Inspection on 24/01/07 for Westbury Lodge

This inspection was carried out on 24th January 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westbury Lodge 13/11/08

Westbury Lodge 19/11/07

Westbury Lodge 10/05/06

Westbury Lodge 13/12/05

Westbury Lodge 28/06/05

Westbury Lodge 25/10/04

Westbury Lodge 20/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

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

CARE HOME ADULTS 18-65 Westbury Lodge 130 Station Road Westbury Wiltshire BA13 4HT Lead Inspector Tim Goadby Key Unannounced Inspection 24th & 26th January 2007 09:40 Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westbury Lodge Address 130 Station Road Westbury Wiltshire BA13 4HT 01373 859999 01373 864512 westburylodge@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Limited 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) Manager post vacant Care Home 9 Category(ies) of Learning disability (9), Mental disorder, registration, with number excluding learning disability or dementia (1) of places Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only the one named service user, referred to in the application dated 9 August 2005, may be in receipt of care due to having been assessed by a person qualified to do so as suffering from a diagnosed clinical mental illness necessitating care and/or treatment. 10th May 2006 Date of last inspection Brief Description of the Service: Westbury Lodge provides care and accommodation for up to nine adults who have a learning disability. One service user has associated mental health needs. Some service users also have sensory impairments. The home is owned by Parkcare Homes Ltd, a division of Craegmoor Healthcare, who operate a group of homes locally and across the country. Accommodation in the home is provided on two floors, with seven bedrooms on the first floor, and one bedroom and a semi-independent flat downstairs. All persons accommodated on the first floor must be able to climb stairs without assistance, as there is no lift. The flat has a shower room, and the other ground floor bedroom has an ensuite shower. There are two bathrooms for general use upstairs, both of which also have showers. The ground floor also has a sitting room, dining room, kitchen, and laundry. There is a secluded and secure garden. The home is on the edge of a residential area, about ten minutes walk from the centre of Westbury. Bus stops and a main line station are a few minutes walk away. A small car park is available at the front of the building, with a driveway on to a busy road. Information for service users is displayed in the home, including some in picture formats. Key issues are discussed individually, or within residents’ meetings. CSCI inspection reports are included in these discussions when they are received, and a copy is always available in the home. Fees charged for care range between £783 and £1427 per week. The usual base price for any new admission is £860. Further costs are based on an individual assessment of need. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed in January 2007. The previous key inspection took place in May 2006. Since that visit, the Commission has had ongoing contact with the service. This included a random inspection in September/October 2006, a meeting with senior Craegmoor managers in October 2006, the refusal of an application for registration of a manager, and involvement in adult protection meetings in response to incidents at the home. For this inspection, surveys were sent to service users and their relatives and representatives, staff of the home and various professionals who have contact with it. Responses were received from one service user, three relatives, one representative, two staff and four professionals. The inspection included two visits to the service. The first was unannounced. The second, two days later, was arranged to meet with the manager and conclude the inspection process. This fieldwork included sampling of records, with case tracking of some service users; discussions with service users, staff and management; and a tour of the premises. The pharmacist inspector visited on the first day to carry out a thorough check of medication practices. What the service does well: Service users are supported to address their health care needs effectively. People have a variety of physical and mental health needs. These issues are set out in their individual plans. There are systems to monitor and record any key indicators. Other relevant professionals are involved in reviewing and evaluating care. Service users receive a range of regular health checks. Since the previous key inspection the home has provided end of life care for a service user who was diagnosed with a terminal illness. This difficult situation was handled effectively, and in line with the service user’s own wishes. It helped to ensure a good quality of life for the individual over the last couple of months before they died. Feedback from another professional who supported Westbury Lodge with this care confirms how positive the experience was. Choice and independence is promoted wherever possible, and the more able service users can access a range of opportunities which are in line with their wishes and preferences. This includes all aspects of day-to-day life, both at home and in the wider community. Service users can maintain appropriate relationships with their family and friends. The home offers necessary support with this. This includes visits and calls to Westbury Lodge, and escorting service users to visit people elsewhere. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service has been without a registered manager for over a year. This means that service users do not benefit from having a suitably knowledgeable and skilled person in place who is directly accountable for their welfare. The manager appointed by Craegmoor in December 2005 applied for registration, Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 7 but this application was ultimately refused by the Commission. A new manager has been appointed and took up post in January 2007. This manager is now due to apply for registration. There are three unmet requirements from previous inspections. In addition, a further eight requirements were identified at this key inspection. Medication was the most poorly performing area at this inspection, and requires urgent attention to ensure that service users are properly protected. Service users at Westbury Lodge rely on staff to manage and administer their medication. Deficits included failure to keep accurate medication records, leading to errors in giving prescribed doses incorrectly; failure to notify a situation when prescribed medication could not be given because stock ran out; and a lack of satisfactory evidence about how identified discrepancies and problems with medication were being followed up. The work undertaken with service users’ individual plans and associated records has brought about some necessary improvements. But more remains to be done. Information is in place about service users’ needs and risk areas, and how to support these. But the clarity and detail of this information varies. Guidance is still sometimes set out in very general terms, rather than giving clear instructions about the actual support which staff must provide. This creates the risk of inconsistent approaches. New systems for evidencing the monthly review of care are not yet fully understood by all staff. Further instruction is required for this step to be implemented effectively. Service user plans do not yet show the input of the individual concerned, or of other relevant persons. This is another area which must be given attention once the first stage of changing the home’s system has been completed. There is a failure to define strategies for the management of behaviour; and to properly evidence the use of restrictions on service users’ choice and freedom of movement. This places some individuals at risk of harm. Service user files would also benefit from the removal of outdated and duplicated material, to reduce the risk of confusion. Staff need to have regular and recorded individual supervision meetings with a senior colleague. This will ensure that service users benefit from staff who are appropriately supported, and who are working to an ethos of continual improvement. It will also help to show that any concerns about staff conduct and performance are dealt with promptly and effectively. Fire safety measures need further attention to ensure the safety and welfare of service users. Records of instruction must show that all staff receive this at least once every three months. The home also needs documentary evidence Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 8 that the new ramp fitted at one fire exit is appropriate to the needs of service users. Service users would benefit from improvements to the décor and furnishings of the home. The most serious issue for attention is a lack of suitable heating in the shower room of the ground floor flat. This makes the room uncomfortable to use and places the relevant service user at potential risk. The service has begun the process of reviewing its night cover. This currently consists of two waking staff. This may change in the future, depending on the needs of service users. In any case, some adjustments are necessary, as the present rotas are heavily reliant on some staff working intensive shift patterns. This may be to the detriment of service users, as the quality of support provided to them may be impaired if staff are physically exhausted. 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 Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards relating to admissions to the home were not applicable at this inspection. Service users have their needs and aspirations met by the care provided. EVIDENCE: There have been no new admissions to Westbury Lodge since August 2005. There were two vacancies at the time of this inspection, but no prospective service users had been referred or assessed yet. Recent changes in the service user group have helped overcome problems experienced in 2006. The atmosphere in the home is now calmer and more stable. Reduced pressure on staff enables them to do more with remaining service users, who can access all their planned opportunities each week. Care will be needed to ensure an effective assessment and admission process for the two vacant places, to minimise the risks of disruption to the service. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 11 The key standard will be inspected at the next visit after an admission has taken place. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have some of their abilities, needs and goals reflected in their individual plans. But more information and detail is needed to ensure that service users benefit from support which meets all their needs and preferences. Service users are placed at risk of harm by a failure to have clearly recorded assessments and management strategies for all areas of need and risk. The home fails to show the input of service users to decisions about their own care. Service users can make choices and decisions in their daily lives. EVIDENCE: Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 13 At previous inspections the failure to maintain effective records of the care provided for service users has been a key failing, undermining performance in a number of areas. In response, the home has now begun a major exercise to review and update all sets of service user records, and move them across to a new format. All staff are getting involved in this, and state that they feel positive about the exercise. Staff appreciate being able to contribute and feel that their knowledge and opinions are valued. This work was in progress at the time of this inspection visit, so records were at different stages of completion between old and new formats. Some material on file is still not noted as reviewed within the past year. Five sets of records were checked by the two inspectors during this visit. Three of these were gone through in detail, and the other two were checked for specific issues relating to medication. The work undertaken so far has brought about some necessary improvements. But more remains to be done. Information is in place about service users’ needs and risk areas, and how to support these. The clarity and detail of this information varies. Guidance is still sometimes set out in very general terms, rather than giving clear instructions about the actual support which staff must provide. This creates the risk of inconsistent approaches. Monthly summaries will be completed by allocated staff keyworkers for each service user. These will provide evidence of ongoing review, and highlight any developing issues which might need updating in individual plans. However, as a new development, staff are not all sure how to complete these summaries. Further instruction is required for this step to be implemented effectively. Service user plans do not yet show the input of the individual concerned, or of other relevant persons. This is another area which must be given attention once the first stage of changing the home’s system has been completed. Risk assessments and management strategies are in place, but don’t have all the necessary information, such as the reasons for deciding on a particular approach. The home’s format includes a space for all relevant people to sign, such as the service user or their representative, and other professionals involved. But this has not been done, so there is no evidence of appropriate sharing of key decisions, on issues such as restrictive interventions. These have been implemented with some service users, for instance to ration drinks or cigarettes. The examples seen did not all explain the reasons for the approach, and had not been reviewed since August 2005. Service users at Westbury Lodge have widely varying needs and abilities. This influences how independent they are in choice and decision making. One service user does lots of things without staff support, both at home and Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 14 outside. This individual chatted with the inspector and explained the range of activities they undertake. It is clear that this person enjoys a lot of autonomy. All other service users need greater support, at different levels. Care plans contain some information about this, and are expected to develop more. Observations during the inspection showed that staff are working to promote choices and decisions for all service users. Those individuals who understand spoken language are given various options to choose from, by asking them what they would like. The home is also looking into other methods which will suit non-verbal service users. These include getting information about various systems which use pictures to aid communication. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a range of activities and opportunities, offering them full engagement with their local community. Service users are able to maintain and develop appropriate relationships with family and friends. Service users’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. Service users are offered a variety of meals, in line with individual needs and preferences. EVIDENCE: Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 16 The atmosphere in the home was noticeably calmer than at inspection visits during 2006. This is largely due to changes in the service user group, but the situation has also been helped by getting a more stable staff team. Staff on duty during this inspection spoke freely about their positive impressions of recent changes. They also commented that they believe the remaining service users are benefiting. Over both days of this inspection visit it was seen that staff had more time to spend with service users, and they made good efforts to do so productively. They were aware when individuals were becoming anxious or restless, and took appropriate steps to try and help them relax or undertake activities. Some service users attend college courses or other day service facilities for part of the week. One also has part-time employment. The home has improved its organisation of daily routines to ensure that all service users are able to attend planned sessions. It is also planned to try and get more college courses for service users at the next round of enrolments. Most service users rely on support in activities, both at home and in the community, from Westbury Lodge’s own staff. The service has a part-time activities co-ordinator who leads on this, but she is only present on two days each week. Other staff also give support in this area. Some service users have proved more difficult to engage in activities outside the home. This may be linked to mental state, anxieties or phobias. Work has been undertaken to try and address these issues. Service users’ participation in the local community varies depending on their abilities and behaviours, and the confidence of the staff team to support these. Access may also be limited because not all the home’s staff team are able to drive. However, progress has been made in both these areas recently. There is now greater evidence of all service users having access to opportunities. Over the two days of this inspection visit five of the seven service users were observed going out for sessions including college, shopping and lunch. Staff and a service user commented that more outings have been taking place recently. They also spoke about plans for more trips later in 2007, including holidays. Service users are getting involved in planning possible destinations. Westbury Lodge also plans to link up with another Craegmoor service in Trowbridge for some sessions, such as swimming. In the home, people undertake various activities in line with their own interests. Examples seen during this inspection included knitting, jigsaws, foot massage and playing ball games. A first floor room has been fitted with sensory equipment. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 17 There is information in service users’ care plans about their key relationships, and how these contacts are maintained. Most have regular arrangements for keeping in touch with relatives, through visits, letters and phone calls. A number had seen relatives over the recent Christmas period. One relative commented that they had not been kept as well informed during 2006 as previously. Others who responded did not have concerns about this. The exits from the home are on a keypad lock, for safety reasons. The property is situated near a busy road, with limited visibility in both directions. Menus are drawn up over a six week period. The majority of service users have no specific dietary needs. One person has to have all food liquidised. The dietician has given input, to ensure that the individual’s needs are being met appropriately. One relative raised concern about weight gain by one service user. They had discussed this with the home, and been assured that appropriate steps would be taken. Service users can access the kitchen, with supervision. Some take part in meal preparation, or in clearing away afterwards. Some are also able to make drinks and snacks independently. Staff give support to any service users who need assistance during mealtimes. But staff no longer dine with residents. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Quality in this outcome area is adequate. Quality for the majority of standards in this area is good, but quality in the area of medication is poor. This judgement has been made using available evidence including a visit to this service. Policies and procedures for the safe handling of medicines are in place to protect the residents from harm; however there is evidence of poor practice, which puts them at risk. Service users are supported to address their personal and health care needs effectively. The service has demonstrated good practice in providing end of life care when needed. EVIDENCE: The pharmacist Inspector looked at arrangements for the handling of medicines at Westbury Lodge. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 19 Procedures are available for all aspects of medication handling, including ‘homely remedies’. Two members of staff administer all medicines and both sign the medication administration record. All residents prescribed medicines for ‘as required’ use have individual protocols with the medication sheets, which are dated and reviewed. Daily stock checks are done for these medicines. Staff who administer medication receive training, and information is available to them. Photographs are used to aid identification of residents. Residents are supported to self-medicate if they are able and risk assessments are done, these are regularly reviewed with healthcare professionals and evidence was seen of this process. The previous month’s records were also looked at. These records showed that changes to medication doses had been signed on the charts by the doctor, giving clear instructions to the carers. However in one case these instructions had not been carried over to the new chart resulting in an incorrect dose being given. When doses are changed a new prescription should be sought immediately to ensure that the correct dose instructions are available to the staff administering medicines. Another medication had been given on the wrong day, the instructions were correct but the chart could have been clearer. For four days during the previous month a medicine was out of stock. There was no record of what the home had done to remedy this situation, or whether they had obtained advice about the effect this may have had on the resident. The Commission had not been informed of this problem that could have adversely affected the resident’s well-being. Previous to this inspection a controlled drug had been used in the home. Staff described how it had been stored securely and the assistance they had had from the district nurses in its use, but no stock record existed. This should be kept in a bound book with numbered pages. During November and December 2006 three medication errors were notified to the Commission. The manager should be able to provide reassurance that this matter has been adequately dealt with. Service users have varying abilities and needs in relation to personal care. Some are largely independent. Others need different levels of support. These issues are set out in care plans. Service users have a variety of physical and mental health needs. These are also covered in their individual plans. There are systems to monitor and record any key indicators. Other relevant professionals are involved in reviewing and evaluating care. The home has good links with its local GP surgery. A specialist consultant in learning disability also gives regular support to the home, including reviews of service user medication. Mental health professionals are involved closely for those people who need this. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 20 Sampled records show that service users receive regular health checks in all relevant areas. This includes input from dentists, opticians, and a chiropodist. Feedback from health professionals stated that they had found the home satisfactory in their own dealings with them. They raised no concerns about the care of service users. During 2006 one service user was diagnosed with a terminal illness. After a period in hospital they returned to Westbury Lodge for end of life care. The home was keen to provide this, in line with the wishes of the service user, to try and give the individual the best possible quality of life in their final weeks. The return to the home worked in the service user’s best interests. The individual was seen at the random inspection in October 2006. Although unwell, they were active, responsive and well cared for. Their general health and appetite had improved since returning. Input was provided by the community nurse and another specialist nurse from a hospice. Relevant staff training was also arranged. Care was taken to provide the service user with activities they enjoyed, including a weekend away and attending a concert. The service user died in December 2006. Comments received from one of the professionals who supported the home complimented the service they provided, describing it as “a very high standard of person centred care”. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are safeguarded by the home’s policies and procedures for complaints and protection. Service users are placed at risk due to a lack of effective planning for management of needs associated with behaviour and mental state. EVIDENCE: Craegmoor has a complaints procedure, which is prominently displayed in the home. Records are kept of any concerns, and of the actions taken in response. No new complaints have been received since the previous key inspection. There are also policies relating to abuse and adult protection. The home is aware of the local multi-agency procedures in this area. Various issues have been referred to this when necessary. Guidelines for the management of behaviour need to develop in line with the principles set out earlier in the report. These include explaining the reasons for an approach; giving clear guidance about what actions staff must take; setting out the service user’s view; showing who else has been involved in reaching these decisions; and keeping the guidelines under regular review. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 22 Examples seen at this inspection did not meet these criteria, and there was contradictory advice. For instance, one service user had a programme of only being permitted hot drinks or cigarettes at set intervals. But a suggested response to the same service user showing disturbed behaviour was to offer them a drink or cigarette. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users mostly live in a comfortable, clean and safe environment, suitable to their needs. One service user is disadvantaged by lack of suitable heating in one part of the building. EVIDENCE: The home is clean and hygienic in all areas seen. Maintenance and décor is generally good, and there is an ongoing programme to address necessary tasks. One vacant bedroom was being redecorated during this inspection. Some other areas would also benefit from attention. In particular, patches of damp have begun to affect the wall in the lounge, after recent heavy rainfall. Part of the ground floor is a self-contained flat, where one service user can live more independently, although it is still part of the registered accommodation. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 24 The flat includes a shower room, which has no heating, and is therefore not comfortable to use. The service user also mentioned that they would like some additional worktop space in the flat’s kitchen. Both these points have been raised by the service user with Craegmoor, and action is planned. Various new equipment has been obtained for the home recently, including a kettle, toaster and pedal bin. Staff commented that these were small things in themselves, but it had been frustrating in the past to request things but never get them. These little changes were all helping them to feel more positive about the home again. One member of staff works some shifts specifically as a cleaner, which enables them to focus on more intensive cleaning tasks. At other times, the rest of the care team are responsible for all cleaning. Service users may also participate, depending upon their abilities and preferences. The home employs its own handyman, who can attend to a variety of jobs as the need arises. External contractors are engaged where appropriate. There had been a recent spate of illness among a number of staff. Extra hygiene measures were being carried out as a result. During the inspection the manager was given guidance on how to access up-to-date information on all aspects of infection control for care homes. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by suitable numbers of appropriately trained staff. Service users are protected by effective recruitment practices. Systems to support and supervise staff need to work more effectively, to enhance the care provided to service users. EVIDENCE: Levels of staff turnover at Westbury Lodge have been a concern in the past, as mentioned in a number of the comments received for this inspection. The service has had long periods when providing minimum staff cover has proved extremely difficult. However, the situation has improved greatly over the past year. Staffing levels are now being maintained appropriately. At the time of this inspection there was almost a full complement of staff. The previous high use of agency employees had stopped. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 26 The staff team for daytime cover consists of a manager, deputy, two senior support workers and a further ten support workers, four of whom are parttime. There is also a part-time activities co-ordinator. With seven service users in residence, the home is running with at least two staff on each daytime shift. There are more usually three or even four people on duty. Night cover is provided by two waking staff. The home is considering possible changes to this. The final decision may be influenced by the needs of any new service users admitted. The overall position regarding night staffing remains in need of review, as there are only three people employed to cover these shifts. This means some of them must regularly work intensive shift patterns. Rotas showed that, during December and January, one employee worked 18 consecutive night shifts, had one night off, then worked a further 10 consecutive shifts. Concerns about the completion of all recruitment checks before employees have unsupervised access to service users arose at Westbury Lodge, due to an incident in July 2006. Craegmoor accepted the failings in this particular case, and gave an undertaking that they would not be repeated. Practice was found to be satisfactory at a random inspection in September/October 2006, and again on this occasion. Three sets of staff records were inspected at this visit and contained evidence of all required checks being carried out. Deficits in the knowledge and skills of Westbury Lodge’s staff team have been found at previous inspections. This was also a concern raised in some responses received for this key inspection. However, there are signs of effective progress being made. Records show that all staff receive mandatory training in topics such as first aid, food hygiene and health and safety. Courses are also being provided on relevant issues such as abuse prevention, physical interventions and medication. All staff of Westbury Lodge who haven’t yet achieved a National Vocational Qualification (NVQ) in care have begun the process of working towards this, at Level 2. Craegmoor has an organisational approach to induction and foundation training which links to national occupational standards for the social care workforce, and to those particularly developed for staff working with people with learning disability. Successful completion of this package provides workers with a pathway into NVQ. Craegmoor also has its own NVQ centre, so it can drive this training for its own employees. A system of regular individual supervision meetings with all staff has not yet been implemented fully. This is an important means of supporting and developing all team members, to the overall benefit of the service and its users. It is also important that individual sessions with staff are used to address any concerns about conduct or performance. This needs to be done as Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 27 promptly and effectively as possible. An example was discussed during the inspection where this had not yet happened. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is currently without a registered manager. Service users are benefiting from new management arrangements, but need the extra protection of having a registered person who is accountable for their welfare. Quality assurance measures underpin service developments. Effective record keeping is maintained initially, but some further improvements would be beneficial to uphold service users’ best interests. Fire safety measures need attention, to ensure that the welfare of service users is promoted and protected. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 29 EVIDENCE: The home’s previous registered manager left Westbury Lodge in late 2005. The former deputy manager, Mrs Gill Hodson, was appointed as home manager in December 2005. She applied for registration as manager during 2006, but this application was refused by the CSCI. Mrs Hodson has returned to her role as deputy and a new manager, Mrs Clare West, took up post in January 2007. Mrs West is now due to apply for registration. Both manager and deputy report that the new arrangements are working well. Craegmoor has various systems for auditing its services. There is a ‘Clinical Governance’ team, aiming to ensure that all establishments achieve a minimum standard of performance, and then promote them to move beyond this to reach a level of excellence. The manager has to submit various weekly and monthly reports. There are also visits to the home by senior managers. The service has a ‘Pathway’ which sets out targets for improvement and development, with the actions to be taken towards these. The document is reviewed and updated monthly. The most recent version was provided during the inspection. Service users all have allocated staff keyworkers, who can be their main point of reference for raising any issues they may have. Service user meetings are also held once a week. Staff commented that they feel much more involved and consulted about the running of the service. They have staff meetings every fortnight. They can also contribute comments and raise questions at any time, and receive an appropriate response. Systems have been put in place to help with the routine daily running of the home, which helps to improve overall quality. One professional providing comments for this inspection highlighted a history in the home of poor record keeping, particularly for noting down and acting on advice received from other specialists involved with service users’ care. This failing has been noted at previous inspections, and some further work is needed to address it. The service has begun a thorough review of systems for service user planning, which should help to tackle this problem. Ongoing records of care for service users are detailed and informative, with entries being made three times per day by staff on different shifts. Evidence is kept of various areas, such as contact with health professionals, activities undertaken, and contact with families. A stronger link needs to be made between these ongoing records and documents such as care plans and risk assessments. This will help with effective goal setting, also raised as a weakness in the feedback received. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 30 Some other improvements could be made. Not all documents are dated, which makes it hard to judge whether or not they remain relevant. There is also some duplication of information. Older versions of records could be removed and archived, so that current files are more user friendly, and any scope for confusion is reduced. Work is in progress on this. Evidence shows that a range of health and safety checks are carried out. This includes both internal monitoring, and programmed visits from relevant contractors. Full audits of the premises are carried out every six months. A health and safety committee meets regularly, to identify any areas for attention and to follow these up. The fire log book shows that all required checks relating to fire safety are carried out at the prescribed intervals. But records of staff instruction are not up to date. All staff should receive this at least once in every three month period. Eight staff are not shown as receiving instruction in the last three months of 2006. Of these, one received their last recorded instruction in April/June 2006, and two in January/March 2006. The fire risk assessment for the premises, conducted by an external contractor, was last updated in September 2005. It is due to be reviewed shortly. Actions recommended from the previous assessment have now all been addressed. However, some further evidence is needed to show how the ramp fitted at the exit from the lounge to the garden meets the needs of service users. There is still a noticeable step down from the doorway to the ramp, and the slope itself is fairly narrow, with a rail fitted only at one side. Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 N/A 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 3 N/A X 3 X 3 2 X Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 32 Yes 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 YA6 Regulation 12-1,2,3 15 Requirement Each service user’s plan of care and associated records must set out the actions to be taken to meet all their needs, and must be updated to reflect changes. COMMENT: The timescale relates to the completion of the current process of transferring all service user plans to a new format. 2 YA7 12-1,2,3 15 Any restrictions to service users’ independence, choice and freedom of movement must be agreed in their individual plans. (Timescale of 31/08/06 partly met) COMMENT: Further work is needed to address this element within the overall progress on service user plans. 2 YA7 17-1a Sch3-3q 12-1 13-6 This part of Regulations also applies to the above Requirement. Risk management strategies must be agreed with all relevant DS0000028438.V320082.R01.S.doc Timescale for action 31/03/07 31/03/07 31/03/07 3 YA9 31/03/07 Westbury Lodge Version 5.2 Page 33 15 persons, fully recorded in the service user’s individual plan, and reviewed regularly. COMMENT: Further work is needed to address this element within the overall progress on service user plans. 3 YA9 17-1a Sch31b,3q 13-2 17-1a Sch3-3i This part of Regulations also applies to the above Requirement. From now on, records relating to the administration of medication for service users must be maintained fully and accurately. This requirement has been made previously and was not fully met at this inspection. From now on, medication administered for service users must only be given in accordance with the appropriate prescribed instructions. This requirement has been made previously and was not fully met at this inspection. The persons registered must inform the Commission without delay of any event in the home which adversely affects the wellbeing of any service user, including failure to administer prescribed medication. The persons registered must ensue that the arrangements for medication handling in the home are safe, and provide a report on any action taken to avoid further medication errors or out of stock situations. Where needed within individual plans, there must be clear and DS0000028438.V320082.R01.S.doc 31/03/07 4 YA20 26/01/07 5 YA20 12-1 13-2 26/01/07 6 YA20 37-1g 26/01/07 7 YA20 13-2 31/03/07 8 YA23 15 17-1a 31/03/07 Westbury Lodge Version 5.2 Page 34 Sch3-1b objective guidance for the management of behavioural needs, with strategies to uphold the protection of service users and staff. (Timescale of 31/08/06 partly met) COMMENT: Further work is needed to address this specific element within the overall progress on service user plans. 9 YA24 23-2p Suitable heating must be provided for the shower room in the ground floor flat. From this point forward, all staff must have regular, recorded supervision meetings at least six times a year. From now on, all required fire safety instruction for staff must be carried out and recorded at the prescribed frequencies. 31/03/07 10 YA36 18-2a 26/01/07 11 YA42 23-4 26/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Following the current review of service user plan formats, steps should be taken to promote greater involvement of all service users in planning their own care. A bound book with numbered pages should be used to keep a record of any controlled drugs used in the home. Consideration should be given to the provision of additional worktop space in the kitchen of the ground floor flat. 2 3 YA20 YA24 Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 35 4 5 YA24 YA30 Attention should be given to areas in need of redecoration, including those beginning to be affected by damp. The service should ensure they obtain up to date information regarding infection control measures, including the requirement to notify other agencies of certain illnesses. The ongoing review of night staff cover should address the shift patterns currently worked by some employees. Consideration should be given to the ordering of service user files, to remove outdated material and reduce duplication. The suitability of the ramp installed at one fire exit needs to be checked, and to be supported by a suitable risk assessment. 6 7 YA33 YA41 8 YA42 Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Westbury Lodge DS0000028438.V320082.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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