Inspection on 08/01/07 for Westbury Nursing Home

This inspection was carried out on 8th 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 but made no statutory requirements on the home.

Other inspections for this house

Westbury Nursing Home 21/11/08

Westbury Nursing Home 04/01/06

Westbury Nursing Home 08/07/05

Westbury Nursing Home 04/03/05

Westbury Nursing Home 26/10/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Westbury Nursing Home 86 Warminster Road Westbury Wiltshire BA13 3PR Lead Inspector Susie Stratton Key Unannounced Inspection 9:50 8th January 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 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 Vacant 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.V320797.R01.S.doc Version 5.2 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 4th January 2006 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 first site visit, there were 49 persons resident in the home. The home currently does not have a registered manager in post, although the CSCI are aware that an active recruitment process was underway at the time of the inspection. An “acting across” arrangement is in place, with an experienced manager from a sister home in the locality providing management cover four days a week. A team of registered nurses, care assistants, an administrator, activities coordinator and ancillary staff are employed in the home. The Westbury 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. The fee range is £336.99 per week (Residential: Social Services) to £735.38 per week (Nursing: Self Funding). Items not included in the fees are hairdressing, chiropody, visitors meals, physiotherapy, newspapers and telephones. A copy of the service user’s guide is provided in each resident’s bedroom and a copy is also available in the main entrance hall. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 25 questionnaires were sent out during the autumn of 2006 and 13 were returned. Comments made by residents and their relatives in questionnaires and during the inspection have been included when drawing up the report , along with the views of relatives, GPs and social workers, who were contacted after the first site visit. The home also provided information requested by the CSCI prior to the inspection, relating to residents and staff. As the Westbury is a larger registration, the site visits took place over two days, on Monday 8th January 2007 between 9:50am and 5:15pm, and Tuesday 30th January 2007 between9:55am and 2:35pm. The first site visit was unannounced. The acting manager was on duty for both the site visits. During the site visits, the inspector met with twenty residents and three visitors, and observed care for eighteen further residents for whom communication was difficult. The Inspector reviewed care provision and documentation in detail for nine residents, three of whom had recently been admitted. The relatives, GPs and social workers (if applicable) of these residents were written to, to gain their opinion of the quality of care provided. As well as meeting with residents and visitors, the inspector met with four registered nurses, three carers, the chef, a housekeeper, two laundresses, the maintenance man, the activities coordinator and the administrator. The inspector toured all the building and observed a lunch-time meal, an activities session and two medicines rounds. Systems for administration of medicines and the clinical rooms were inspected. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: The Westbury presents a friendly and welcoming atmosphere, with enthusiastic and kindly staff. A range of equipment to meet the needs of disabled persons is available and staff were observed to be competent in their use. Staff spoken with knew their residents’ nursing and care needs well. The home has close working relationships with local healthcare and other professionals. They work to foster good relationships with relatives, visitors and the local community. Residents and their supporters expressed their appreciation of the home. One said “It’s very nice actually”, another said “I’m settled here” and another “I’m Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 6 most comfortable here”. Residents and their supporters made comments particularly on the staff: “We’re well looked after”; “The staff are very helpful, especially the nurses”; “The carers were so good to me when I was poorly”; “Some staff really put themselves out to help you”. Residents also reported on individual staff. One described the person who had bathed them that morning as “delightful”. One person called a certain registered nurse “a lovely lady” and another described one of the assistant chefs as “a darling”. Staff spoken with said that senior staff always listened to them when they brought up issues relating to individual residents. One senior member of staff reported that care staff were supportive to them, promptly reporting changes in residents’ conditions, so that they could take action quickly. What has improved since the last inspection? What they could do better: Three requirements and nine good practice recommendations were identified at this inspection. Full records of changes of position were not being maintained for each resident assessed as being at risk of pressure damage, to ensure that they had their positions changed at the regularity indicated in their care plan, to avoid risks of pressure damage. Where a resident was prescribed or needed a topical application, there was not always a care plan in place to direct staff on where Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 7 and how often the application is to be used. Records of staff training were incomplete and needed to be fully up-dated, so that an assessment can be made of any gaps or deficits in training, to meet residents’ diverse needs. If deficiencies are identified, an action plan must be put in place, to detail how these deficiencies are to be addressed. The resident’s usual bowel habit prior to admission should be documented as part of the admissions procedure, to establish a base-line for future care provision. Where residents are having their fluid intake monitored, the amount taken in should be totalled every 24 hours, so as to assess for risks of dehydration. All documentation relating to resident care should be dated and signed by the person completing the record. 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. Local arrangements for management systems, similar to that for the maintenance man and chef, should be put in place for the activities coordinator, to ensure that the service is developed along good practice guidelines. Records should be available to show that all staff who have resident contact have been regularly trained in abuse awareness. Valuables, such as cheques handed in for safe keeping, should be documented and stored in the same way as other valuables. In this large home, additional staff should be trained to become manual handling trainers, to support the current trainers in their role. 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 Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 8 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.V320797.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, the home does not admit persons for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The Westbury has a safe system for assessing residents prior to admission, to ensure that they can meet their needs. EVIDENCE: The inspector met with three persons who had recently been admitted. One resident reported that they had come into the home previously for respite care, so when they needed permanent care, the Westbury was the obvious choice for them. As the Westbury generally admits frail persons, many residents were not able to recall being assessed by home staff prior to admission, however all three had very detailed and individual assessments of their nursing and care needs completed, which fully complied which what the residents said. Details included such matters as the resident’s preferences for wearing their dentures or how they wished to spend their day. The acting Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 10 manager reported that she and another member of staff always assess prospective residents before admission. Where additional assessments are indicated, for example from the hospice team, these are obtained, to inform decisions about admission to the home. The acting manager reported that she was able to decide not to admit a prospective resident, if she felt that their needs could not be met within the home. The registered nurses in charge of each floor reported that once assessments had been completed, they were given a copy and were then able to prepare the resident’s room for their arrival. Nearly all of the assessments had been dated and signed, but this had not taken place for two of the documents reviewed and they do need to be dated and signed by the person performing the assessment, to provide a full audit trail for the admission process. As many older persons experience problems relating to their bowel care, it is advised that in order to ensure that discomfort is reduced as much as possible, a record of the prospective resident’s usual bowel habit, if known, is made prior to their admission, so that appropriate care can be provided after admission. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents have their health, nursing and care needs assessed and care plans are put in place to direct staff on how these needs are to be met. Some residents who require topical applications may not have their individual needs met, as these are not included in all care plans. Some residents who are at risk of pressure damage, do not have full indication that their positions have been moved at the frequency indicated by their condition. There are safe systems in place for the administration of medicines. The home works to ensure that residents’ privacy and dignity are respected. EVIDENCE: Residents and their supporters expressed their appreciation of the nursing and care provided in the home. Many described staff as “helpful”, one saying that “staff really put themselves out to help you” and another said “we’re really well looked after”. Three persons described how supportive staff had been when they had recently been unwell, one saying “I’ve been poorly for the past two weeks and they were kind.” Some residents commented particularly on the Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 12 night staff, one describing them as “so very good”. Many residents were unable to communicate and spent much or most of their time in bed. These residents looked comfortable, with well brushed hair, fresh bed clothes and clean eyes and mouths. Five of the thirteen people who responded to the questionnaire said that they always received the care and support that they needed and six that they usually did. Eight reported that they always, and three that they usually, received the medical support that they needed. As the Westbury is a larger home, staff are divided into two teams, who are under the direction of a senior registered nurse, one on each floor of the home. Both teams manage care in a similar manner, so residents experience similar nursing and care provision on either floor of the home. All residents have full assessments of their nursing and care needs performed after admission. These are regularly evaluated. Assessments include risk of pressure damage, nutritional needs, risk of falls and manual handling, among other areas. Not all of the assessments had been initialled and dated by the person performing the assessment and this should take place whenever assessments are performed or revised. Where a need was identified, care plans were put in place to direct staff on actions to take to meet the resident’s nursing and care needs. The majority of nursing and care plans were clear and very detailed. All residents had a care plan describing their personal hygiene, dietary and night care needs. These were individual in tone and directed staff on actions to be taken to meet individual needs. Where residents needed the application of topical preparations, some had this detailed in care plans, but not all. A requirement was made about this at the previous inspection. One of the registered nurses explained that for some residents, this had not been included when new documentation was introduced. She agreed staff need to be informed of which applications to apply and where, especially in the light of current increased usage of agency staff. Where residents were assessed as being at risk of pressure damage, care plans on how the risk was to be reduced were in place for all residents. Documentation stated how often a resident’s position was to be moved. In one case the night care plan stated a different frequency of changes of position from the day care plan, this was clarified during the inspection. Where residents need their positions changing, a chart is in place, so that staff can monitor if residents did have their positions changed. Some charts were fully completed, but others were not and so did not provide evidence that residents were having their positions changed on the frequency directed in their care plan. If frail residents do not have their positions changed at the frequency assessed as being required by their condition, there is a risk of pressure damage. Pressure damage wounds take time to heal, are painful and easily infected. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 13 Residents who were at nutritional risk had care plans to reduce their risk. All residents were weighed monthly and changes in weight were noted in evaluations of care plans. Dietary and fluid intake was measured by use of charts. These were all fully completed and reflected what was observed during the site visit. It is recommended that fluid intake charts be totalled every 24 hours, so that staff can fully assess if residents have had the fluid intake needed to ensure that they do not become dehydrated. Care plans relating to medical conditions were clear. All residents who had urinary catheters in place had the clinical indicator for the use of the catheter documented, together with the size, batch number and balloon size. All apart from one of the diabetic service users, had precise documentation in their care plans which stated the blood levels to be maintained. There was also evidence of contacts with the diabetic specialist nurse when indicated, with records to show that her advice was being followed by staff. Where residents with swallowing difficulties needed a thickening agent to their drinks, observations made in their rooms showed that these were being used. All residents with wounds had clear assessments, treatment plans and monitoring systems in place. Staff reported on the good working relationships with local healthcare professionals and clear records were in place for all residents. Clear individualistic end of life care plans have been developed for dying service users. All staff spoken with reported on the good working relationship with the local hospice and how supportive their staff were. The home has two clinical rooms for the storage of medicines. All medicines were safely stored and there was a full audit trail of medicines brought into the home and disposed of from the home. Medicines administration records were fully completed. If a resident was prescribed one or two tablets, the amount given was documented on their record. Any changes to the medicines’ administration record were signed and counter checked. Two medicines administration rounds were observed and the registered nurses were noted to perform the round in a safe manner, not signing for a drug until it was clear that the resident had taken it. Where a resident wished to self-medicate, an assessment was made, which the resident themselves signed. Where residents were prescribed drugs which could affect their daily lives, such as painkillers or aperients, care plans were in place, so that response(s) to treatment could be assessed and medical staff informed accordingly. All clinical items were within their use-by dates. Many of the residents were frail and had difficulties with communication. All such residents were well presented, wearing their own clothes. The laundresses reported on work that they put in to ensure that all personal clothing was returned to the right resident. Residents are encouraged to bring in items of their own. One resident said how much they appreciated that the maintenance man had put up some of their “things” in their room. Staff were observed to knock on residents’ doors prior to entry and to call them by their Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 14 own preferred name. One person said how much they appreciated the senior nurse on their floor supporting them and saying that people could all be on first name terms in the home, describing it as “very friendly”. Where two members of staff were needed to perform a resident’s personal care, they worked with the resident, not conversing about other matters with each other. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Activities are provided by the home. Contact with family and friends is seen as part of care provision. Residents were supported in exercising control over their lives. There had been issues expressed about the quality of the meals during the past year, however this had been addressed by the managers and improvements were progressing. EVIDENCE: The Westbury employs an activities coordinator. She works 30 hours a week and so cannot provide a full-time service; however, she is supported by a volunteer. On the day of the first site visit, the volunteer was observed to lead a skittles game. He encouraged residents to take part and supported them, kindly reminding any person who was loosing concentration of what was happening. Residents expressed their appreciation of the activities, one said “They do all kinds of things here”. One resident said they liked the quizzes, another the music and another the skittles. Where residents chose not to go out of their rooms or were too frail to do so, the activities coordinator visited Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 16 them in their rooms. This was taking place on the afternoon of the first site visit. The activities coordinator draws up a weekly programme of events and these are given to all residents, so that they were aware of what was on offer. Of the thirteen persons who responded to the questionnaire, two reported that there were always activities arranged by the home that they could take part in, five that there were usually were. Five responded “sometimes” and one “never”. All residents have an assessment of their social care needs, and care plans as to how these needs are to be addressed. Assessments include their spiritual needs and its importance to the individual. All residents had a pen picture completed of their life prior to admission to the home, so that all staff could be aware of residents’ diverse lives previously and what was important to them personally. The activities coordinator has been in post since July 2006 and is still building up working processes with staff, and local links. She is enthusiastic and is keen to develop the service. She maintains clear records of activities and evaluates the activities sessions provided. BUPA has standard management systems for the support of services in the home such as catering and maintenance but they do not do so for activities. This is advised, so that activities coordinators in different homes in a similar locality benefit from learning from each other and from mutual support. This would also assist in ensuring that homes all work within the same systems for budgeting of activities. The Westbury offers open visiting and this was appreciated by residents, several of whom said how much they liked their visitors being able to come when they liked. Several people were visiting the home on the day of the site visit. Visitors said how good staff were at informing them of changes in the resident’s condition. One person reported that the staff had just told them all about a new treatment and why it had been commenced. Several visitors reported on how supportive staff were to them. One older person said how much they appreciated staff helping them to cross a busy road in the evening when they had finished visiting their relative. Residents go out of the home when they want to. Two trips were organised by the activities coordinator since she took up post. One resident said that their family took them home to their old home when they felt able to, another said that they went into the centre of Westbury, with support from friends, when they wanted to. One relative said that the home was situated conveniently, as it was so close to the middle of the town. Senior staff spoken with stressed the importance of working with families and visitors, to ensure that residents continued to be treated as part of a family and local community. One senior registered nurse reported that she “really enjoyed” working with the families and friends of residents. Residents reported that it was up to them when they got up and went to bed. One said “I get up when I want to – I just ring my bell and they come and sort me out.” Several said that they could chose whether they attended activities or not and that no pressure was put on them to attend if they did not want to. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 17 One reported “I’m not a very sociable person & they don’t make me come out of my room when I don’t want to”. One resident said that they found that they were more comfortable in bed and that staff did not make them get up, as they did not want to. As would be anticipated in a larger home, there were a range of opinions expressed about the meals, from “excellent”, through “very good” to “pretty poor” to “dreadful”. Of the thirteen people who responded to the questionnaire, three said they always liked the meals, four that they usually did, four that they sometimes did and one that they never liked the meals. Some people said that meals were variable. Two people commented favourably on the puddings, one said they liked the scrambled eggs and one said that they did appreciate being able to have a hot drink whenever they wanted one. Meals which were not liked, included the pies and the frequency of rhubarb crumbles. The home has very recently appointed a new chef. He is enthusiastic and is planning to develop and change menus, to respond to comments made by residents. Some residents commented on his friendliness and that he had “new ideas” A mealtime was observed during the first site visit. Most residents were too frail to go to the dining room. They were taken meals in their rooms. Staff were observed to check with residents that they had all they needed before leaving them. There were clear management systems in place to ensure that all residents received the meals that they had requested. Staff were available to assist residents who needed to be fed and sat with them, supporting them and encouraging them to converse while they were being fed. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The Westbury has a complaints procedure, which functions in practice. Staff showed an awareness of the importance of the protection of vulnerable adults. EVIDENCE: The Westbury has a complaints procedure, which is displayed in the main hall and is available in the home’s literature. Of the eleven people who completed this part of the questionnaire, eight reported that they always knew who to speak to if they were not happy with the service and three that they usually did. All residents and their supporters that were spoken with knew how to raise issues. None of the residents expressed concerns about doing so. One said “I’m able to tell” and another “I tell them what I want when I want to”. Several residents mentioned the registered nurse in charge of their floor by her first name and reported that she was “very good at sorting things out if there are problems”. The new chef reported that he had already received a range of comments about the meals and had begun to go and meet residents and their supporters to try and improve matters. A complaints record is maintained. This showed that verbal, as well as formal complaints are responded to. The acting manager has introduced a system for daily report from the registered nurses in charge of the shift for each floor, to ensure that she is made aware of any issues reported to them and dealt with during their shift. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 19 Staff spoken with, including non-care staff such as the laundresses and the maintenance man, showed a good appreciation of abuse awareness. One domestic worker was aware that on occasion, some people might say things to someone in her position first, or that she might observe something not observed by anyone else. She knew that she must report it. All ancillary staff reported that they were confident that if they reported an issue to senior staff, they would be listened to and action taken. Such staff were also able to cite a range of examples of when this had happened. One resident met with said “I feel safe here”. Records of training in abuse awareness were not clear. There was a matrix to ensure that staff received regular training, but this did to reflect what staff told the inspector and it was not possible from records to assess if all staff had been regularly trained in accordance with company policy. This matter is to be dealt with as part of the new deputy manager’s roles (see Standard 30 below). Since the last inspection two issues had been referred by the home, in support of a vulnerable adult, into the local interagency safeguarding procedures for vulnerable adults. Residents who were assessed as needing restraints such as safety rails and lap belts had assessments which were regularly reviewed. Where a resident did have safety rails, there was a documentary system for hourly checks on residents, to observe for risk of entrapment of their limbs in the safety rails. The maintenance man also performs monthly checks on safety rails, with clear records that he takes action to ensure that they are correctly fitted. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The Westbury is a clean and well maintained. It offers a range of communal space and sanitary facilities to residents. Equipment to support disabled residents is largely provided and more variable height beds are on order. Systems are in place for the prevention of spread of infection. EVIDENCE: The home has a record for the reporting of minor areas which need attention. Close working relationships exist between maintenance and nursing and care staff. During the first day of the site visit, a registered nurse was heard to discuss priorities for maintenance with the maintenance man, who had just returned from annual leave. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 21 One large sitting room and one smaller sitting room are provided on the ground floor, together with a dining room. A smaller sitting room is provided on the first floor. There is a safe, enclosed patio garden area, which opens from the main ground floor sitting room. All rooms are en-suite and all double rooms have screening available to ensure privacy. These were observed to be in use on the day of the inspection. Bedroom furniture is domestic in tone. One person said that they were “most comfortable here”. A range of assisted bathrooms and wcs are available. One person said how much they appreciated and enjoyed being able to have their own phone in their room. All residents had full assessments of manual handling needs, which directed staff on actions to be taken to prevent risk. There were a range of different hoists provided to assist manual handling. The home is gradually introducing assessments for variable height beds and more such beds have been provided since the previous inspection. One frail person was cared for in a divan bed on the first site visit. This had been addressed by the end of the first site visit and they had been placed in a variable height bed. The manager reported that ten more variable height beds were on order and would be delivered in the new financial year. A wide range of pressure relieving equipment was provided. This was being used correctly. Where service users showed wandering behaviours, pressure pads were used to ensure that staff could be promptly alerted and take action when residents might be putting themselves at risk. Where pressure pads were used, individual risk assessments were drawn up. These were regularly evaluated. The home showed high standards of cleanliness. One of the domestics was observed to perform a full deep clean of a resident’s room. She pulled out furniture and included difficult-to-reach areas, such as underneath the cushions of recliner chairs, in her deep clean. She reported that she had a full supply of cleaning equipment and chemicals, and had been trained in their use. One resident described their cleaner as “excellent”. All sanitary items such as commode buckets and toilet rails had been reviewed and any stained ones replaced. Hoists in communal bathrooms were clean, including their undersides. Two of the washer disinfectors showed signs of deterioration on the first site visit, with brown/yellow encrustation under the lids. These had been fully cleaned by the second day of the site visit and the maintenance man had been given the role of checking on their condition every month. The contact with the clinical waste removal contractor has changed since the previous inspection and the clinical waste storage area was organised and tidy. Many residents expressed their appreciation of the laundry service. One said “The laundry’s quite alright here – you put it in one day & its back the next” and another “we always have clean sheets and pillowcases.” One relative reported that the laundry staff knew their relative and understood about their clothes. The laundry was clean throughout, including the area behind the Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 22 machines. There were full systems in place for the separation of used and potentially infected laundry. The laundresses reported that staff kept to these systems. Laundry staff had full supplies of personal protective equipment for the handling of potentially infected materials. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including, visits to this service. The Westbury’s team of staff has a skill mix to meet residents’ nursing and care needs. There is no evidence that the current high use of agency staff has affected outcomes to residents. Residents are protected by a safe recruitment procedure, which is fully complied with. Standards of record keeping for training need attention, to ensure that all staff are trained appropriately to meet residents’ diverse needs. 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 with staffing levels in excess of the Condition. This home had recently had to rely more on agency care staff than previously. An active recruitment campaign was taking place and two new carers were due to commence employment the week after the first site visit. Two agency carers were on duty on the day of the first site visit. The acting manager reported that the home was fully up to establishment for registered nurses and ancillary staff. Residents and their supporters expressed a range of opinions about the staffing levels, some viewing the home as short of staff. Of the thirteen people Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 24 who responded to the questionnaire, four felt that the home always had enough staff available, four that they usually did and five that they sometimes did. One person reported “We’ve a staff shortage here”. Others had noticed the use of agency staff as an issue. One said “You get a lot of agency here”. Others however did not report such concerns. One said “Oh yes, they come if I ring my bell – you don’t have any worries about that”, whilst another said “Staff come as quick as they can and they are helpful when they come”. A further comment was that “You don’t need to call, they just come and help you when you need it”. One registered nurse in charge of the floor reported that they used largely the same agency, so the same agency carers returned to achieve consistency of care for residents. She also said they never let agency staff work on their own, without support from a permanent member of staff, and that they were not allowed to go off on their breaks together. Considering the home’s current increased reliance on agency staff, it is surprising that there were not more negative comments about staffing. This indicates the effective management arrangements which have been put in place by the registered nurses and BUPA’s management team. BUPA has a clear policy and procedure on recruitment of staff, which was fully adhered to by the home. All required records were in place for all newly recruited staff, including proof of identity, two references, criminal record checks, heath checks and past working history. All staff were interviewed using an interview assessment tool. This had recently been revised to include a more detailed assessment. BUPA also has specific interview assessment tools for specialist roles, such as catering. The manager reported that they were awaiting return of information on some potential employees and hoped their reliance on agency staff would soon reduce. Discussions with staff showed that where performance issues were identified, the home took action within BUPA’s disciplinary procedures, to ensure the safety of residents. All staff were given a standard induction on commencement of employment, in accordance with BUPA’s own procedures. Examples seen on files had been fully completed. One new member of staff reported on the training they had been given on induction. Induction programmes for agency staff were not so clear and full records were not maintained in every case. This had been identified by the acting manager prior to the site visits and action was being taken to ensure that there was evidence that all agency staff were fully inducted into their role. Training records needed much improvement. Discussions with staff and reviews of staff information indicated that training was offered but this was not supported by records. Several staff members reported that they were not always remunerated for training. For example, if they had to come in when they were not on duty, they were not paid. For some staff, particularly where attending a training session would involve additional costs such as child-care, this could be a deterrent to attending training. All staff did have an individual training record but these had been sparsely completed. Of the six records Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 25 reviewed, only two showed any detail of training provided, the others were not completed. The home therefore cannot provide evidence that staff have been trained to meet the needs of residents. NVQ training is supported and nearly all the night carers are trained to NVQ 2 or above, but this was not the case for day carers, something that needs development. The acting manager reported that the home had recently appointed a new deputy manager and that when she came into post, training and development of staff was to be part of their role. Training records need to be fully revised and action plans developed if relevant. If an action plan is indicated, it needs to be submitted to the CSCI, to provide evidence of how the home proposes to ensure that staff are trained to meet residents’ nursing and care needs and how long this will take to action. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home does not currently have a manager in place, but effective management systems have been put in by BUPA to ensure that residents are protected. BUPA has standard systems for evaluating the quality of service provided. Residents’ financial interests are supported by BUPA’s systems for management of their moneys. The health and safety of residents and staff is promoted by BUPA’s systems, but record keeping systems for mandatory training do not demonstrate that this takes place for all staff Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 27 EVIDENCE: The previous registered manager was successful in gaining a more senior position within the BUPA organisation. An active recruitment campaign for a new manager is being progressed and it was understood that the first interviews for a new registered manager were held soon after the day of the first site visit. During this interim period, the home has been supported first by an experienced deputy manager and then by the registered manager of a sister home on a nearly full-time basis. The responsible individual has maintained close contact with the CSCI to inform them of progress. Unfortunately, at the same time, the deputy manager retired, having been in post for many years. A recruitment campaign had also been progressed for a deputy manager and an appointment made. She was due to start in post in February 2007. Some residents were aware of the issues presented, one said “we need a manager” and another “I’m looking forward to having people in place”. However, it should be noted as an indicator of good practice that, despite the current management situation for the home, overall residents and their supporters made very few non-positive comments about its management. One said “They give a good service”, another “It’s fine here” and another “It’s a nice place to live”. The fact that many service users felt unaffected by the management changes says much for the permanent staff and the management systems put in by the BUPA management team. BUPA has standard systems in place for reviewing quality of service provision to residents by way of an external quality control audit team. The last audit was performed in November 2006. Managers are also required to perform monthly audits of certain topics, such as care plans or administration of medicines. Complaints returns are made to the parent company monthly. Accidents are reviewed quarterly. Service user and supporter satisfaction surveys are produced annually. The home is visited monthly by a senior manager from BUPA, and a report made. Where issues are identified, the manager is required to submit an action plan to the parent company detailing how service provision is to be improved. BUPA has a standard system for management of residents’ moneys. All residents were able to have their own account with the company for their pocket money, if they wished. Charges such as hairdressing, newspapers and chiropody were then debited from their account. Residents’ supporters were contacted when accounts were becoming low, so that they could be “topped up”. If residents wish to pay for such additional services themselves, they can continue to do so. Full receipts of all items were available so that the administrator could provide an audit trail. There was a clear system for the management of residents’ valuables, with secure storage facilities. Where residents’ cheques are handled by the home, it is advisable that the same systems for documenting and safe storage are used, to provide a full audit trail and protect staff involved. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 28 BUPA has clear systems for ensuring the health and safety of residents and staff. All equipment was serviced regularly, in accordance with manufacturers’ instructions, and clear records maintained. The fire log book was maintained as directed by the local fire safety officer. Two further members of staff had received training so that they, as well as the maintenance man, can train staff in fire safety. Staff were observed to use safe practice when performing manual handling and all residents had clear manual handling assessments and care plans, which were regularly evaluated. These documents are available in all residents’ rooms, so that all relevant persons could have access. In this large home, it would be of benefit if more staff could be trained as manual handling coordinators to support the current trainers. It was reported that about one quarter of care staff had now completed BUPA’s distance learning pack on infection control. This needed to be further progressed. As noted in Standard 30 above, records of training need development, as the home cannot at present demonstrate that all staff have received training in all mandatory areas relating to health and safety. This will be part of the new deputy manager’s role. A date for completion of the work was agreed with the acting manager at the time of the second site visit. Westbury Nursing Home DS0000015949.V320797.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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 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 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 x x 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17(1)(a) S3(3)(k) Requirement Timescale for action 28/02/07 2. OP9 15(1) 3. OP30 OP38 18(1)(c) (i) Full records of changes of position must be maintained for each service user assessed as being at risk of pressure damage. Where a service user is 28/02/07 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. Progress has been noted but the requirement had not been addressed in full. Previous timescale for action was 28/02/06. Staff training records must be 30/04/07 fully up-dated to reflect training undertaken. If deficiencies are identified, an action plan must be developed and submitted to the CSCI. Westbury Nursing Home DS0000015949.V320797.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. 1. 2. 3. 4. 5. Refer to Standard OP3 OP3 OP7 OP7 OP8 6. 7. 8. OP12 OP18 OP35 9. OP38 All admission assessments should be dated and signed by the person performing the assessment. The service user’s usual bowel habit prior to admission should be documented, as part of the admissions procedure. Where service users are having their fluid intake monitored on a chart, the amount taken in should be totalled every 24 hours. All documentation relating to service user care should be dated and signed by the person completing the record. All service users with diabetes should have care plans which state the specific blood sugar levels indicated for that individual, and the actions to be taken if the person’s blood sugar levels fall outside these levels. This recommendation was identified at the previous inspection; it has been addressed for nearly all service users. A management system should be put in to support the activities coordinator, similar to that for the maintenance man and chef. All persons who have service user contact should be regularly trained in abuse awareness. Where the home looks after items such a cheques for service users, these should have the same record-keeping systems and be stored in the same way as other valuables. Additional staff should be trained to become manual handling trainers. Westbury Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 32 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 Nursing Home DS0000015949.V320797.R01.S.doc Version 5.2 Page 33 - 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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