It is recommended that clearer guidance as to the circumstances when PRN medications may be administered be entered on MAR charts (see recommendation 2). On review of medication no discrepancies were identified, and records were good. Staff receive training with regard to medication and are familiar with the home’s policy and procedure. There are no tenants who take responsibility for administering their own medication. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, have access to an appropriate complaints procedure, and are protected from abuse. EVIDENCE: The home has a complaints procedure in symbol format and accessible to tenants. The tenants are asked about any concerns that they might have during their monthly care plan reviews and at the weekly tenants meetings. One of the tenants also attends the Proprietor’s Quality Assurance Forum which is another opportunity to raise concerns. All four comment cards received from tenants indicate that they feel safe at the home. From information provided by the manager there have been no complaints received by the home in the past 12 months. The Commission had received a complaint that was passed to the Proprietor’s general manager who undertook an effective investigation into the issues raised. Each of the staff spoken with were clear about the action they would take if concerned about the possibility of abuse taking place and were confident that their manager would deal with this appropriately. Experienced staff are aware of the home’s ‘Whistle-blowing’ procedure and its function. Staff have received training in the protection of vulnerable adults. Evidence of this was seen in training schedules for staff. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at the home is safe, well maintained and designed to support the needs of people who use the service. EVIDENCE: The premises are suitable for the homes stated purpose, and in keeping with the local community. The interior accommodation is in a good state of repair and there is redecoration planned to hall and stairway areas, which is referred to within the manager’s annual development plan for the home. There are good quality furnishings and fittings throughout the home. The home has a computer for tenants use. One tenant confirmed that they use this to type up their monthly care summary. Tenants bedrooms are well furnished and decorated. Each of the bedrooms seen during the visit reflected the personality and interests of the individual tenant. One tenant stated that they had chosen the colour for their bedroom that had recently been redecorated. Another tenant had pictures and objects that reflect their ethnicity. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 17 Premises were safe, clean and hygienic throughout. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are trained, skilled and in sufficient numbers to support the people who use the service. EVIDENCE: There were seven tenants accommodated at the home at the time of the inspection visit, cared for by three staff. The care staff compliment is generally two or three care staff on duty each morning and the same each afternoon. There is a total care staff compliment of nine, excluding the manager. The manager indicated that further appointments to the staff group were planned. From information provided by the manager there are currently five carers with a qualification at least NVQ level 2 or equivalent, and a further carer signed up to undertake NVQ 2. From observation it was evident that tenants have confidence in their carers, and that carers carry out their role competently and enthusiastically. From discussion with staff and a review of personnel files, it was evident that tenants are protected by good recruitment practices. Care staff have clearly defined roles within their job descriptions. These contain equal opportunity and anti-discriminatory statements and copies of job descriptions were evident in staff files. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 19 Training records seen at the visit provide evidence that staff receive good induction and ongoing training from the proprietor’s own training department. This was confirmed in discussion with newly appointed and more experienced staff. Care staff spoken with confirmed that they think their training is relevant and equips them for their roles. Training schedules for the home shows that staff are continually booked to attend a range of courses over a rolling schedule. This includes mandatory training such as medication administration, first aid, fire safety and moving and handling, and specialist training including total communication and ‘signalong’. There is a programme of formal supervision for staff. Staff indicate that they have periodic formal supervision with the managers. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home promotes the care and the aspirations of people who use the service, has effective quality assurance systems developed by the proprietors. EVIDENCE: The registered manager has several years management experience, has managed the home since September 2005, and holds the ‘Registered Managers Award’. Comment cards from tenants and their relatives/visitors are positive about the way the home is managed. This is supported by comments made by staff at the inspection visit, who say that the manager is approachable, fair and hard working. The home has a quality assurance process in place which involves a variety of ways of gathering information about the quality of the service provided. For Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 21 example, monthly care plan reviews, weekly tenants meetings, quarterly ‘Quality Forum’ meetings for tenants run by the Directors, Annual Development Plan (that incorporate suggestions from staff about improvements) and annual questionnaires for relatives and health/social care professionals. Copies of relevant survey information are provided to the Commission. The home demonstrates good practices ensuring service users health, safety and welfare. Relevant health and safety training for staff, including moving and handling, first aid, food hygiene training, fire training and good fire records support practices. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 22 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 X 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 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 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 X 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 3 X 3 X X 3 X Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 23 No 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA18 YA20 Good Practice Recommendations It is recommended that visual impairment training be provided for new staff and repeated for existing staff. It is recommended that clearer guidance as to the circumstances when PRN medications may be administered be entered on MAR charts. Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westbrook House DS0000027329.V340540.R01.S.doc Version 5.2 Page 25 - 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. 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