Inspection on 04/08/08 for Westbrook House

This inspection was carried out on 4th August 2008.

CSCI found this care home to be providing an Adequate service.

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 24/09/07

Westbrook House 11/01/07

Westbrook House 16/05/06

Westbrook House 13/09/05

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Westbrook House 150 Canterbury Road Westbrook Margate Kent CT9 5DD Lead Inspector Lisbeth Scoones Unannounced Inspection 4th August 2008 09:50 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.V369375.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbrook House Address 150 Canterbury Road Westbrook Margate Kent CT9 5DD 01843 254100 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) sarah.khamsoda@kent.gov.uk www.kent.gov.uk/Social Care/carers-andfamily-support/adultKent County Council Mrs Sarah Elizabeth Khamsoda Care Home 60 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) - maximum number 25 Mental disorder, excluding learning disability or dementia (MD) maximum number 15. The maximum number of service users to be accommodated is 60. 2. Date of last inspection 24th September 2007 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 units and has day centre facilities. The units are used to provide separate areas of care according to the needs of the resident. These are intermediate care with nursing (2x 15), dementia (15) and mental health nursing (15). The home employs a team of registered nurses, health care assistants, team leaders and care workers. The ancillary & catering services are contracted. The home is situated close to local amenities and is on a main bus route. The grounds have two enclosed garden areas and a car park. Fees are free for 6 weeks intermediate care then a weekly fee of £379.02 for both dementia and intermediate care. Those residents residing at the Ogden unit have been assessed as requiring continuing care. The Welcome Pack clearly sets out which items and services are not included in the fees. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Key Lines of Regulatory Assessment (KLORA) have informed the judgements made based on records viewed, observations made and written and verbal responses received. KLORA are guidelines that enable The Commission for Social Care Inspection (CSCI) to make an informed decision about each outcome area. This unannounced inspection took place over two days on 4th and 5th of August 2008 and comprised discussions with the registered manager, nursing sister and staff on the intermediate units, assistant manager, senior team leader, team leader and staff in the dementia and mental health care units. Residents on all units and two visiting relatives were spoken with. A tour of the premises was carried out and documentation examined on all units. Documents related to care planning, medication administration, menus, staff rotas, complaints, staff files, audits and risk assessments. The inspection was further informed by an AQAA (annual quality assessment audit) completed by the registered manager prior to the visit. An improvement plan was received following the previous inspection. 7 Comment cards completed by residents and 7 completed by staff were received and information thus received is incorporated in the report. The CSCI has not received any complaints of the service and has been aware of 5 safeguarding vulnerable adults referrals. Two of these needed investigation and were satisfactorily concluded. What the service does well: Following the previous inspection, an improvement plan was submitted which identified the action taken to meet the requirements. Equality and Diversity are promoted as part of induction and through supervision and training. Residents are provided with a modern, well-furnished and spacious environment. The dementia and mental health units have direct access to well laid-out and furnished gardens. Staff are recruited in accordance with robust employment practices. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 6 Residents are provided with a choice of varied meals, which is of a good standard. Each unit has a beverage area so drinks and snacks are available throughout the day. Staff are provided with a structured training programme as evidenced on the training matrix. What has improved since the last inspection? What they could do better: It remains of concern that the home continues to rely heavily on agency staff as reported in the previous report. Whilst it was said that new staff will be recruited and that the same agency staff are used, residents and staff said that all would benefit from a permanent staff team. The registered manager reported that the use of agency staff slows down the delegation of key roles and responsibilities within the care home. The staffing situation on Appleton unit was discussed. The registered manager said that an additional member of staff for the morning shift is under discussion. It was observed that at lunchtime staff are particularly busy as many residents need assistance with their meals. It was noted that several relatives were present offering assistance to their relative. It was further observed that the majority of residents in the intermediate care units do not need assistance with their meals. The units were well staffed and the discussion had that staff might be better deployed during busy times to assist at other units. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 7 The staffing structure in Ogden unit was discussed in respect of roles, delegation and responsibilities. The management and delegation of how units are run and staffed was discussed particularly as it appears that the units are managed individually and not as one registered service. Different rotas were observed and different ways in which care plans are completed. Residents’ care plans are now computerised following staff training. Paper copies of the care plans are kept in residents’ rooms. It was difficult to follow care planning and reviews as some information, although on the system, was not updated in the (paper) care plans. A more integrated system would ensure that staff have all the information available to them to care for the residents. Some documents were not completed or signed. Some documents seen in residents’ room were no longer relevant to the care provided. In the intermediate care units, the physiotherapist and occupational therapist write an assessment and plan of care, which includes the ‘goals’ to be achieved. Staff must now ensure that these goals are transferred into the care plan. The home is in the process of devising individual activity sheets/programmes to ensure that these are of their choice and interests. The home needs to ensure that menus on display reflect the correct week and season and are user-friendly and in large print. All clinical rooms were visited and medication charts examined. The shared clinical room of Appleton and Ogden units was cluttered and ways of improving the use of space were discussed. Medication charts for both units identified several gaps for non-administration. A tin of topical creams was noted containing creams, which were no longer prescribed. The sluice of Ogden unit contained items of furniture blocking the access to the sluice machine and hand wash facilities. A sluice on the intermediate care unit contained miscellaneous items on the floor, which could prevent effective cleaning. The odour on entry of Ogden unit was discussed. The registered manager and unit staff are aware of this issue and are trying to find ways to solve the problem. Whilst the gardens are well laid out and furnished, they were in need of attention and the removal of rubbish. All staff should have regular safeguarding vulnerable adults training. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 9 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.V369375.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the information they need to make an informed choice of the facilities and services available. Before a resident is admitted to the home, their needs are assessed thus ensuring that these can be met. Residents assessed as requiring intermediate care are assisted and encouraged to maximise their independence and return home. EVIDENCE: Permanent and short-term residents are provided with the information they need about the service. The Statement of Purpose has been updated (July 2008) and the Service User Guide is to be updated. There is a Welcome Pack and Intermediate Care leaflet. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 11 The staff team in the intermediate care unit comprises care and nursing staff, and a team of therapists (occupational and physiotherapists), some of whom are employed by Social Services and others by the PCT. During the visit to the intermediate care unit, the inspectors spoke with residents, nursing, care and other staff. The physiotherapist said that the referral system works well and that a copy of the appropriate professionals assessment would be obtained. A screening tool informs the referral/admission. The physiotherapist and occupational therapist assess the residents on admission and devise a plan of care. ‘Goals’ are set with a view of discharge usually after six weeks. These goals are regularly reviewed and discussed at weekly multidisciplinary meetings. See also standard 7 in respect of care planning. For residents admitted to the dementia care unit, a senior member of staff would carry out a pre-admission assessment. The registered manager reported that the working relationship with staff at the QEQM hospital has improved resulting in a better understanding of the intermediate care services the centre provides. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s health, social and personal care needs are recorded in a regularly reviewed care plan but deficits were noted and intermediate ‘goals’ were not clearly identified in the care plan. Residents’ health care needs are met by the staff on duty and other health care professionals. Residents are not fully protected by the home’s administration of medication practices as deficits were noted in the medication administration records. Residents in the intermediate unit are supported and encouraged to manage their own medication. Residents are treated with dignity and respect. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 13 EVIDENCE: Since the previous inspection, care plans are maintained on computer. Overall the three units are using their own system of recording care plans. Staff on all units had difficulty in ascertaining information when questions asked. It was difficult to see evidence of continuity of recording of care due to two systems in use. When this was discussed with the registered manager she agreed that there had been difficulties in implementing the new computer system of record keeping. Staff are still receiving training and changes are necessary to the system that are beyond the control of the manager to make. She said that action was being taken to address issues raised such as there not being enough terminals. Care plans in the intermediate care unit contained mostly adequate information for staff to carry out the care. However see comment in standard 6 regarding the inclusion of ‘goals’. Paper copies kept in residents’ rooms were not always up to date. Care plans examined in the Appleton unit were well maintained and contained the information needed for staff to carry out the care. Residents’ relatives had signed the care plan. Care plans examined in the Ogden unit are maintained in hard copies in NHS folders information on the computer system. For one resident a record of fluctuating blood sugar levels was noted. With two systems in use it may be difficult to ascertain what action staff should take in the event of blood sugar levels being too high. A recommendation was made for additional input for diabetes management. Residents have access to the GP of their choice or a visiting medical officer (VMO) who visits three times a week. A direct computer link and access to surgery records ensures quick and effective communication. A psychogeriatrician holds a monthly clinic in the dementia units. Specialist nurses visit the home as appropriate and also provide training such as continence management, stroke management, peg feeding and catheter care. The sister in the intermediate care unit is a nurse prescriber. All clinical rooms were visited and medication charts examined. No deficits were noted in the medication charts of the Victoria units. A CD (controlled drugs) audit was carried out and proved satisfactory. Evidence was seen of weekly medications audits. The shared clinical room of Appleton and Ogden units was cluttered and ways of improving the use of space were discussed. Medication charts for both units identified several gaps for non-administration. The home could therefore not demonstrate whether these residents had Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 14 received their prescribed medication. A tin of topical reams was noted containing creams, which were no longer prescribed. During the inspection, the inspectors were informed of a recent medication error. This was being investigated and the CSCI was to be advised of the outcome and the action taken. See also standard 38 in relation to the reporting of incidents and accidents (Regulation 37). Records seen in the intermediate care unit evidenced that residents are encouraged to administer their own medication. It was observed throughout the inspection that staff interacted with the residents in a dignified and respectful manner. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents in the intermediate care unit are provided with some activities. In the dementia care unit, good facilities have been made available. Structured person-centred activities are provided in the mental health unit. Residents are encouraged to maintain close links with their relatives and friends. Residents are provided with a good choice of wholesome, appetising meals. EVIDENCE: Since the previous inspection, in the Appleton unit, the role of activities organiser has been assigned to a newly appointed team leader. She works three days a week as an activity coordinator. A large amount of activity equipment has been purchased such as Karaoke machine, extra large chess set and scrabble game. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 16 In the Appleton unit, staff assisted the residents with puzzles, drawing and looking at photographs of film stars and celebrities of the past. Activities sheets demonstrate residents’ participation. A Life history has been obtained for each resident. Such information provides the staff with knowledge of residents’ previous life experience and interests. The walls in both Appleton and Ogden units had reminiscence displays of photographs and pictures. A resident was playing the piano. Staff interacted well with the residents and the atmosphere was lively. Since the previous inspection, the unit benefits from OT input for the more active residents. The ‘transition team’ continues to provide musical sessions and has contributed to a garden project in the Ogden unit. The ‘Forget-me-not’ cafe has recently been opened during two afternoons a week. This is run by volunteers and professional support provided by the assistant manager of Ogden unit. A relative said how much this was enjoyed. A recent “Breath of Fresh Air” week was also a great success. A member of staff said, “I was really impressed by that event, lots of activities went on.” Photographs were shown of the various beach-themed events on offer for both residents and relatives. Further plans exist to introduce cookery classes. Activities programmes are being devised for the residents. Residents from Ogden and Appleton have access to a sensory room and safe gardens. A resident said that he had been involved in potting up plants and proudly showed the beans and tomatoes. However, on Ogden unit, on the day of the inspection, in the early afternoon, there was only one member of staff engaged with the residents. All other staff were involved in handovers. The manager reported that the home now has access to a minibus via the Partnership Trust with a view to widen the activity programme to include visits to shows, pantomimes and local museums. At the time of the inspection this had not as yet been used. The manager said that the activities programme in the intermediate care units remains variable due to the ongoing use of agency staff. See also standard 27. For everyone’s benefit, a shop has just been opened during two mornings a week run by volunteers. A team of volunteers offer regular support with fundraising and social activities. The next Summer Fete is being planned. It is evident that staff welcome visitors and relatives and involve them in residents’ care. A varied and nutritious menu is available as evidenced on menus seen and meals plated. However, staff must ensure that menus on display are correct Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 17 and user friendly. The majority of the residents and relatives spoken with praised the food. “It is excellent”. However, comments were also made that “the fish was sometimes dry and could do with a sauce. Fruit cocktail would be better served with a cream or custard.” A resident said, ” I really enjoy the salads.” Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents’ complaints are taken seriously, investigated and acted upon. Residents are protected from abuse. EVIDENCE: From conversations with residents and relatives it is evident that they know the route to take when there is an issue of concern. The issue of complaints was discussed with the registered manager and it is evident that complaints are taken seriously and acted upon in a timely manner. The CSCI has received no complaints since the previous inspection. The home’s complaint procedure is incorporated in the Welcome Pack. The home has safeguarding vulnerable adults procedures, which are followed appropriately. The registered manager said that a tool is being developed for monitoring protection issues. Since the previous inspection, the CSCI has been made aware of 5 safeguarding vulnerable adults referrals. These have now been satisfactorily concluded. The training matrix identifies that there are some gaps in adult protection training. The assistant manager in charge of the Ogden unit is an adult protection trainer. Due to high volumes of work, the training has been delayed for some staff. External safeguarding vulnerable adults training has been difficult to access. See also standards 27 and 30. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a modern, spacious, well-maintained, purpose built care home. Residents benefit from living in a clean and mostly hygienic environment. An odour issue must be addressed 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. It provides a spacious, clean and modern environment. Gardens are available for all residents. Residents in the Appleton and Ogden units have direct access to secure and well-equipped gardens. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 20 At previous inspections, it was reported that access to the building outside office hours continues to be problematic and relies on care staff leaving their work areas to allow visitors into the building. The registered manager reported that the front door intercom video link has been moved into the care areas. This would enable staff to access it quickly during out-of-hours periods. An agreed plan within these two areas would provide clarity of who is to respond. At the previous inspection it was reported that there was a need for additional rehabilitation equipment. At this inspection it was reported that additional equipment has been purchased. All bedrooms have en-suite facilities including assisted walk-in showers. Additional assisted bathrooms are available. For those residents admitted for rehabilitation there are additional facilities provided; assisted kitchens and bathrooms. Residents from the intermediate care unit are not able to access the gardens easily unless they are able to manage stairs or are assisted by staff to accompany them downstairs in the lift. The home provides a clean and apart from in the Ogden unit an odour free environment. However, the sluice of the Ogden unit contained items of furniture blocking the access to the sluice machine and hand wash facilities. A sluice on the intermediate care unit contained miscellaneous items on the floor, which could prevent effective cleaning. In two sluices brushes were noted. When queried what these are used for, no answer could be given. The odour on entry of Ogden unit was noted and commented on by staff, residents and relatives. The registered manager and unit staff are aware of this issue and are trying to find ways to solve the problem. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ needs are not always met by adequate numbers of staff on duty. The home continues to rely on agency staff. Residents are protected by the home’s recruitment policy and procedures. Permanent staff are provided with good training opportunities. EVIDENCE: The previous inspection reported that the home continued to rely on high numbers of agency staff. Whilst new staff have been recruited, the home still relies on agency staff to complement the permanent workforce. It was reported that both nursing and care staff have been recruited who are soon to join the staff. A member of staff said,” The use of so many agency staff leads to a lack of team spirit for regular staff. Management are aware of this and are supportive. “ The employment situation at Westbrook House is complex in that it employs KCC, PCT and NHS staff with different job descriptions, shift start times and pay scales. The registered manager reported that the use of agency staff Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 22 slows down the delegation of key roles and responsibilities within the care home. Several relatives said that agency staff don’t know the residents as well as regular staff. A relative in the Appleton unit said that staffing levels could be improved especially around meal times. Another relative said, “I consider the home to be understaffed. There are times when two girls are on duty specially at meal times and are seriously overworked.” The staffing situation on Appleton unit was discussed. A member of staff said in a comment card “either more staff should be provided per shift or a kitchen person to allow the care staff to meet residents’ needs”. Another, “Many of our residents need hoisting with at least two staff. Other residents need oneto- one attention.” Another, “ A extra member of staff for the morning shift would be helpful.” Another, “Rushing between nursing duties and catering duties when busy is quite challenging.” The registered manager said that the recruitment of an additional member of staff for the morning shift is under discussion. It was observed that at lunchtime staff are particularly busy as many residents need assistance with their meals. It was noted that several relatives were present offering assistance to their relative. It was further observed that the majority of residents in the Victoria units do not need assistance with their meals. The units were well staffed and the inspectors suggested that staff might be deployed during busy times to assist at other units. The staffing structure in Ogden unit was discussed in respect of roles, delegation and responsibilities. It was reported that the assistant manager in charge of the Ogden unit regularly works agency shifts in addition to her management and trainer role. This situation needs to be carefully looked into to ensure that these roles are not compromised. The management and delegation of how units are run and staffed was discussed particularly as it appears that the units are managed individually and not as one registered service. Different rotas were observed and different ways in which care plans are completed. See standard 31 in respect of management. A training matrix evidences training carried out and planned. All new staff undertake an induction programme according to “Core Induction Standards.” A member of staff said on a comment card, ” I had a very good induction.” A new member of staff said, “I have been really impressed by the training I have been offered. I have found my supervisor very supportive and feel I can be honest about any problem I have ands she will work with me to solve them.” Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 23 NVQ training is encouraged. 23 members of staff are NVQ trained and 7 members of staff are working towards NVQ training. In addition to all mandatory training, staff receive training in Equality and Diversity, dementia care, challenging behaviour, Mental Capacity Act, wound care, continence management and catheter care. Staff training needs are further discussed at supervision. The assistant manager in charge of the Ogden unit is a training facilitator for dementia care and adult protection and a moving and handling coordinator. See also standard 18. The manager reported that the induction on the intermediate care units has improved. It has no longer a PCT bias but is specific to working at Westbrook House and the intermediate care unit specifically. This is a good initiative. A sample of staff files was examined and this evidenced that sound recruitment procedures are followed. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The manager endeavours to run the home in the best interest of the residents. The delegation of roles and responsibilities within all the units needs to be reviewed to ensure clarity and consistency. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager has the skills and knowledge required for running the home. She has a Diploma in Management and more than 4 years experience in managing residential and day care services for older people. She is a first level nurse with 11 years nursing and 8 years experience in social services care management. She is supported by her line manager, 2 assistant managers and senior staff. In the AQAA she said “that ongoing recruitment to vacant posts has meant that we continue to rely on the use of agency staff, slowing down the delegation of key roles and responsibilities within the care home”. It is the registered manager’s intention “to improve the way we audit our services in order to provide a more cohesive picture of individual aspects of the service.” The registered manager said that quality assurance systems have improved and new monitoring tools introduced. In the dementia care and mental health care units monthly carers meetings are well attended. Multi-disciplinary meetings are held weekly in the intermediate care units. Monthly staff meetings are held and quarterly staff surveys introduced. Clinical governance meetings are held jointly with another care home to develop integrated procedures. Care plans and medication audits are carried out. Residents are asked for their views through quality surveys. Regulation 26 visits are carried out. From information provided before the inspection, it is ascertained that residents’ monies may be handled through a none-interest making bank account. None of the staff are appointees for the residents and records are kept. From information supplied by the registered manager, it is ascertained that all maintenance and certificates for the servicing of equipment and services are up to date. All staff are provided with statutory training including moving and handling, first aid and infection control. The registered manager informs the CSCI of all incidents as per Regulation 37. Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 26 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 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 x x 3 Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 (2) Requirement Timescale for action 15/08/08 2 OP27 18 (1) (a) That the registered provider make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home The registered person shall 31/08/08 having regard to the size of the care home, the statement of purpose and the number and the needs of service users: ensure that at all times suitably qualified, competent and experienced persons are working at the care home is such numbers as are appropriate for the health and welfare of the service users RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 28 Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westbrook House DS0000064161.V369375.R01.S.doc Version 5.2 Page 30 - 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!