Inspection on 30/07/07 for Westbury Court

This inspection was carried out on 30th July 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

Westbury Court 21/08/06

Westbury Court 21/11/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Westbury Court Westbury Court Gardens Westbury-on-severn Glos GL14 1PD Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 08:30 30th July 2007 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 Westbury Court DS0000064610.V341909.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. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbury Court Address Westbury Court Gardens Westbury-on-severn Glos GL14 1PD 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) 01452 760429 01452 760355 manager.westbury@osjctglos.co.uk The Orders of St John Care Trust Suzanne Heller Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2007 Brief Description of the Service: Westbury Court is a purpose built care home located in the village of Westbury on Severn, and is approximately 10 miles from the centre of Gloucester. It is registered to provide personal and nursing care for 42 older people, and also has two designated respite accommodation rooms. The home is managed by the Orders of St John Care Trust. A registered general nurse is on duty twenty-four hours a day. All health care services are accessible from community resources, and residents can register with one of the local General Practitioners. The home provides level access throughout, and residents are accommodated on two floors; a staircase and shaft lift provide access to the first floor. Accommodation is provided in single rooms, though a small number of rooms have an interconnecting door if wanted for couples. Each room has its own wash hand basin, and three rooms provide en-suite facilities. Bathrooms and toilet areas are numerous and easily accessible, and are spacious and fully equipped to meet the needs of less able residents. Communal areas include a smaller lounge on both floors and a large lounge/dining room and small conservatory on the ground floor. A pleasantly situated garden is at the rear of the home, and is easily accessible to the residents. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Westbury Court range between local authority and self-funding rates, which are from £337.15 to £682.00 per week. Hairdressing, chiropody, toiletries, magazines and newspapers and holistic therapies are charged as extra individual costs. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over one day in July 2007. A check was made against the small number of requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents were spoken to directly in order to gauge their views and experiences of the services and care provided at Westbury Court. Some of the staff were interviewed. Survey forms were also issued to a number of residents and visitors to complete and return to CSCI if they wished; a large response was received and some of their comments are featured in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 6 What the service does well: Westbury Court provides a comfortable and pleasant home for its residents. It is very clean, safe and well maintained. Residents have access to a good amount of information about the home when making their choice about it, and are admitted on the basis of an individual assessment, so that they can be assured the home can meet their particular needs. Residents’ care is planned and recorded, with just isolated areas of recording identified for improvement, with facilities and services designed to meet the needs of the residents; due regard is paid towards respect for individuals’ privacy and dignity. The home sources and involves other health services in the community appropriately, and residents and their relatives were overwhelmingly positive in their praise about the standard of care they received from staff at the home. They were also full of praise for the varied and stimulating social activity programme that is available. Residents are enabled to make choices about how they live their life here, and can receive their visitors at any time they wish. A good standard and variety of food is served in this home, and again residents spoke very favourably about this. Residents and their families can be assured that the home has a robust approach to addressing any complaints or concerns, and that the standard of care, services and facilities is regularly reviewed as part of good quality monitoring systems. Residents and visitors indicated their confidence in the manager and staff, feeling reassured by their approachable demeanour, and their responsiveness to any issues or concerns that were raised. The manager has adopted a strong focus on monitoring standards at the home, and is driving improvements here for the benefit of the residents and staff. The protection and rights of residents here are promoted, although updated training in this area for staff has been allowed to lapse over the past year. Residents confirmed that they felt safe in this home, and that they had faith and confidence in the staff. They spoke very positively about the manager and staff group, with just one isolated exception who raised some small concerns. New employees are recruited following strict pre-employment checks and good recruitment practices. New staff receive a good level of support through induction training and supervision from existing team members. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Despite the largely praiseworthy comments about the care and staff at Westbury Court, there were isolated comments about staff needing to take more time over certain aspects of care, and to respond to some call bells more quickly. Some comments were also made about laundry items going missing on occasions. The systems for managing medications is generally safe, however certain areas require a degree of improvement, and these relate primarily to recording. Despite previously very good systems for ensuring the ongoing training and development for staff, this has been allowed to lapse more recently. Important training in areas such as adult protection, fire safety and first aid has not been renewed for the staff, although this is now being addressed by the manager. The home does not have the recommended 50 of its care staff qualified to at least NVQ level 2, but is making progress towards achieving this. Please contact the provider for advice of actions taken in response to this Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 8 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. Westbury Court DS0000064610.V341909.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 Westbury Court DS0000064610.V341909.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have access to a good amount of information about it, and are assessed prior to their admission so that they can be assured that the home will be able to meet their needs. EVIDENCE: The home has recently introduced a new and revised Statement of Purpose and Service User Guide, known as the Residents’ Handbook. The former is readily available in the entrance hall for anyone wanting to read it, and a copy of the latter, which contains all the information that is required, is issued to each prospective resident. The content of the Statement of Purpose in relation to the age range of residents that could be accommodated was discussed with the manager, and Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 11 this particular aspect will now need a review and amendment, as the home is accommodating someone under the age of 65 years. Care records belonging to three more recently admitted residents that were inspected as part of the case tracking exercise, contained assessment forms that identified their care needs prior to admission to the home. Although assessments had clearly been conducted, parts of these preadmission assessment forms were incomplete, with only basic recording in some places. Assessments had evidently been carried out at locations convenient to the prospective resident, and were supported by information provided by other health and social care professionals previously involved in the care of the individual. Prospective residents receive written confirmation of their placement in the home, as is required. Some residents and their relatives commented that they had had good information about the home before their admission, and had been able to look around and had had time for questions and answers with staff. Westbury Court does not provide intermediate care. Westbury Court DS0000064610.V341909.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 good. This judgement has been made using available evidence including a visit to this service. Despite some isolated recording omissions in care and medication records, people living in this home have their health and personal care needs met through good care delivery, which is mindful of their privacy and dignity, and through a generally safe system for administering their medications. EVIDENCE: All residents have their own personal plan of care, which is kept under regular review. Four were selected for a case tracking exercise, and were scrutinised in closer detail. Each of these care plans was directly linked to a variety of assessments. These included general health, personal and social needs, and also a range of risk assessments, incorporating pressure sore vulnerability, manual handling, and falls and nutrition where applicable. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 13 Care plans were informative in the main, with clear instruction regarding the care needed to meet the needs of the individual. Residents were regularly weighed, with those at risk having special attention to their diet. Support equipment was in place for those assessed as being at risk of developing pressure sores. Plentiful continence aids were provided to those where this was necessary. There was recorded evidence of regular monitoring of residents’ health, with good multidisciplinary working with all available health care services. The home has done well to improve the standard of care documentation, with planning more clear and informative. However there were very isolated gaps in recording that would have made certain aspects of the recorded care being delivered more complete. In one case the resident had bed rails in place. These had evidently been introduced as a very appropriate safeguard, with the resident and his family involved in the decision; however their use did not feature in any recorded risk assessment or care plan. In one case the risk assessment and care plans drafted since admission showed there had been no history of falls. Comparing this with the preadmission assessment the resident had quite clearly had a fall just before coming into the home. Other recording showed she suffered dizzy spells, and in consideration of each of these points would definitely have been at risk of falling. It must be reported however, that the person had not fallen since admission. In another case the general practitioner had referred the resident to the Community Psychiatric team. There was no further mention of this in the records, with no evident outcome or even mention of this in associated care plans. The home was calm, with residents quite peaceful and receiving regular attention from staff, in an apparently timely way. Despite one resident having had experience of the call bell not being answered very promptly, call bells were generally answered very quickly during this visit. Residents themselves were overwhelmingly positive regarding the way in which they were looked after at Westbury Court. Comments heard for example were: ‘We are very well cared for’, ‘Staff are very supportive and have a first class attitude’. Visitors to the home were also overwhelmingly positive in their praise of the home. Comments received included: ‘We are very happy with the care here’, ‘My relative’s health and well being bear out the good care here’. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 14 Another said that the home fully met her relative’s needs, with a couple saying that they ‘enjoyed peace of mind here’. Among the predominately positive praise for the home, there were isolated comments that were less positive. One resident felt that staff could take more time with her when putting her to bed. Another said that they are sometimes kept waiting when they ask for help to use the toilet. Residents are able to manage their own medications if they wish and are able, and this is done on the basis of a documented risk assessment process; at least one person was doing this at this time. Storage for medications was secure, clean and well organised. Controlled Drug (CD) storage was provided and a meticulously recorded bound register was maintained. The receipt of medications was recorded on designated forms, and a separate register of returned items was kept. The home has enhanced its checking in process for newly received medications in response to an error committed in the supplying pharmacy some months ago. This is very time consuming for the staff involved, and the home should be commended for its robust approach under such circumstances. The nurses handwrite medication administration charts, with two signing the entries; this system is again very time consuming for them, and although legible, some entries were more so than others. Charts had been meticulously signed, though in some areas the amount of a variable dosage had not been identified when given. Start dates of some medications had not been recorded. In one case, the medication administration chart did not provide clear instruction for the use of an external preparation, however there was a very clearly written plan of care associated with its usage. Two recorded medications were seen that had been ‘struck through’, having been discontinued. The chart did not include when and who had stopped them. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date, and also provided a good means of conducting audits. A random audit was carried out on five separate boxed medications; one definite discrepancy was found. In one box there were five tablets in excess of what there should have been in comparison to numbers received and dosages administered. This could not be explained at the time, and the deputy manager agreed to investigate this with all staff involved in drug administration for the relevant period. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 15 Staff were observed interacting with residents, and without fail were most respectful and sensitive in their approach. Most were very discreet when helping residents. Some residents and relatives commented that the staff would do anything for them, and that they were exceptionally pleasant to them. Two relatives said that the care and attention given to their relative was attentive and respectful. One person said that staff always maintained their father’s ‘dignity and character’. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to this service. People living in this home have good opportunities to remain as socially active as they are able and choose, and also have a nutritious diet that offers choice and variety. EVIDENCE: The home employs a designated social activities organiser, who is clearly very committed and enthusiastic about her role. An assessment has been undertaken of each person, with staff then aiming to address each person’s respective wishes and needs. Records of social activity are maintained, and a regularly updated social activity programme is on display. A monthly newsletter is produced in the home to help keep residents informed in this area. An innovative plan of activities has been arranged, including trips out and the provision of entertainers; the home should be commended for its committed fund raising efforts, and to now find themselves in a position to purchase a mini-bus to take the residents out more frequently. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 17 Residents are supported to join in anything they wish, including those with varying abilities and limitations, and are also supported to pursue personal hobbies and interests. Photographs and an evolving scrapbook contain a lovely record of social events and activities that have been enjoyed by the residents and their families. Residents and visitors to the home spoke positively about the range of activities and interesting things available for them, with one saying that the ‘manager should be commended for employing such a good activities coordinator’. One person said that ‘the coordinator was full of fun ideas, and really was a ray of sunshine’. One relative commented prior to this visit that he would like to see his relative being supported to do more physical activity in the way of exercises. During the morning the inspector can confirm that this particular resident was joining in with a group of others in a gentle exercise class, provided by a sensitive instructor. Religious services are held on a monthly basis. Residents’ religion is generally recorded in their notes, although there were very isolated gaps with this, and staff confirmed that diverse denominations could be catered for. A mobile library visits the home on a regular basis, and special occasions are observed and/or celebrated. Contacts within the local community are being promoted, and the home has developed positive social links with the local school. Visitors are free to visit at any time of theirs or their relative’s choosing, and some confirmed that the home has a very welcoming and friendly atmosphere for visitors. Nearly all visitors and residents spoken to or surveyed said that the home keeps them very well informed, and that staff were communicative. Just one visitor commented that they ‘had to ask if they wanted to know anything’. Residents were seen moving around the home as they wished, within the bounds of their abilities, whilst there were some who clearly were much more reliant on staff to meet their needs. In every case staff were observed to be very respectful and mindful towards individual’s expressed choices and preferences. Some relatives commented that in their view the home was always most respectful to people’s diversity, and supported residents to spend their time as they chose. Bedrooms had a degree of individuality, with residents having personalised their room with their own belongings and treasured possessions. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 18 Advocacy information, plus other useful information about advisory and support services was readily available. Residents are consulted about their particular choices from each day’s menu as well, and the service of breakfast and lunch was seen. Meals were varied according to choice, with each looking wholesome, nutritious and appetising; those requiring a special diet were catered for. Throughout the meals staff were readily in attendance, and were offering additional choices and discreet assistance to residents where appropriate. The atmosphere was calm, and residents could enjoy their meal without being rushed. The service of breakfast in particular has improved, with residents having their meal in a much more timely and conducive manner than some were previously experiencing. One visitor commented, as did some residents, that there is always a varied menu on offer. Residents themselves all indicated their satisfaction with the standard of the meals. The kitchen was seen during the lunchtime preparations. Although clearly busy, it was well organised. The kitchen area was clean, with appropriate catering records maintained. The cook was well informed about each individual’s dietary requirements, and demonstrated a commitment to providing residents with what they wanted. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 19 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. People living in this home are able to express their concerns and are reassured by the home’s complaints procedure, and despite some training gaps for staff, also feel safe and protected against abuse and have their rights protected. EVIDENCE: Westbury Court has a clearly written and displayed Complaints Procedure, a copy of which is provided to each prospective resident and/or relatives along with other information about the home. Residents and visitors confirmed they knew how to make a complaint if they needed to, and without exception all indicated that staff responded positively to any concerns raised. They said that the staff were approachable and helpful, and were ready to listen and act on what is said; just one resident said that staff did not always act upon what they said. The home has received two complaints over recent months, and the records for each were available for inspection. Records demonstrate that the complaints were taken seriously and that each was addressed robustly. There were also records of regular monitoring and auditing of any concerns, complaints and compliments that had been received. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 20 The home provides fully documented policies to address all forms of abuse, which are readily available for staff to read. A copy of the home’s Whistle Blowing procedure and an ‘easy read’ version of the Mental Capacity Act is issued to all staff. Basic underpinning knowledge in abuse related issues is covered in the induction-training programme for new staff. Although there is a specific adult protection training course available for staff to update their knowledge in this area, none have attended it in the past year. The home manager fully recognised that this was an issue that had been allowed to lapse, and that it required her prompt attention, and that really staff should have received this mandatory training by this time. The manager resolved to source updated training for the staff group as soon as possible. Despite this shortfall, the protection of vulnerable adults has a high profile in the home, with staff aware of the importance of upholding the rights of those in their care, and the manager ensuring the subject remained at the top of people’s agenda when dealing with residents. Staff were obviously very respectful to residents, and some residents themselves said that they ‘felt safe and happy here’. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. Although some of the bedrooms are small, people living in this home are provided with comfortable and pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: Westbury Court provides suitable accommodation for the residents living there, although some of the bedrooms are quite small, with the majority not having an en-suite bathroom. All areas are accessible, and allow for freedom of movement. There have been significant improvements made since the last inspection, with the dining room being completely refurbished to a good standard, and some bedrooms redecorated and recarpeted; this work is set to continue on an ongoing basis as bedrooms become vacant. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 22 The dining room, which combines with a lounge area, now appears more bright and spacious. Residents were consulted on their ideas for this room. One of the first floor bathrooms has also been refurbished with an improved assisted bathing facility. The manager’s office and reception have also been separated and refurbished to allow for improved working conditions in those areas. Storage areas are limited for equipment, and on this occasion a large number of wheelchairs were being stored in one of the ground floor bathrooms; the manager said that this room was rarely used, and this was not impacting on residents. A new ‘sit on’ weighing scales, some new commodes and variable height profiling beds have been purchased and are in use. The manager has plans to upgrade the conservatory with a garden room, and to improve the gardens, fences and outside walkways for the residents’ use. The garden is currently well maintained, and is laid out in such a way as to provide residents with a very pleasant outdoor area. The home is well maintained, and has a designated maintenance person. The environment is also kept very clean. There were no odours detected, apart from one very transient, but contained odour in one of the bedrooms. There are currently no residents who smoke at Westbury Court, and with the newly implemented Smoking Regulations in mind, the home is offering nowhere for residents to smoke if they wished to. This will have to be considered by the home, with any necessary adjustments made, including written reference to circumstances within the Service User Guide. Liquid hand soaps and paper towels have been provided throughout each individual room for staff use, as part of the infection control procedures. The sluice rooms were clean and orderly, with clinical waste appropriately managed. The laundry room was immaculate and clean, with laundry being properly segregated and laundered in accordance with infection control protocols. Residents and visitors to the home spoke very positively about such standards in the home, commenting particularly on the cleanliness of it. Just two people made comments to the contrary, with one saying that laundered items of clothing sometimes go missing, and another saying their curtains hadn’t been washed in a long while. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 23 The manager acknowledged that missing laundry was sometimes a problem, but that she was currently looking into this. She was also able to confirm that the curtains in question had been laundered since those particular comments had been received. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 24 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. Although staff training has been recently lacking, people living in this home receive care from a developing, but generally competent workforce, and can be reassured by the rigorous pre-employment checks carried out on new staff. EVIDENCE: The vast majority of residents and visitors felt that there was normally an adequate number of staff on duty to provide care for them, who were appropriately skilled and experienced. There were just two comments about staff not always being readily available and that they could do with more. Comments heard from residents and relatives indicated overwhelmingly that the staff were very attentive, courteous, kind and efficient. One person said that there was ‘a good calibre of staff here’. Throughout this visit staff were attentive and available to the residents, and there were very positive interactions between them taking place. Rotas show that there is one registered nurse on duty at all times, with seven care staff in the morning, and five care staff in the afternoon and evening, and two overnight. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 25 A solid ancillary team of cleaning, catering, maintenance, administration and laundry staff very ably supports the care and nursing team. A Deputy Manager has been confirmed in post now, and this is a very positive development for the home and staff team. There has been some agency staff usage, but a degree of continuity has been achieved with personnel used for the benefit of the residents; it is anticipated that this agency usage will reduce significantly when a new nurse can be employed onto the team in the near future. There have been many changes among the care team, with a lot of leavers and a lot of new starters. Although this has proven disruptive in some ways for residents and remaining staff, positive things have emerged from it. Working practices have been developed and changed to be more in line with the needs of the residents, and an ethos of team support and more collaborative working is now being developed. The home was making progress with the National Vocational Qualification (NVQ) training programme for care staff. There were eight care staff qualified to at least level 2 at this time, with a further ten identified to start the course to achieve their award. Three care staff were being put forward for NVQ level 3 training. Personnel files relating to three members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. Two written references had been provided in each case, including one from the last employer. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. The General Social Care Council Code of Conduct for care workers had been issued to each member of the care staff. Although the home normally has access to a good training programme for the ongoing professional development of its staff, this is an area that appears to have suffered adversely without the continuity of a designated training coordinator. Training records for staff are not up to date, and attendance on courses has been very sporadic recently. Manual handling training updates were being scheduled for all staff at the time of this visit. Fire safety training has not been updated recently, although the manager fully accepted this was the case, and had a strategy to address it. She acknowledged that staff training was an area that required some focus now; this will be even more important with a new team emerging. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 26 New staff had received induction training, and induction records were seen for some. Some new staff spoke very positively about the training and support they had received since joining the home, and confirmed that they had worked under direct supervision. Induction training is usually delivered on a set day at a training centre before work commences, and also using a programme designed for use when actually working in the home; one person said that despite being at the home for some weeks now she had not attended the one day course at a training centre. Induction training can also be delivered via an electronic induction-learning package that provides training in six modules, each of which incorporates the Common Induction Standards for care staff, however unfortunately this has not been in use recently, apparently due to ongoing problems with access. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 27 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. Although more of a management focus is needed in relation to staff training, the people living in this home benefit from open and respectful management, in which the manager effectively monitors quality and standards. EVIDENCE: The home manager is a first level registered nurse, and is registered with CSCI for her role. She is currently studying for her Registered Manager’s Award with an ‘out of county’ college. The manager has adopted an ‘open-door’ style of management, and has worked tirelessly to drive improvements at Westbury Court, establish a better team working ethos, and to improve services for the residents. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 28 At least two residents and their families said that ‘there had been 100 improvement under the new manager’, and that ‘she had been proactive in making improvements’. Others commented on how approachable she and her staff were, always ready to discuss anything. Residents and their families have had regular opportunities to have a say in how their home is run. Survey forms have been issued, the results of which have been collated ready for reporting and to take any actions necessary. Written minutes of a recent residents’ meeting were read, and these demonstrated that their contributions and input is sought and welcomed; their relatives are welcome to join in with these meetings. Feedback and suggestions forms are available in the entrance hall for people to use if they wish. Records of six monthly reviews for residents were seen, and these provided an ideal opportunity for residents to give their views about the services and care they were receiving. Westbury Court conducts a range of its own internal quality audits in areas such as health and safety, medications, the environment, and annually in all areas of performance. External auditors have also assessed the home, and it is to the home’s credit that it has been awarded the ISO 9001 Quality Award. Many residents have placed personal money and valuables in the home’s main safe for safekeeping. Clear and transparent records for each person were kept, and these included transaction details, running totals, and receipts. A random check on one account was entirely accurate. Residents or their representative have access to their records, and can sign to acknowledge transactions, but this had not been possible in nearly all cases at this time, and two staff members had signed the record to witness on behalf of the resident. A number of systems are in place to promote the health and safety of the home for residents and staff. Maintenance records showed that regular checks are carried out on the fire safety systems, and two fire drills had occurred this year due to the alarm sounding. Apart from this, fire safety training had only been given to new starters, with nothing recently for existing staff; this is being addressed and is reported under standard 30. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 29 A full fire safety risk assessment throughout the whole building has been undertaken by an external assessor, with due regard to revised fire safety regulations; there remain certain issues the home has yet to address on that basis. There is first aid equipment in the home, and although there are qualified nurses on duty at all times, there has been no recent first aid training here. Hot water temperatures are regularly checked for safe levels, and regular Legionella checks on the water supply have also been carried out, with the appropriate control measures in place. All the necessary safety checks and maintenance of utilities and equipment are undertaken in a timely fashion, and meticulous records are kept in these areas. The building was secure, with coded door entries in a number of locations. Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 30 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 N/A 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 4 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 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 13(4b.c) Requirement Vulnerable residents must be assessed for the risk of them falling, and for the use of bed rails, with associated care plans recorded on the basis of the findings. This will ensure that the health and safety of all people living in the home is promoted as much as possible. Medications charts must clearly identify: • The date when a medication is commenced • The amount of variable dosages administered. This will help to ensure that all people living in the home receive their medications correctly. The scheduled dates for updated Adult Protection training for staff must be submitted to CSCI. The scheduled dates for updated Fire Safety and First Aid training for staff must be submitted to CSCI. Timescale for action 30/09/07 2 OP9 13(2) 30/09/07 3 4 OP18 OP30 OP38 13(6) 18(1c.i) 23(4d) 30/09/07 30/09/07 Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 32 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 Westbury Court DS0000064610.V341909.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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