CARE HOMES FOR OLDER PEOPLE
Westcliffe Care Home Westcliffe Country House 78 Shelford Road Radcliffe-on-Trent Nottingham NG12 1AW Lead Inspector
Karmon Hawley Unannounced Inspection 10th January 2006 10:00 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 Westcliffe Care Home DS0000008819.V274410.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. Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Westcliffe Care Home Address Westcliffe Country House 78 Shelford Road Radcliffe-on-Trent Nottingham NG12 1AW 0115 9335 197 0115 9110089 vanceowen@fiskertonvcb.net Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Vance Lloyd Garnet Owen Mrs Beverley Owen Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Westcliffe is a converted and extended period house set in the pleasant village of Radcliffe on Trent and is near to local amenities and is set in well-maintained grounds. The conversion has been sympathetic to the character of the building and the home is decorated to a satisfactory standard and provides a welcoming, homely feel for service users and visitors. Radcliffe on Trent is supported by rail, bus and road networks. The home provides care for nineteen older people with personal care needs in single and double rooms, some with ensuite. There is a large dining, seating area and a conservatory sitting room. The grounds to the rear of the property are inviting, well kept and accessible. There is a passenger lift and levelled areas throughout the home to enable access for service users with disabilities. Within one area of the home there are steps due to the nature of the house, therefore mobile service users occupy this part of the home. Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in four hours and was performed by two inspectors. The main method of inspection was case tracking, this is a method of sampling the records of three randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Six service users were spoken with so as to give the inspectors an insight into the conditions and standards within the home. Those spoken with were happy with the staff, care received and the standards within the home. The registered managers and providers assisted in the inspection process and three members of staff were spoken with. Staff were able to demonstrate a good understanding of service users needs and the core values and principles in relation to their job role. The focus of this inspection was to concentrates on the remaining core standards not assessed and the requirements made at the previous inspection. What the service does well: What has improved since the last inspection?
Care plans have continued to improve working towards ensuring specific needs are being addressed. Whilst improvement is still require with regards to risk assessments there was evidence available to demonstrate that this is actively being worked towards
Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 6 and additional assessment methods have been introduced since the previous inspection. The managers office has now been moved downstairs which enables easier access for service users and visitors should they wish to approach them. Staff are actively working with information gained form the environmental health officer to improve hazard analysis. Fire alarms are tested on a weekly basis ensuring further protection for service users and relevant others. 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. Westcliffe Care Home DS0000008819.V274410.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 Westcliffe Care Home DS0000008819.V274410.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 Service users may be assured their needs will be assessed and met prior to entering the home. EVIDENCE: The providers visit prospective service users in the community prior to entering the home to carry out a preadmission assessment. The assessment covers the requirements of the standard and there was evidence within care plans observed that these are taking place. Staff spoken with were able to substantiate this procedure. One service user spoken with stated she had had the opportunity to visit the home, received appropriate documentation, stayed for lunch and the afternoon, thus made an informed choice that she wished to enter the home. Westcliffe Care Home DS0000008819.V274410.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): 7,9,10 Service users health, personal and social care needs are set out in an indivudal plan of care, however further consideration as to the support and input required by each is required to ensure needs are fully met. Risk assessments also require further attention to ensure all risks are identified and reduced as far as practicable. Service users are protected by the homes policies and procedures with regards to medication, however minor improvements are required to ensure they are fully protected. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Three case files were examined which demonstrated that service users undergo assessments with regards to the daily activities of living, whole person needs, falls and mobility, information gained forms the basis of the plan of care. Care plans in place were personalised and reflected choices and preferences, however further information in some instances such as dealing with moods and paranoia and catheter care need to identify how the service user will be supported in this process thus their needs met. Progress notes are maintained and reflected significant events, however further information is required to demonstrate how incidents are followed up and resolved as in one
Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 10 case file examined where an infected toe had been identified and a request made that the district nurse be called, there was no further mention of this. Further risk assessments have been introduced with regards to manual handling and falls since the last inspection and these were completed in two of the files examined, however in one file this was not completed where a risk of falls had been identified, also additional risk assessments were not in place where needs dictated the need for these to be in place. There was evidence of reviews taking place with service users and relevant others. Medication examined on the day of inspection was checked and correct against the prescription. Charts were clear and demonstrated per required need medication. On two charts examined written entries had been made, these were not signed, the provider stated it was difficult to get General Practitioners to sign any alterations when these have occurred. During induction staff are instructed on the core values and principles to enhance privacy and dignity of service users. The manager also stated that consideration is given with regards to service users past experiences to ensure individualised care is maintained. All consultations are carried out in private and there are areas service users may use in addition to their own rooms should they wish to receive visitors in private. It was evident during the inspection that staff respectfully maintain privacy and dignity of service users. There was also evidence of a good rapport between service users and staff. Service users spoken with stated that staff were respectful at all times and maintained their privacy. Staff spoken with were able to discuss the core values and principles and service users needs in respect to these. Westcliffe Care Home DS0000008819.V274410.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, Service users are helped to exercise choice and control over their lives and find the lifestyle experienced in the home matches their expectations and preferences. EVIDENCE: All spoken with stated the routine within the home was flexible and undemanding. Service users may choose how they spend their day and which activities they take part in. Although an activities coordinator is not specifically employed staff ensure that outside entertainers and the local churches visit the home. Activities are also provided by the staff and service users spoke of their trips out and the activities they partake in. There are no restrictions placed upon visitors which may be received in private should it be required. The ethos of the home evidently displayed that service users are able to express their thoughts and opinions and have them listened to. Several service users meeting have been held in the past, which service users substantiated. This has enabled the opportunity to express their opinions. Meal times are as flexible as able and choices are on offer at each mealtime. Those service users who are able deal with their own personal finances; they are informed of advocacy services should they be required. Service users are
Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 12 encouraged to bring in personal possessions to ensure a more homely atmosphere and environment. Westcliffe Care Home DS0000008819.V274410.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 Service users are protected from abuse. EVIDENCE: Relevant polices and procedures were in place with regards to adult protection. Evidence was available to demonstrate all staff employed have criminal record bureau checks place. A number of staff have received training in adult protection during the induction programme and undertaking the National Vocational Qualification, there are a number of staff still to undergo this training, however the ethos of the home reflected staff have a good understanding of these issues Westcliffe Care Home DS0000008819.V274410.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): 26 The home is clean, pleasant and hygienic, however further consideration with regards to the addition of further hand washing facilities would be considered good practice. EVIDENCE: There are sufficient domestic staff employed to maintain the standards of cleanliness throughout the home. Contract laundry services are in place for the main linen and the home carries out the laundering of service users personal clothing. The washing machine is in an outbuilding attached the back of the building, there were no hand washing facilities with the exception of alcohol rub available here, however the manager stated staff use the hand wash basin in the staff toilet which is close by. As laundry passes the kitchen laundry bags are used to prevent cross contamination. The dryer is in an out building at present, however the manager stated that development plans are being considered for this area to enhance these facilities. There are two toilets
Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 15 situated along a side corridor, opposite service users rooms and leading on to the dining area which do not have hand wash sinks, however again alcohol rub is available and service users may use their rooms if along this corridor. Following discussions with regards to this the manager is implementing a risk assessment to reduce any risk of cross contamination. Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 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 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): 28,30 Service users are in safe hands at all times and staff are trained and competent to do their jobs. EVIDENCE: Both managers are working towards the completion of the Registered Managers Award. One staff member has attained the National Vocational Qualification level three and one is currently working towards the qualification, several staff have also attained level two and on speaking with staff they were able to substantiate this. Staff training records were examined which demonstrated sufficient training is taking place in mandatory areas. Staff spoken with stated they felt supported with regards to training, training was sufficient and should they require any additional training this would be offered. Service users spoken with stated they felt staff were competent in their job roles and their needs are met. Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 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 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 Service users live in home run in their best interest which is managed by persons fit to be in charge who are of good character and able to discharge their responsibilities. Service users financial interests are safeguarded. EVIDENCE: The proprietors are both registered as the home managers. Each is able to demonstrate experience gained in managing the home and the skills developed during this time. Both Mr and Mrs Owen are working towards the Registered Managers Award and the National Vocational Assessors Award; they also remain up to date with mandatory training and other training specific to their job role. Whilst working towards the Registered Managers Award Mr Owen has spent a great deal of time improving the quality assurance systems in place. Questionnaires are sent to service users and their families twice a year; he is
Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 18 also looking to extend these to the multidisciplinary team and suppliers in order to gain a wider picture. Results from previous questionnaires were observed and results were positive, should there be any concerns these would be discussed on an individual basis so these may be resolved. Service users meetings also take place to enable service users to express opinions and have a voice, service users were able to substantiate these take place. The results from questionnaires are collated and presented in pie charts which is an easy format for service users and relevant others to evaluate results. If required service users are able to a have personal allowances in safekeeping. Appropriate records were maintained and three accounts checked on the day of inspection were correct. Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 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 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X 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 X X X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 3 3 X X X Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 20 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 15 Requirement Ensure identified needs are highlighted in the plan of care and action identified to specify how service users will be supported in meeting these needs. The responsible individual is required to ensure appropriate individual risk assessments are completed for all identified needs to ensure service users are fully protected. This has been partly met; however further development is required to fully meet this requirement. The responsible individual is required to ensure the safe administration and recording of medicines, handwritten entries are required to be signed by two staff members to ensure correct. Carry out an appropriate risk assessment with regards to hand washing facilities in the discussed areas. Timescale for action 15/02/06 2 OP7 13(4,c) 15/02/06 3 OP9 13(2) 15/02/06 4 OP26 23(2,j) 15/02/06 Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Westcliffe Care Home DS0000008819.V274410.R01.S.doc Version 5.1 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!
