CARE HOMES FOR OLDER PEOPLE
Westbury Nursing Home 86 Warminster Road Westbury Wiltshire BA13 3PR Lead Inspector
Susie Stratton Unannounced Inspection 4th January 2006 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Westbury Nursing Home Address 86 Warminster Road Westbury Wiltshire BA13 3PR 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) 01373 825868 01373 825013 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Mrs Angela Lorraine Fawcett Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (5), Terminally ill (4), of places Terminally ill over 65 years of age (4) Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The staffing levels set out in the Notice of Staffing dated 9 January 2004 must be met at all times 8th July 2005 Date of last inspection Brief Description of the Service: The Westbury Nursing Home is registered for 51 people. The building was purpose built as a care home and opened in December 1993. Accommodation is provided over two floors with a passenger lift in between. The home aims to meet the needs of frail/elderly people, those with a physical disability and those who need care in the terminal stages of life. It also offers respite care for people living in the town of Westbury. On the day of the inspection, there were 49 persons resident in the home. The manager of the home is Mrs Angie Fawcett, she was appointed as manager by BUPA during the summer of 2004. She is an experienced manager, who has worked across a range of homes within BUPA. Mrs Fawcett is supported by a deputy manager, registered nurses, care assistants, an administrator, activities coordinator and ancillary staff. The home is situated on the A350, leading into the small market town of Westbury. Car parking is available on site and a bus stop is situated close to the entrance. Westbury also has a main line railway station. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between 11:30am and 5:05pm on Wednesday 4th January 2006, in the presence of Mrs Angie Fawcett, home manager. During the inspection, the Inspector met with thirteen residents and observed care for eleven residents who were not able to communicate. The Inspector reviewed notes of seven residents in detail and also reviewed a further three notes relating to specific areas of resident nursing and care. The inspector met with the deputy manager, one senior registered nurse, one junior registered nurse, three care assistants, the administrator and one domestic. The Inspector toured the home, observed an activities session and a medicines round. She reviewed among other areas, staff training records, medicines records and residents’ valuables records. What the service does well: What has improved since the last inspection?
The one requirement and six recommendations identified at the previous inspection had all bee addressed. Medicines administration records had all been completed and the reasons for any non-administration documented. BUPA is reported to be reviewing and up-dating their policy on prevention of pressure damage. The inspection
Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 6 showed that there were sufficient types of pressure reliving equipment available to residents and where a resident had specific requests about pressure reliving equipment, that this was documented. Residents who require suction procedure now have care plans in place. Residents’ records document if they are practicing their religion. Records of valuables handed in for safekeeping, now accurately describe their appearance, not their apparent value. 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. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. The home does not provide intermediate care, so 6 is N/A Residents are admitted following a full assessment of their nursing and care needs by a person who is qualified to do this. The home are able to meet the needs of their residents. EVIDENCE: Records relating to one recently admitted resident were reviewed during the inspection. The assessments had been carried out in detail, reflected what the resident told the Inspector and what was observed during the inspection. One of the registered nurses reported on the admission system, detailing that the manager or delegate assessed the needs of the resident and then provided them with the full written assessment of nursing and care needs so that they could prepare for the admission of the resident. Discussions with residents and staff, observations of care and reviews of records showed that the home were able to meet the nursing and care needs of residents. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 11 Residents are protected by full and detailed care plans, which were observed to be followed in practice and by regular consultations with relevant healthcare professionals. There are effective systems for the management of medicines, however residents who are prescribed topical applications may be put at risk by not having clear plans to direct staff. Residents who are nearing the end of their lives are cared for properly. EVIDENCE: All residents have individual assessments of their nursing and care needs. These are used as a basis to develop care plans to direct staff on how to meet individual residents’ nursing and care needs. Assessments and care plans are regularly evaluated and up-dated as resident’s conditions change. All residents also have a daily written report of their condition. Records of consultations with resident’s GPs and other healthcare professionals, including the Community Psychiatric Nurse, Tissue Viability Nurse and Diabetic Nurse are also maintained. The standards of assessments and care plans were generally high and are written in clear non-judgemental language. All residents are assessed for risk of pressure damage. Relevant equipment to prevent pressure damage was observed in residents’ rooms where indicated
Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 10 and all frequent care charts were completed in full, to show that frail persons have their positions changed regularly. Residents who had frail skin had care plans developed each time they sustained skin tears. If was advised that where residents had vulnerable tissue, it would decrease documentation and improve management systems for monitoring of care needs if all persons at risk had a specific care plan relating to tissue viability to direct staff on actions to be taken to prevent overall risk and to provide clear evidence that all staff were directed on how to take a consistent approach to prevent tissue damage. The home cares for some residents who have diabetes. All residents have care plans relating to management of their diabetes, however such care plans are generalistic, stating, for example that blood sugar levels should be kept in “reasonable limits”, without stating the specific limits required for that resident. They should also state the actions to be taken by staff if the resident presents with blood sugar levels outside these levels. All medicines were safely stored. All records were kept in full, including Controlled Drugs. One junior registered nurse had a full knowledge of the recent legislative changes relating to the disposal of drugs. Some residents had been prescribed topical medications. For example one resident was prescribed a particular type of topical cream and hair preparation. Both the prescription labels on the preparations were not specific as to where and when the applications were to be used and the resident did not have a care plan to direct staff on the use or application of such prescriptions. This is needed to ensure that all staff are correctly applying such applications at the frequency required. Where residents are prescribed drugs which may affect their daily lives, such as mood altering drugs or pain killers, some residents have care plans relating to the use of such drugs, but not all, and more consistency in approach is indicated. Most of the sterile supplies and appliances inspected were within their expiry dates, but a few items were identified which were not. A review of such items is indicated and all out of date items disposed of. The home cares for many frail persons. Such residents looked comfortable in bed, with brushed hair, clean fingernails and bed clothes. The home has recently taken part in an End of Life Project, together with the local Hospice, working together on developing plans for how residents’ wishes can be supported towards the end of their days. One resident said they had been ill recently and lost their appetite and how supportive staff had been in encouraging them to eat and finding things that they felt able to eat. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 Residents are supported by a full activities programme, which they were observed to enjoy. Staff work to support residents in exercising control over their lives. EVIDENCE: The Westbury has a full activities programme, this includes individual, small group and large group activities. Copies of the programme are given to all residents. On the night before the inspection, staff in the home had put on a show for residents, which most residents attended and had been clearly enjoyed by all. One resident said that “staff did extremely well yesterday”. On the day of the inspection, a post-Christmas party took place, during which some residents put on a show for staff. Residents were observed to enjoy themselves, taking part according to their different abilities. All residents have individual care plans in place detailing their own social care needs, these are regularly evaluated and developed as residents’ needs change. Residents spoken with said that it was up to them when they got up and went to bed. One said that it they felt like a lie in, in the mornings, staff respected this. Another resident said “It’s up to me how I spend my days.” One resident said that they did not like mixing and appreciated that staff did not encourage them to be involved in activities in the home, as they preferred their own company. It was clear from one resident’s notes that where the resident
Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 12 informed their relatives that they felt they had been restricted in choice, that staff had fully investigated this and tried to work with the resident and their relatives, to ensure that their needs could be met. Residents had been supported in bringing in items of their own and some rooms had a highly individual appearance, reflecting the residents’ likes and preferences. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are protected from abuse by the systems in the home. EVIDENCE: All staff are regularly trained in abuse awareness. The manager has experience of working within local vulnerable adults procedures. Staff were observed to work with residents, supporting them and ensuring their safety. For example two staff were observed to assist a service user to transfer to a wheelchair using an electrically operated hoist. The resident was nervous about the procedure and staff reassured the resident throughout, explaining what was going to happen and professionally completing the procedure. Once they had transferred the resident, they ensured that they were safe in the wheelchair with their feet on foot-rests and their lap-belt properly secured. Where residents need restraints such as safety rails or pressure pads, all residents have a care plan in place. These are regularly evaluated. Two residents had similar names, clear systems were in place to ensure that they were not given each other’s drugs and records of nursing and care were individually maintained. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 23 & 26 The Westbury is a clean and generally well maintained. It offers a range of communal space and sanitary facilities to residents. Equipment to support disabled residents is provided. Generally systems are in place for the prevention of spread of infection, however attention needs to be paid to certain specific areas of equipment, to prevent risk. EVIDENCE: The home has a record for the reporting of minor areas which need attention. BUPA has systems for ensuring the maintenance for all areas and equipment. A continuous process of review of equipment and furnishings is in place, for example, new curtains and chairs have recently been provided to the sitting room on the ground floor. A range of communal rooms are available to residents and there is a large patio garden area outside to which residents who are wheelchair dependent have access. All rooms are ensuite and all double rooms have screening available to ensure privacy. These were observed to be being used on the day of the inspection. Bedroom furniture is domestic in tone. One described their
Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 15 new bed as “so comfortable”. A range of assisted bathrooms and wcs are available. All residents have a full assessment of manual handling needs, these direct staff on actions to be taken to prevent risk. Discussions with the manager and staff indicated that while a range of variable height beds are provided for some residents who had complex manual handling care needs, the number of such beds was not enough to meet the needs of all such residents. The manager reported that she had ordered an additional number of variable height beds which would be delivered during the current year. Some of the residents who were not provided with variable height beds had a manual handling assessment specifying the risk where such beds were not provided and how risk was to be minimised, but some did not. This means that the manager cannot be properly informed of the situation and if the number of beds ordered will be sufficient to meet the needs of residents in the home. All residents had been left with access to their call bells. All residents spoken to commented on how prompt staff were in responding when they used their call bell. One said “If I ring they always come”, another said that staff were “very good” about coming when they used their bell. Residents who are at risk of pressure damage are provided with relevant equipment, one of these residents had the dial of the motor for the mattress placed at a level which did not reflect their weight. Such dials should be regularly checked when providing care. The home was clean throughout. The domestic was noted to be careful in performing their duties. Two toilets which showed slight odour at the start of the inspection, they had been fully cleaned before the Inspector brought the issue up with the domestic. One area which needed cleaning had been fully dealt with by the end of the inspection. Three of the baths showed scrapes in their surfaces, probably caused by the bath hoists. These need to be fully cleaned, to prevent risk of cross infection. Some of the commode buckets, urinals and wc rails were new, others were much older and showed staining and deterioration, as such they are difficult to keep fully cleansed. An audit of such items should take place and any deteriorated items be despised of and replaced if needed. Two of the bath hoists were just beginning to show splits in the protective cover of their chassis, if such splits progress and the undersurface is exposed, they cannot be cleaned properly with a risk to cross infection. This needs to be attended to, to prevent deterioration. Most of the washer disinfectors are new, however one of the older ones showed that deposits of limescale were beginning to develop round the seal for the lid. These deposits need to be removed to prevent grown of micro-organisms on the limescale. The home has recently effectively managed an outbreak of an infectious disease and liaised fully with the local infection control team. Adequate supplies of gloves and aprons are available to staff and sterile gloves are used for aseptic techniques. The clinical waste contractor has recently been changed, a review of the clinical waste disposal area indicated that this
Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 16 contractor may not be providing an effective service. The manager reported that the situation was under review and that relevant action would be taken if the situation was not addressed by the contractor. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 The Westbury has a stable team of staff, with a skill mix to meet resident’s nursing and care needs. Training for all staff is supported. EVIDENCE: The Westbury is required to staff the home in accordance with minimum levels set out in a Condition of Registration. They were meeting this Condition. A review of records and discussions with staff indicated that the home generally worked at levels in excess of the Condition. On the day of the inspection, despite sudden unplanned sickness amongst members of the staff, they continued to meet the condition. The use of agency staff happens occasionally but not on a frequent basis. Staff turnover is low, this was supported by residents, who reported that they knew the team of staff. One resident said that “The night staff are just the same as the day staff in caring”. A full team of ancillary staff are in post. A new chef manager had just commenced duties and was undertaking an induction. A full induction programme, which conforms in full to Skills for Care, is in place. Documentation examined showed that inductions had been completed in full by both the trainer and inductee. There is a system for ensuring that all staff undertake regular mandatory training in areas such as fire safety, manual handling, infection control and abuse awareness. Additional training is provided in areas such as prevention of pressure damage, nutritional support for residents and cessation of life for registered nurses. NVQ training is encouraged and up-take is high.
Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 36 The Westbury’s manager is experienced and well qualified. BUPA has wellestablished systems to review quality of care. Residents’ moneys are properly managed. Residents are protected by staff who receive regular supervision. EVIDENCE: The manager is an experienced registered nurse and manager. She has gained the managers’ award and up-dates herself regularly across a range of areas, relating to resident care. BUPA has standard systems in place to review quality of care, reviews are undertaken across a range of areas on a regular basis. The manager reported that the next review is due to start shortly. The home is visited every month by a manager from BUPA and a report of this is sent to the Commission. The reports show that the managers meet with residents and staff as well as reviewing records and the home environment.
Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 19 The home uses the standard BUPA invoicing system for services such as hairdressing and chiropody. All accounts are regularly audited by qualified auditors. Records of items handed in for safekeeping are fully maintained. All staff are given regular supervision and annual appraisal. Detailed individual records are maintained. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 3 3 3 3 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x x Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2), 15(1) Requirement Where a service user is prescribed a topical application, there must be a care plan in place to direct staff on where and how often the application is to be used. The surfaces of all communally used baths must be fully cleaned, particularly the areas under the hoists. Timescale for action 28/02/06 2. OP26 13(3) 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP8 Good Practice Recommendations All residents who have risks for pressure damage and/or tissue damage should have care plans in place to direct staff on how risk is to be reduced. All residents with diabetes should have care plans which state the specific blood sugar levels indicated for that resident and actions to be taken if the resident’s blood sugar levels fall outside these levels. Where residents are prescribed drugs which may affect
DS0000015949.V275588.R01.S.doc Version 5.1 Page 22 3. OP9 Westbury Nursing Home 4. 5. 6. 7. 8. 9. OP9 OP22 OP22 OP26 OP26 OP26 their daily lives, they should always have care plans in place relating to the use of such drugs. All sterile supplies and appliances should have their expiry dates reviewed and any out of date items disposed of. Manual handling risk assessments should all include an assessment of the height of the service user’s bed. The dials on electrically operated mattresses should all be regularly reviewed to ensure that they relate to the service user’s weight. All commode buckets, urinals and wc rails should be reviewed and any stained ones removed, and replaced if indicated. The two bath hoists which are just beginning to show splits in the plastic coating of their chassis should be repaired, before they deteriorate. The washer disinfectors should be regularly inspected and any signs of limescale on the lid seals removed. Westbury Nursing Home DS0000015949.V275588.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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