Inspection on 23/05/07 for Westbury House Nursing Home

This inspection was carried out on 23rd 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

Westbury House Nursing Home 10/01/07

Westbury House Nursing Home 08/11/05

Westbury House Nursing Home 12/07/05

Westbury House Nursing Home 04/01/05

Westbury House Nursing Home 13/07/04

Similar services:

Flint House

The Cotswold Home

Fairways

Treloar College

Rush Court

The Maypole Nursing Centre

Fir Tree Lodge

Chilmington House

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Westbury House Nursing Home West Meon Nr Petersfield Hampshire GU32 1HY Lead Inspector Tim Inkson Unannounced Inspection 23rd May 2007 09:30 X10029.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 House Nursing Home DS0000011525.V335967.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 and 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. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbury House Nursing Home Address West Meon Nr Petersfield Hampshire GU32 1HY (01730) 829511 01730 829108 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) Mr Irvine Navid Naqvi Mrs Linda Murray Care Home 70 Category(ies) of Physical disability (70), Physical disability over registration, with number 65 years of age (70) of places Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Other than one service user admitted on the 27/11/06, no service user is to be admitted over the age of 70 10th January 2007 Date of last inspection Brief Description of the Service: Westbury House is a care home situated on the edge of the rural village of West Meon. The home is registered to provide accommodation and nursing care for up to seventy service users, though at the present only up to fifty service users are accommodated at any one time. The home caters for persons that have an acquired brain injury or an illness affecting the nervous system. The home has an occupational therapy facility and a facility for service users to purchase private physiotherapy. The registered manager has recently left the home. People wishing to move into the home are given written information about the services that it provides and they and/or their representatives are invited to visit to look around for themselves. A copy of a report of the last inspection of the home by the Commission for Social Care Inspection (“the Commission”) is readily available in the reception office. At the time of a site visit to the establishment on 24th May 2007, the weekly fee ranged from £482 to £770 a week, this did not include hairdressing, toiletries, and some of the cost of trips out Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 24th May 2007, starting at 08:55 and finishing at 18:30 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 47 people and of these 26 were male and 21 were female and their ages ranged from 31 to 92 years. There was 1 individual living in the home from a minority ethnic group. The home’s proposed manager and head of care/matron were both present throughout the visit and were available to provide assistance and information when required. People living in the home were canvassed using questionnaires before the site visit took place and their responses were taken into consideration when producing this report. Other matters that influenced this report included: An Annual Quality Assurance Assessment document that had been completed and returned to “the Commission” before the site visit took place. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 15th January 2007, such as statutory notices received about incidents/accidents that had occurred. What the service does well: Records were in place that gave nursing and care staff information that enabled them to provide the help that people living in the home needed. Individuals felt safe and secure and happy that staff could look after them properly and treated them with respect. The home’s routines were flexible and people living there were encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. People living in the home were positive about the food that the home provided, were pleased with the range of activities in which they could participate and the condition of the accommodation that they occupied. Staff, people living in the home and relatives had confidence in the effectiveness of the home’s management team. Management systems and procedures in the home worked well including, the administration of medication, dealing with complaints, quality monitoring, and health and safety. There was a commitment to staff training development and support to ensure that they were able to fulfil their roles and responsibilities and meet the diverse needs of people living in the home. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3 and 6 (Older People) and NMS 2 (Adults 18 - 65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There home had procedures in place to identify the assistance and support that people needed before they moved in to ensure that their needs could be met. EVIDENCE: As at the last key inspection of this establishment on 10th January 2007, there was also clear evidence on this occasion that the help and care that people living in the home needed was identified before they moved in. A sample of the records of 6 residents was examined including those concerned with the actions that the home took to identify the support that people needed. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 9 There was evidence from these documents and discussion with people living in the home that the admissions of the individuals concerned that they had been involved in the process, that their admissions had all been planned. Where the admission of a person to the home had been made through care management arrangement i.e. with the support of the adults services department of a local authority. The home had obtained copies of the assessments of the needs of the individual concerned completed by officers of the authority. Comments from people living in the home about the process referred to above included: • “The matron came to the hospital to see me on a Thursday and the next Monday I was here. She asked about what help I needed with things and asked me what I wanted and explained as best she could about the place”. The home’s pre-admission assessment was complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. There was documentary evidence that assessments of residents needs were generally reviewed regularly and were revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 (Older People) and NMS 6, 9, 16, 18, 19 and 20 (Adults 18 - 65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure; the personal and healthcare needs of people living in the home were met and medication was managed safely and effectively. The rights of people living in the home could be adversely affected if decisions to impose any limitations have not been properly agreed with all interested and relevant parties. Staff working practice helped to ensure that residents’ privacy and dignity was promoted. EVIDENCE: Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 11 At the last key inspection of the home on 10th January 2007 the home’s care planning process was described as comprehensive and covering a full range of individuals’ needs. Care plans seen during that visit were also described as well written and clear about what staff needed to do in order to those needs. On this occasion the care plans were examined of the same sample of 6 people as in the section above. Another plan was also examined of an individual who was receiving treatment for a pressure sore and this indicated that progress with the healing process was carefully monitored. There were plans in place for all individuals’ concerned setting out some detail of the actions that staff had to take to meet the needs of those persons. The plans were based on the assessments referred to in the previous section and also included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; going out; and smoking. Where a pressure sore assessment indicated that an individual was at risk it was noted that the use a pressure relieving aid was identified as a means of reducing or eliminating the risk of harm. There was evidence from documentation and discussion with residents and relatives that wherever possible individuals and/or their representatives had been involved in developing the plans and agreed with the contents. Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. pressure relieving aid; Zimmer frame; or hoist. The care plans examined indicated that most of them had been evaluated at least monthly. Some had not been reviewed for 3 months and the home’s matron was made aware of the omissions and she said that she would take action to remedy the oversights identified. Daily notes/records were also kept that referred to the actions taken by staff to meet the needs set out in care plans and these were supplemented by a hygiene chart completed in respect of each individual everyday recoding the help that a person had received with washing, bathing, etc. There was some discussion with the home’s matron about the care plan documentation and about how they could possibly be improved. One omission noted in the plans examined included evidence that other relevant and interested parties had been involved where decisions had been made to limit and individuals rights e.g. access to cigarettes and lighter. This should be done to ensure that the rights of the individuals concerned are properly protected. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home, visiting relatives and a visiting social care professional about the abilities of staff the care and support that they provided included: Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 12 • • • • • • “They help me bath and I feel quite all right when they do that. They seem to know hat they are doing” “In general the staff are top notch, they bend over backwards to help you, and they are really lovely”. “I feel safe here”. “My main impression is that the staff are very kind and try to make life pleasant for the residents. They are very thoughtful and nothing seems too much trouble for them ... They are good about contacting us if he is unwell. We have been asked if we have any comments about his care ... we have been very pleased, I don’t think that he could have moved anywhere better”. “The staff know the needs of the clients well and understand what they require”. “It is brilliant. They help with anything that they can. Anything that he wants they do for him”. The views of people living the home that were canvassed before the site visit took place indicated that 88 believed that the home always or usually met their needs and 12 sometimes. The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. The home’s matron referred to specialist advice, support and training being obtained through range of individuals and organisations including, the Multiple Sclerosis Society, Huntingdon’s Disease Association, Dietician, and mental health services. The home had written policies and procedures concerned with the management and administration of medication. A range of reference material about medication was readily available including a relatively recent copy of the British National Formulary (BNF). Medication was kept in locked and secured medicine trolleys, cupboards and where required in a medical refrigerator. Controlled drugs were stored securely and appropriately. A sample audit of controlled drugs indicated that the records were accurate and up to date. All medication was dispensed from its original container and the only staff in the home that gave out and were responsible for the management of medication on a day-to-day basis were registered nurses. Good practice noted during the fieldwork visit included: • Recording the temperature of the refrigerator used for storing some medication Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 13 Sample copies of the signatures of the Registered General Nurses that dispensed medication • Some sedative medication was treated as if it was a controlled drug • The dating of all medicine containers when they were opened. The home strongly promoted the independence of people living there and its medication policy indicated that individuals assessed as being able and who wished to would be encouraged to keep, and take their own medication. At the time of the fieldwork visit however no one was managing all of his or her own medication. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. All the people living in the home were accommodated in single bedrooms a factor that helped to promote individual’s privacy and dignity. Bedrooms were viewed during a tour of the premises and it was very evident that the people occupying them could personalise them with their own belongings. People spoken to said that staff usually knocked before they entered their rooms and they all said that staff were respectful and polite. Comments from people living in the about this aspect of their life included: • “They are polite and deal with intimate matters respectfully”. • “Staff respect my bedroom as my personal space”. • Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 (Older People) and NMS 12, 13, 15 and 17 (Adults 18 - 65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefited from having control over their own lifestyles having opportunities to enjoy a range of social and educational activities and maintain contact with friends and relatives. They were also provided with a well-balanced and varied diet. EVIDENCE: At the last inspection of this establishment on 10th January 2007 this group of standards were rated as good. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 15 In a large room in the basement area of the home there was a Recreational Therapy Department, that was open Monday to Friday from 09:00 am – 04:00 pm. It provided a range of activities and crafts both indoors and outdoors and people living in the home were able meet and socialise with other users engaging in painting, craft making and personal learning. The home had also developed a link with a loacl adult education college and weeky sessions took place in another room in the basement area and a number of individuals spoken to said that they enjoyed attending them. Regular religious services took place in the home which also arranged outings and social events and relatives spoken to about the latter said that they attended them. The home also provided a minibus service enabling people living there to use the amenities in nearby towns and outings to take place. There was information on display in the home about local places of interst including details of the latest production at a local theatre. Activities the home arranged for people living there included picnics, theatre trips and sailing. The views of people living in the home canvassed before the site visit took place indicated that the vast majority believed; that they could make decisions about what to do each day; that they could do what they wanted; and that there were activities arranged that they could take part in. Comments from people living in the home and relatives spoken to about these matters included the following: • • • • “We have an OT (occupational therapist) …. We have parties and trips out”. “With Highbury College we do quizzes, listen to music, and do things on the computer”. “I live on the top floor and there is a kitchen there and there is always bread and things and you can make a snack for yourself at any time”. “I have a computer in my room and use e-mail. There are no rules we go to bed and get up when we want. I get up at 7:30 a.m. and go to be about 10:00 p.m. The night staff help me ….I like to go shopping in Fareham and Petersfield … I like doing jigsaw puzzles. We have entertainers come in”. “There are no rules here that spring to mind, it seems to depend on the level of help that you need. The only rule will be no smoking from 1st July. The activities here don’t appeal to me. I keep meaning to go to the Highbury College thing but keep forgetting. They go out to Birdworld and places like that which is of no interest to me but they are going to the dog track next month and I may well go to that. Some of the other residents have gone out to football matches. They go out to pub lunches. They have said that if there is anything that I would like to do they will see if they can sort it out so it is down to me”. • Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 16 People living in the home and relatives spoken to confirmed that there were no restrictions concerned with visiting the home and relatives also said that they were always made welcome. There was information in the entrance of the home with details about a local n independent advocacy service that could provide impartial advice, information and guidance to people living in the home and/or their families. Some individuals managed their own financial affairs and others were supported by the home to do so. Sensitive information that the home held about people living there was kept secure and the home had written policies and procedures about maintaining confidentiality and residents rights to access their personal files and case notes. All people spoken to about the food that the home provided i.e. individuals living there and relatives were highly complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. There were facilities for making snacks on all floors of the home and there was a soft drinks vending machine in the ground floor communal dining room. The menus that were on display in the ground floor dining room indicated that the food provided was nutritious and there was a wide range of meals provided with an alternative available every day day. A member of asked individuals what choices they wanted concerning the menu everyday. Special diets and individual preferences and needs were catered for e.g. soft and pureed meals, and diabetics. The chef working on the day of the site visit had experience of working in a large hospital and was well aware of the need when required to make sure some meals had extra protein and of diets such as low fat or sodium and gluten free. There was some discussion about the presentation of pureed meals. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. Individuals’ food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plan documents and the information was also readily available to catering staff in the kitchen area. The main meal of the day was observed and it was unhurried but staff assisting individuals that required help with feeding were noted standing over the persons concerned. There was some discussion about the appropriateness of this practice. Comments from people living in the home and relatives about the food provided included the following: • “The food is very good”. • “The food is extremely good”. • “The food is lovely, the salad I had for lunch was first class. It is in excess of what I had at the last place. They do a 6-week menu in Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 17 advance and it is on the wall in the dining room. We can always choose an alternative”. • “The food is superb… The last thing that they go short of is drinks” (relative). Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 (Older People) and NMS 22 and 23 (Adults 18 - 65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of people living there and relatives/representatives and robust procedures were in place to protect service users from the risk of abuse. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. Copies of the procedure were prominently displayed throughput the home and every person living in the home was given a copy when they moved into their accommodation. Response from people living in the home canvassed for their views before the site visit took place indicated that 100 of them knew how to make a complaint and people spoken to during the visit including visiting relatives expressed confidence in raising any concerns with the home’s proposed manager. The home kept a record of complaints and details of the home’s response and the outcome of any such matter. There had been 2 complaints made to the home since the inspection of 10th January 2007 and they had been dealt with appropriately. There had been no complaints about the home made to “the Commission” during the same period. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 19 The home had written procedures available concerned with safeguarding vulnerable adults These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. Following the last inspection of the home completed on 10th January 2007 a requirement was made that all staff in the home must receive training in adult protection. On this occasion there was evidence from documents examined and discussion with staff that progress had been made with this matter and that apart from staff that had recently started work in the home most had attended such training. Staff spoken to were able to demonstrate an awareness of the different types of abuse that could occur and the action they would take if they suspected or knew that it had occurred. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19 and 26 (Older People) and NMS 24 and 30 (Adults 18 - 65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable and it was reasonably well maintained and further improvements were planned. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: The home employed maintenance personnel to; undertake minor repairs and some re-decoration; keep the grounds and garden maintained; and ensure that safety systems were checked and serviced. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 21 The premises are old and extensive and not purpose built. At one time the building was used as a school and it retains some of old features such as fitted bookcases in the room used as the main dining room. In this room there was a soft drinks machine and a pool table. The main lounge situated on the ground floor was very spacious and was where a lot of social events take place. Part of this lounge was used by people who smoked and consequently smoke permeated from here into the rest of the lounge and also into the adjacent dining room. Some individuals spoken to during the site visit were unhappy about this and this was also an issue identified at the last inspection of the home on 10th January 2007 and as a result a requirement was imposed that the home must provide facilities for those that smoke to ensure that their “habit” did not impact on others in the home. The home was preparing for the impending legislation concerning workplace smoking due to come into effect on 1 July 2007, and there was a large poster on display in the entrance area of the home with information about this. People spoken to were aware that from that date that smoking could only take place in a dedicated and appropriate area. The home had the advice of a fire safety adviser/consultant identified a suitable room and it was being converted for use as the home’s only area where smoking was to be permitted. During a tour of the building it was noted the following 2 matters of concern. 1. At least 13 bedroom doors were wedged open and in one of these the occupant was smoking. This issue was discussed with the home’s proposed manager and the head of care. They said that a fire officer had agreed to the practice because of the difficulties many people living the home and particularly wheelchair users had getting in and out of their bedrooms. It was pointed out that this practice undermined the home’s fire safety systems and exposed people living and working in the home to the risk of harm. It was also stressed that there was door equipment available that could be installed and linked to the home’s fire alarm system that would enable bedroom doors to be left open without risk. 2. On the top/second floor that there were cupboards in the corridor that were used for storage and that there was some spare bedding in the top of one of them. The home’s proposed manager said that the fire safety adviser/consultant that visited the premises regularly and completed the home’s risk assessment had not made any requirements about them. The home is required to consult with Hampshire Fire and Rescue Service about both these issues. The home was provided with equipment and adaptations that enabled the needs of people with a range of disabilities to be accommodated and these included; assisted baths; level access showers; hoists; nurse call systems; passenger lift and stair lift. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 22 At the last inspection the cleanliness of the building and condition of some of the bathing facilities had been identified as matters that required attention and had resulted in a requirement to improve and maintain adequate levels of cleanliness and hygiene within the home. The proposed manager said that improvements planned for the home included the installation of “free view” television in the main lounge and the installation of sensory equipment in a room to provide stimulation for individuals that would benefit from it. At the time of this visit there were 4 staff on duty in the home with specific responsibility for cleaning. The building was clean with the exception of the exteriors of windows on the second floor. The responses from people living in the home that were canvassed for their views before the site visit took place indicated that 70 believed that the home was “usually” fresh and clean and 30 thought it was “always”. Comments from individuals spoken to during the visit about this matter included: • “They clean the place every day”. • “ Regular cleaners clean our rooms”. • “They keep the place clean”. There was evidence that other matters identified at the last inspection of the home had been addressed as flooring had been replaced in most bathrooms and WCs and also that baths had been re-enamelled. High cleaning had been carried out and the home was negotiating a contract with a company that had the equipment that would enable them to clean the windows on the second floor of the building. The proposed manager said that one contractor indicated that health and safety requirements meant that a specialist vehicle (a “cherry picker”) was required. The home had written procedures in place and advice posted around the home concerned with infection control and there was evidence from records and discussions that many of the home’s staff had attended training in the subject. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. There were alcohol gel disinfectant dispensers placed strategically throughout the building. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 (Older People) and NMS 32, 34 and 35 (Adults 18 - 65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s level and mix of staff on duty and staff training and development programme ensured that the needs of people living there were met and robust recruitment procedures protected them from harm. EVIDENCE: The care team working in the home comprised, 11 trained i.e. registered and enrolled, nurses and 21 health care assistants. Out of the latter 6 (i.e. 29 ) had obtained a qualification equivalent to at least National Vocational Qualification (NVQ) at level 2 and 3 (14 ) were working towards the award. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 24 At the time of the site visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 08:00 to 14:00 14:00 to 20:00 20:00 to 08:00 2/3 2/3 2 Registered/enrolled nurses Health care assistants Total 6/5 8 5/4 7 3 5 The home had the following ancillary staff: cooks; cleaners; laundry; administrative; and maintenance. People living in the home and visiting relatives that were spoken to indicated that they thought that the level of staff on duty at any time was sufficient and comments about this matter included the following: • “We think there are enough staff on duty. There are at least 5 on at night and there are quite a few more on during the day” (group of 4 people living in the home). • “I think there are enough staff on duty. I don’t have to wait very long for help”. • “I think the numbers of staff are all right I always see plenty of people around when I visit”. Records were examined of 3 staff that had been employed to work in the home since the last inspection of the home was completed on 10 January 2007. It was apparent that in all the necessary pre-employment checks had been completed before the individuals concerned started work in the home. There was evidence form documents examined that all new care staff received comprehensive induction training that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions and training that some staff had or were completing completed that was relevant to their respective work roles included: Challenging behaviour; Supervision and mentoring: Infection control; health and safety; Control of Substances Hazardous to Health: Protection of Vulnerable Adults: and NVQ in Housekeeping. The home’s proposed manager said that future planned training included equality and diversity. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 26 NMS 31, 33, 35, 36 and 38 (Older People) and NMS 37, 39 and 42 (Adults 18 - 65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The person managing the home did not have a formal relevant qualification as evidence that she could meet the minimum standards deemed essential to effectively undertake the role. The home had systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s had been subject to several changes of manager over the previous 4 years. The management arrangement that had been in place in the home since December 2006 consisted of a member of the home’s management team who had a range of experiences but no appropriate management qualification (the proposed manager) who was supported in clinical matters by a very experienced registered nurse (head of care/matron). Both individuals had worked in the home for some years and as such provided some continuity for the rest of the home’s staff. The proposed manager had worked at the home for some 19 years and had worked as care assistant both at Westbury House and at another care home. She had NVQ level 2 in care. More recently she had worked as the home’s estate manager with responsibilities that included, health and safety, transport, social events and outings. She said that she had been advised by “the Commission” that she should not submit an application to be registered as the home’s manager until she had started to pursue a relevant qualification. She had subsequently started an NVQ level 4 and was in the process of submitting an application to be registered at the time of the site visit. It was apparent from discussions with staff that they were very clear about the division of roles between the proposed manager and the head of care/matron. Comments from staff, people living in the home and visiting relatives about the skills and qualities of the proposed manager and head of care included the following: • “I report to J (proposed manager) and she is lovely, she is very helpful”. • “If I have to discuss anything about care I go to matron, anything else I go to J (the proposed manager). Matron goes out to view prospective residents and works on the floor with the rest of us … She (proposed manager) is doing a good job. She is approachable and will listen to suggestions”. • “J (proposed manager) is very efficient. If there is anything to do with nursing I go to matron”. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 27 • • “She (proposed manager) seems quite efficient. The other staff treat her with great respect and loyalty, when she comes in a room everyone wants a piece of her, if you know what I mean, because they trust her. A (the matron) also has a good rapport with residents and does a good job” (person living in the home). “J (proposed manager) is helpful and pleasant … A who is the matron is a very good nurse”. The home had a system in place for monitoring the quality of the service that it provided that included the use of questionnaire to obtain the views of people living there. The results of these had been collated indicating what people thought and it was suggested that these be circulated/published and a plan of improvement based on the outcomes implemented. Discussions with people living in the home indicated that they felt that residents meetings held every 3 months and other of the home’s practices (i.e. involvement in the interviews of prospective staff) enabled them to influence day-to-day life in the home. • “We have residents meetings every quarter and we can make suggestions and have a good moan. They will change things and do listen to us” (group of 4 people living in the home). The home had a range of written policies and procedures that informed staff working practice including one that was concerned with promoting equality and diversity. At the last inspection of the home completed on 10 January 2007 it was noted that the financial affairs of most of the people living in the home were dealt with through one central account held by the home. Although the home kept clear records for every individual concerned because this was contrary to Regulation 20 of the Care Homes Regulations 2001 a requirement to rectify this matter was imposed on the home. Subsequently arrangements had been made to set up individual accounts for all the persons concerned and these had been successful in the majority of cases. The proposed manager said some difficulties had arisen because of banking regulations designed to prevent money laundering but they were attempting to make appropriate arrangements for the remaining individuals. The home did also look after sums of monies on behalf of some individuals and accurate and up to date records were kept of all transactions and the balances being held for those people. There had been a requirement outstanding from 3 previous inspections of the home that all staff must receive support and supervision at least six times a year. There was evidence on this occasion that a system has been put in place to address this requirement had been implemented and at the time of the site visit there was evidence that some care staff had received at least 2 formal one to one supervision sessions. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 28 Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. Staff said and records examined confirmed that that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practices were undertaken. One health and safety matter was discussed with the proposed manager and head of care (see also above in the section ”Environment) that concerned fire safety arising from the wedging of a considerable number of bedroom doors throughout the premises and storage of material in the second floor corridor. The proposed manager said that the former practice had been approved by a fire officer because of the difficulty many or the people living in the home and particularly those who were wheelchair users experienced attempting to get in and out of their bedrooms. As this practice and storage of flammable material in a passageway potentially undermines the fire safety arrangements in the home and exposes people living and working in the home to the risk of harm. The home is required to consult Hampshire Fire and Rescue Service and get written approval about this specific matter. Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 29 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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 3 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 3 37 X 38 2 Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 30 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. 1 Standard OP7 YA6 Regulation 12 and 15 Requirement Written evidence must be available to demonstrate that where any limitations of an individuals rights are imposed this has been agreed with all relevant and interested parties and as far as is reasonably possible with individual. This is to ensure that the rights of the person concerned are properly protected. The Fire and Rescue service must be consulted about the practice of wedging bedroom doors and the storage of materials in the second floor corridor and any advice must be acted upon. This is to ensure that the home’s fire safety arrangements are not undermined and exposing people living and working in the home to avoidable and unnecessary risk of harm. Timescale for action 31/08/07 2 OP19 OP38 YA24 YA42 23(4) 31/08/07 Westbury House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 31 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 House Nursing Home DS0000011525.V335967.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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