CARE HOMES FOR OLDER PEOPLE
Westbury Nursing Home 86 Warminster Road Westbury Wiltshire BA13 3PR Lead Inspector
Susie Stratton Unannounced 8th July 2005 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 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 D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Westbury Nursing Home Address 86 Warminster Road Westbury Wiltshre BA13 3PR 01373 825868 01373 825013 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (CFC Homes) Limited Mrs Angela Lorraine Fawcett Care Home with Nursing 51 Category(ies) of OP Old Age (51) registration, with number PD Physical Disability (5) of places TI Terminally ill (4) TI(E) Terminally ill (4) Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The staffing levels set out in the Notice of Staffing date 9 January 2004 must be met at all times. Date of last inspection 4th March 2005 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. 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 adminstrator, activites 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 D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Friday 8th July 2005 between 9.55am and 3.30, in the presence of Mrs Angie Fawcett, registered manager. During the inspection, the Inspector met with three registered nurses, four carers, the chef, the administrator, the maintenance man and a domestic. The inspector also met with fifteen residents, three visitors and observed care for eleven residents who were unable to communicate. The inspector looked at documentation relating to eight residents in detail, toured the home, including the kitchen, reviewed records relating to residents’ moneys, three files of newly employed staff the fire log book and medicines records, among other documents and records. What the service does well: What has improved since the last inspection?
A full system for staff supervision is now in place, before the requirement date. This means that staff are supported in their roles to ensure that residents receive the care that they need. The shifts for kitchen staff have been changed, to improve the catering service to residents. This also means that the
Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage4.doc Version 1.40 Page 6 kitchen is staffed during the afternoon, meaning that residents who may wander into the area can be quickly observed and their safety maintained. Pre-admission assessments are now all signed by the person performing the assessment. Consistency in care planning between different staff continues to improve. Records of residents’ weights are now consistently made in metric measurements. The home discusses with residents or their representatives what their wishes are in the event of sudden illness or collapse and documents this in their records. The person who witnesses an accident now documents what they saw in accident records. Clinical rooms have been improved by having the tiling round the wash hand basins tiled. Both of the requirements and all six of the recommendations from the previous inspection have been addressed. 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 D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 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 standard(s) 3 & 4. The homes does not provide intermediate care. The Westbury ensures that assessments of residents’ nursing and care needs are completed prior to and after admission. This ensures that residents’ care needs can be met by the home. EVIDENCE: Full and detailed assessments of nursing and care needs are completed on all prospective residents prior to admission, by the manager or her delegate. Where a resident is admitted from a distance, written assessments from external professionals are obtained on the resident’s nursing and care needs. When a resident is admitted, further assessments of their care needs are completed during their first few days in the home. Residents and staff said that their nursing and care needs could be met in the home, this was supported by observations of care and reviews of records. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 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 standard(s) 7, 8, 9 & 10 The Westbury has full and comprehensive risk assessments and care plans to protect residents. Staff ensure that residents are treated with respect. Where residents may be at risk of pressure damage and need technical intervention, policy and records could be improved, to ensure that residents are fully supported. Medicines procedure is complied with in all areas apart from completion of administration records where some residents could be put at risk by insufficient verification that they have been administered their medicines. EVIDENCE: All residents have full and detailed assessments and care plans in place. Care plans reflected what residents told the Inspector and care was observed to be provided in accordance with care plans. Records showed that residents’ medical conditions were regularly reviewed by their GPs and that specialist healthcare advice was sought when indicated. Written assessments are performed for manual handling and risk of falls. These conform to researchbased guidelines. Risk assessments are completed for all residents for risk of pressure damage. However the company’s procedure for prevention of pressure damage does not reflect current research based evidence, in that it states that pressure relieving equipment is to be provided after damage has been observed. Current
Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 10 research based evidence is that pressure relieving equipment should be provided as soon as persons are assessed as being at risk of pressure damage, to prevent pressure damage occurring. The owners are advised that they should review their procedure, to ensure that residents are properly protected from risks of pressure damage. One member of staff reported that occasionally pressure relieving equipment had been taken from a resident who had risk of pressure damage and given to a person with higher risk, due to availability. They also said that there were fewer low airloss cushions in the home than low airloss mattresses. In order to ensure that all equipment needed for prevention of pressure is available to service users, who are assessed as needing it, the home should review if they have sufficient types of equipment and if they do, how co-ordination of equipment between floors can be improved. One resident’s notes indicated that equipment to prevent pressure, which did not conform to company policy was in place. It was reported that this was at the resident’s request, this was not documented in their records. Records relating to clinical dressings were clear and showed the wound’s response to treatment. One resident who needed care relating to an ostomy and had clear records relating to its management. Their care plan evaluations showed that registered nurses needed to use suction therapy at times and the care plan did not detail how this was to be done. As the home on occasion employs agency registered nurses and staff who may no longer be familiar with such procedures, the care plan should direct staff on how suction procedure is to be carried out. The suction equipment was clean and maintained in accordance with current guidelines. Staff were observed to consistently knock on residents’ bedroom doors prior to entry. Staff were observed to call residents by their preferred names, as documented in their records and the use of general terms of endearment such as “love”, “darling” and the like was avoided. Several residents commented to the Inspector on how much they appreciated having their own telephone in their room and being able to use it whenever they wished. All medicines on both floors were stored safely in locked cupboards and full records were maintained of drugs received and disposed of from the home. Where medicines administration records needed to be changed by hand, this had been counter checked by a second person. At least nine medicines administration records had not been completed, so the home were not able to provide evidence to show that the resident had been administered their drugs and if not, why not. Where to home are administering medicines to residents this information is needed, to ensure they are being administered their medicines and to advise other staff and their GPs of why a resident has not been given their drugs. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 Residents are supported in maintaining an active social life and continuing with their own preferred way of life. Visitors are encouraged and residents go out of the home if they wish. Meals are attractively presented and given in pleasant surroundings. EVIDENCE: The Westbury has a full activities programme, this includes individual, small group and large group activities. One group was being led by a volunteer during the afternoon of the inspection, residents were actively supported in taking part and one resident was assisting the volunteer in doing this. Several of the residents who preferred to remain in their rooms said they appreciated that activities coordinator coming to see them. One resident said “I never get bored”, another that they liked the Bingo and another the newspaper group. Residents’ religion is documented, however to prevent distress for frail persons, it is advised that it should be documented whether the resident wishes to actively practice their religion or not. Residents said their visitors could come and go as they wished. Several residents reported that they regularly went out of the home with relatives. Trips out are organised in good weather. Residents reported that it was up to them how they spent their days, they could get up and go to bed when they wished and could have their meals in
Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 12 their own rooms if they preferred. Several of the residents had brought a range of their own items into their rooms and some of the rooms were highly personal in appearance. Nearly all residents said how much they enjoyed their meals. One said that the portions were “pretty generous” another said that they favourite meal was fish and chips and another roast beef. The dining room was set out attractively and there was space for wheelchair dependant residents to get up to the tables. Meals were attractively presented. One resident said that they did not like either of the choices for lunch and asked for scrambled eggs on toast, which they were given. The chef showed a good individual knowledge of residents’ personal likes and preferences. Where residents needed artificial feeding systems, full records were in place. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 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 standard(s) 16 & 18 The home maintains a full record of complaints and residents spoken with knew how to complain. Residents are supported by staff who are aware of how to work within vulnerable adults procedures. EVIDENCE: The home’s complaints policy is displayed and available to all residents in the service users’ guide, which is available in their rooms. Residents knew who to bring matters up with if they had concerns. One said that they could talk to staff and say if they were not happy about their care, another said that they talked to the registered nurse in charge of the floor and another that they told “the head one”. The manager of the home maintains a detailed complaints log, in which all matters that have been reported to her, whether verbally or in writing, are documented, together with details of response from staff, so that she can assess if all matters have been addressed in full. Staff spoken with were aware of local vulnerable adults procedures. One registered nurse was observed being very supportive to a resident who had become confused, supporting the resident gently and taking them for a walk, helping them to calm down. Restraints such as safety rails and lap belts are documented in residents’ notes and regularly reviewed. The manager has experience of working with local vulnerable adults procedures. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23 24 & 26 The Westbury is a clean, well maintained home, which offers a range of communal space and sanitary facilities to residents. Equipment to support disabled residents is provided. EVIDENCE: The Westbury gave the appearance of being well maintained, with plans in place to address areas which need attention. The carpets in the upstairs corridors are to be replaced shortly and the maintenance man was fully aware of two areas of tiling which needed to be attended to and had plans in place to repair the areas. A range of communal rooms are available to residents and there is a large patio garden area outside to which residents who are wheelchair dependant have access. All rooms are ensuite and all double rooms have screening available to ensure privacy. Bedroom furniture is domestic in tone. A range of assisted bathrooms and wcs are available. All relevant equipment is provided to residents, including variable height beds, hoists and recliner chairs. All residents had been left with access to their call bells. One resident said “If I ring my bell they always come”, another said that they were too frail to use their call bell but if they called out, staff always came to attend
Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 15 to them. The home was clean throughout. One domestic said that she ensured that she gave residents’ rooms a thorough clean on days that they have having a bath, so that she did not interfere with their daily lives. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 The Westbury’s recruitment polices and procedures protect service users. EVIDENCE: The files of three recently employed members of staff showed that proof of identity, two references, a CRB and pova check and medical questionnaire are obtained for all staff prior to employment. All staff complete an application form and they are interviewed, given terms and conditions of employment and a job description. All staff receive an offer letter before they commence employment. The files examined were maintained in an orderly manner and were easy to audit. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36, & 38 The Westbury’s manager is experienced and well qualified. Residents’ moneys are properly managed. Residents are protected by staff who receive regular supervision. There are effective systems to ensure the health and safety of residents and staff. 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. Residents’ moneys are maintained in individual accounts. Full records are maintained in the home and all receipts are kept. Relatives can receive statements on request and the home corresponds with relatives when needed about finances. Records are maintained of valuables handed in for safekeeping. Descriptions of valuables should describe the appearance of items handed in, not their apparent worth, so rings should be described as
Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 18 “yellow metal”, rather than “gold”, to ensure that each item is accurately described. All staff are given regular supervision and annual appraisal. Detailed individual records are maintained. Residents are protected by effective health and safety procedures. The fire log book was fully maintained. Equipment had been regularly serviced. The kitchen was clean and well stocked. The chef reported that when he needed new equipment, he was able to order it. Sluice rooms were tidy and waste was correctly disposed of. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x 3 3 x x x 3 3 x 3 Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement All medicines adminstration records must be fully completed at the time of adminstration. If a medicine is not adminstered, the reason why must always be documented. Timescale for action 30th September 2005 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 8 8 Good Practice Recommendations The homes policiy and procedure on prevention of pressure damage should be revised, to reflect current research based guidelines. The home should review if they have sufficient types of pressure relieving equipment according to need and if they do, how co-ordination of equipment between floors can be improved. Where a service user requests pressure relieving equipment which is not in accordance with the homes procedure, this should be documented in their records. Where a service user requires suction procedure, they should have a care plan in place to direct staff on how to perform the procedure. Service users records should document if they are actively practicing their religion or not.
Version 1.40 Page 21 3. 4. 5. 8 8 12 Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc 6. 35 Records of valuables handed in for safekeeping should describe the appearance of the item, not the apparent value. Westbury Nursing Home D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 22 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 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 D51_D01_S15949_WestburyNursingHome_V235382_080705_Stage2.doc Version 1.40 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
