Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Westcroft 1 Cleveland Walk Bath Bath & N E Somerset BA2 6JS The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Grace Agu
Date: 1 1 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home
Name of care home: Address: Westcroft 1 Cleveland Walk Bath Bath & N E Somerset BA2 6JS 01225466685 01225443367 westcroftcare@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Jean Uter care home 21 Number of places (if applicable): Under 65 Over 65 21 old age, not falling within any other category Additional conditions: 0 Manager must be a RN on parts 1 or 12 of the NMC register May accommodate 21 Patients aged 50 years and over requiring nursing care May accommodate one named person with Mental Health needs. The registration will revert when this person leaves the Home. Staffing Notice dated 03/10/1996 Date of last inspection Brief description of the care home Westcroft Nursing Home is registered as a Care Home with nursing. It is situated in an elevated position in Bathwick, close to the city centre of Bath. The home is an older property with an extension, set out over three floors. There is a mixture of single and double rooms. One double room has an en-suite facility. There is a passenger lift in the old wing and a chair lift in the new wing: however the home is not suitable for independent wheelchair users and does not enable people that require aids and equipment to move around the home independently. The front entrance has one step into the porch and another step into Care Homes for Older People
Page 4 of 34 Brief description of the care home the foyer; level access is through the side entrance. The home has a large garden to the rear with extensive views over the city. Fees for placement at the home currently range from between £494 - £630, and are determined on an individual basis. Hairdressing, newspapers and chiropody costs incur additional charges. Prospective residents can be provided with information about the home by requesting the home?s brochure from the proprietor - this will detail the services and facilities available at the home. Care Homes for Older People Page 5 of 34 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit that was undertaken by two inspectors over two days to review medication and other requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. In addition to the above, the inspection was undertaken in response to the complaint raised by an individual in relation to recruitment practices at the home. The pharmacy inspector reviewed the homes medication on 10/02/09 her report can be found in the body of the report under Standard 9. Care Homes for Older People
Page 6 of 34 We met with the Acting manager, the provider and the homes administrator. To enable us to form judgement about the quality of care provided at the home we toured the building and viewed a number of records. Residents, staff members two health professionals and two relatives were spoken with on the day. What the care home does well: What has improved since the last inspection? What they could do better: It was clear that the home has made significant improvement to ensure that the requirements made at the previous visits are being met. However, the general cleanliness of the home must improve by ensuring adequate numbers of domestic staff to ensure that the residents are provided with a clean environment where they are happy to live. The registered person must ensure that records are kept of all prescribed medicines given by staff. This refers to records for food supplements and topical preparations. Care Homes for Older People Page 8 of 34 At this inspection we noted that the kitchen dry food store had not been cleaned for quite sometime. After discussion with one of the cooks, the area was tidied and thoroughly cleaned. We noted that the home had a cleaning schedule but this was not being followed. The home must ensure that this area is clean at all times to prevent the risk of food comtamination. The risk of injuries to the residents will be greatly reduced if the hoists identified and one arm of the stair lift chair are repaired or replaced. To minimise the risk of falls and possible injury a permanent clear warning sign along with risk assessment must be put in place in relation to a sloppy area on the corridor outside a residents bedroom on the 2nd floor. It is recommended that systems are put in place to allow medicines supplied in standard packs to be audited. This is so that staff can check that they have been given correctly. It is recommended that clear information is available to staff about when some medicines prescribed when required should be given. This is so that residents can be confident that they will be given these medicines in a consistent and appropriate way. It is recommended that the home make arrangements to provide the residents with a regular hairdresser to meet their needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that residents are assessed before admission to ensure that their needs will be met. Evidence: A detailed pre-admission assessment of needs is available and used and this ensures that the individuals needs can be met by the home before the admission is accepted. This was evidenced in care documentation read in relation to two recently admitted residents.The homes Annual Quality Assurance Assessment states that following the pre-assessment, and after admission, a full assessment is carried out covering all areas referred to in Standard 3 of the National Minimum Standards (NMS) for older people during a trial period, which is one month. The Acting manager confirmed this. The home caters for older people with continuing social, health and nursing needs and
Care Homes for Older People Page 11 of 34 Evidence: has no other speciality. Training records evidenced that there is a wide range of skills available within the team. As a high percentage of the service users suffer with Dementia, planned ongoing training for all staff in this key area needs to be provided and regularly updated. Mr Joel Awe, the acting manager is motivated to explore learning opportunities and liaises with other skilled professionals to the residents benefit. For example Mr Awe is attending a course update on Tissue viability on 24/03/09. We noted that the home has equipment to meet needs of people with physical disability. This includes a range of pressure relieving and moving and handling equipment. The AQAA states that the home provides comprehensive and accurate information (Brochure, Service Users Guide, Contract, Complaints information, Statement of Purpose) in a timely manner to those enquiring about coming to the home and to those who are admitted to the home. This enables them to make an informed choice about what they can expect. The AQAA confirms that the information in relation to the Service Users Guide must be updated on a scheduled basis. The care home gives notice of changes to its fees to the residents. Care Homes for Older People Page 12 of 34 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are assessed and respected. Doctors and other health professionals are involved in their care. Procedures are in place for the safe handling of medicines however some improvements in the records kept would further protect residents health. Evidence: To enable us to determine if peoples needs were being met we sampled three residents individual care files; these had been updated since the last inspection. They demonstrated clear evidence of a holistic approach to care. The activity of daily living assessments and completed social care assessments contained detailed information which lead to needs based all inclusive care plans. The care files also confirmed evidence of regular reviews by staff, residents and or their representatives. Individual risk assessments for individual residents had been undertaken and reviewed as well as risks regarding moving & handling / mobility and
Care Homes for Older People Page 13 of 34 Evidence: pressure sore development, for example using the Waterlow assessment tool. Whilst we note that the home had undertaken risk assessments and obtained consent from residents or their relatives/advocates in relation to bed rails for those who need them in order to prevent them from falling out of bed, three of those bed rails were very loose and had other significant faults that presented a risk of potential of them suffering harm or injury. We issued an immediate requirement for those bed rails to be removed from use in order to prevent further risk or harm from the bed rails. We followed up the requirement with another visit to the home on 17/02/09 and can confirm that this requirement had been fully met. The manager stated that the home would be purchasing two new beds with new bed rails to replace two of the three beds identified. Mr Uter the owner of Westcroft Nursing Home confirmed this. All residents can remain registered with their own GP if they wish and if the GP consents to visit them at Westcroft. We saw evidence of GPs visit to the home upon request from the home to monitor the health of the residents. Residents can meet visitors/care professionals in their own rooms. We met with two health professionals who were visiting the home in relation to monitoring an individual with significant pressure area wound. They told us that the monitoring visit was as a result of the decision made by safeguarding adult team at a recent meeting regarding concerns raised after a review by the Social Worker. The health professionals stated that the wound is improving and that the home had purchased an electric profiling bed and that the Primary Care Trust had supplied a high spec gel mattress to make the individual more comfortable and independent. They would continue to support the home to monitor the wound in order to prevent further breakdown. The acting manager stated that the home had also purchased the needed handling equipment to aid this process. The home has adequate supplies of other equipment for the present residents group, which is regularly evaluated. Arrangements are made when requested for residents to attend their own or a local dentist/optician. Domiciliary optical services are provided annually and dental on request to the home for residents who are unable to access the community facilities. Staff ensure all service users are offered a yearly eye check, this was evidenced in the care files. Care Homes for Older People Page 14 of 34 Evidence: All other specialist services are accessed by referral if there is an assessed need. Mr Joel Awe informed us that the home has adequate supplies of equipment for the present resident group and that he regularly evaluates equipment needs. Staff were observed to be knocking on doors before entering service users rooms. Staff and residents interactions were seen to be friendly and supportive and residents comments also indicated staff were considerate to their needs and helpful. A resident who was recently bereaved told us at a discussion that she was expecting a visit from a Bereavement Counsellor following the death of her spouse. The pharmacist inspector looked at the handling of medicines in the home on the 10th February 2009. Residents are registered with a number of different doctors practices. Staff order their prescriptions via the pharmacy, who then supply them using a weekly blister pack system. The manager told us that he had asked the pharmacy to provide regular advisory visits to help him look after medicines safely. All the prescribed medicines used in the home are looked after and given by staff. Staff told us that one person did look after their own medicines, but had since decided that they would rather the nurses take on this role. This person told us they were happy with the way staff took care of their medicines. A supply of Paracetamol is kept as a homely remedy to treat minor ailments but the manager told us that staff would always check with the doctor before giving a homely remedy. A medicine policy is available for the home. We saw staff giving one person their medicines during the inspection and saw that staff used the medicine trolley to transport medicines around the home safely and that the medicines given were recorded on the medicines administration record sheet. The pharmacy provides printed medicines administration sheets for staff to complete when they give medicines. These showed that generally medicines were given as prescribed. We could see that appropriate medicines were missing from the weekly medicine boxes. We could not check the medicines supplied in standard packs because there was no record of when packs had been started. It is recommended that this is addressed so that staff are able to check whether medicines have been given as recorded. We saw that records had not been made of the use of some prescribed creams and ointments. Records were also not made of the food supplements that had been prescribed. This meant that it was not clear whether these medicines had been
Care Homes for Older People Page 15 of 34 Evidence: given or not. Action is needed to make sure that records are kept of all prescribed medicines given by staff including food supplements. The manager told us that he would make sure this happened. We looked at four peoples care records. These have space for recording peoples medicines and any review that is done. Two people had been prescribed medicines to be used when required both had clear dosage instructions but there was no information in the care plan about why these medicines should be used. Staff explained that both medicines were used for types of anxiety. Clear guidance for the use of these medicines should be available for staff to make sure that they are used consistently and appropriately. Secure storage is provided for medicines. A medicine fridge is available and records showed that temperatures are checked daily and remain in the correct range. A cupboard is available for storing Controlled Drugs, which need additional security. A suitable register is kept of the use of these medicines showing how they had been used. Suitable supplies of medicines were available, however the administration records showed that one medicine had been out of stock for eleven days. The diary showed that staff had requested the medicine the day before it ran out but the manager told us there had been difficulties between the doctors and the pharmacy which meant that the medicine had not been supplied for a number of days. The manager told us that he was discussing these difficulties with the relevant people to make sure that medicines were received promptly. Records are kept of the receipt of medicines into the home and of the disposal of unwanted medicines. Care Homes for Older People Page 16 of 34 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home enables the residents to maintain contact with families, friends and the local community. It provides activities and choice in respect of meals and meal times. Evidence: From a review of the visitors book, and from speaking to residents and relatives it was noted that residents are enabled to maintain contact with families and friends. We spoke with two residents who stated that their visitors are always made welcome. Visitors were seen to come and go regularly during the inspection and were made welcome. In relation to activities the homes Annual Quality Assurance Assessment (AQAA) states that Westcroft has strong Community links so that the residents can access services usually from church or community groups who come to the home and get involved in the homes activities. One survey we received from a relative before the inspection states My mother is able to attend a Fellowship meeting every week in the home. Care Homes for Older People Page 17 of 34 Evidence: The AQAA also states that residents preferences for activities and pastimes are encouraged and respected through the person centred care planning process. One resident told us during the inspection that they like their own company and prefer to stay in their room. Staff would always come in and have a chat so that they dont feel isolated. One of the comment cards we received states I am Comfortable in my room, like to read, do crosswords. I have a television, CD player and a phone but join in most things. Another comment was Have had some games of scrabble with another resident, which makes a change but can cope on my own. Have a radio, television, CD player and take daily newspaper. Like doing cryptic crossword. The home told us that the residents are encouraged to become involved in group activities and learn/participate in skills such as cookery. The homes monthly newsletter viewed showed the recipe for creamy mango cheesecake for the month of January 2009. We are unable to confirm if this took place. We also noted that information about activities is circulated through the newsletter and the notice board. Some of the recent activities have been Games afternoon, manicure, music, mobile shop. The acting manager stated that the home is actively looking for an Activity Coordinator to provide more activities for the residents. We discussed the comment we received in relation to lack of regular hairdresser at the home. The acting manager told us that the home uses the services of a freelance hairdresser that would attend at a short notice. We made a recommendation that this arrangement is regularised in order to meet the needs of the residents. The home has a four-week menu plan. The main meal of the day is also displayed on a board with an alternative choice. However this did not match what was prepared at lunchtime. The cook confirmed that the residents were informed of the change in menu before it was prepared. Residents would normally make their choice the day before as much as practicable, but can choose an alternative on the day if they wish. The records of food served reflected individual choice in all cases. The cook stated she regularly talks to the residents to identify likes/dislikes. We
Care Homes for Older People Page 18 of 34 Evidence: observed the residents at lunch in the dining room. The meal was well presented and the residents spoken to said that they enjoyed their meals. One individual told us in the feedback card that the home makes a special effort to provide them with a vegetarian meal. This was available on the day of the visit. There is a lounge / dining room on the ground floor. The dining tables were nicely presented with individual place settings. Staff members served, supervised and assisted residents discreetly in the dining room; the meal was unhurried. We noted that some residents remained in their bedrooms and were served there as they requested. One individual was noted feeding their relative, the person told us that they enjoy coming in everyday to participate in their relatives care. The AQAA states that the home offers three meals, together with snacks and drinks each day. Care Homes for Older People Page 19 of 34 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled to complain and are confident that their complaint will be listened to. Practises at the Home ensure protection of residents from harm and abuse. Evidence: The home has a complaints procedure, which contained all the required information to enable the residents and their representatives to make a complaint to the home. The complaint procedure also offers the residents/relatives an opportunity to contact the Commission for social Care Inspection if they are not satisfied with the outcome of their complaint to the organisation. This document is displayed in the front entrance of the home. The complaints record was viewed and evidenced seven complaints had been recorded since the previous inspection. We noted that in each case the complaint was satisfactorily investigated and action taken to prevent further occurrence. The complaint record confirmed that the complainants were satisfied with the actions taken. AQAA stated that staff receive training in Protection of Vulnerable Adults (POVA) from abuse and that procedures are in place and action taken to respond to evidence or suspicion of abuse.
Care Homes for Older People Page 20 of 34 Evidence: We saw that Bath and North East Somerset (BANES) Council and the Department of Health (No Secrets) guidance on suspicion of abuse were in the home. Contact telephone numbers were displayed in the office for easy access. The home has written procedures for adult protection, whistle blowing, management of aggression and abuse. One registered nurse we spoke with demonstrated knowledge and action to be taken if abuse is suspected. The acting manager was aware of the inter agency protection procedures and his responsibilities in the reporting of Protection of Vulnerable Adults from Abuse (POVA) incidents to the local authority. An adult protection meeting held in respect of one resident who developed significant pressure sore at the home was discussed previously under standard 7. Care Homes for Older People Page 21 of 34 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely warm and generally clean environment, however it must ensure that adequate numbers of cleaners are regularly on duty to ensure that all the residents bedrooms are clean at all times. Evidence: The home is an older property converted and adapted to care for elderly people. It provides care over three floors. The passenger lift in the main building provides level access to the three floors in the main house. The annex is over two floors and has a stair lift. The connecting link corridor on the ground floor only provides level access between the buildings for wheelchair users. The AQAA states that a programme of maintenance work is carried on in the home and that the home has a full time maintenance person to achieve high standards of maintenance and immediate response to urgent maintenance requests from residents and staff. This person was on duty on the day of the inspection. We noted that the home has records of the regular maintenance of gas and electrical equipment lifts and hoist and fire safety equipment including alarms and emergency lighting. Care Homes for Older People Page 22 of 34 Evidence: There is a communal lounge/ dining area situated on the ground floor in the main building. This offered a choice of seating for recreational, social, cultural and religious activity. Residents can meet in private with their visitors in their bedrooms or use the communal area. The standard of the new furnishing is good. Adapted equipment is provided within the home for residents with limited mobility, for example grab rails and handrails. All rooms were naturally ventilated with most window heights affording sitting views outside the home. Central lighting was available, with most areas enjoying natural light. At the time of inspection the home was generally clean with no offensive odours but would benefit from regular deep cleaning. This is because in one residents room furniture was found to be very dusty. We believe that this is due to lack of adequate cleaners at the home. Cleaning rota showed that the home employs one cleaner who works 0800 -1300 five days a week. The acting manager stated that the cleaner might decide to take a day off during the week to enable them to work on the weekend. This means that on their days off there is no cleaner. The acting manager told us that care staff tidy up the home on those days. We believe that this arrangement is not adequate to keep a home of this size clean. We have made a requirement for the home to ensure that there are adequate cleaners at the home in order to maintain good cleanliness at the home. The home is reminded that this is a repeat requirement from the previous visit. We noted while touring the building that the dry food area of the kitchen was untidy and had not been cleaned for some time. We discussed this with the acting manager and one of the cooks. This area was cleaned before the inspection was completed. We have made a requirement to ensure that this area of the kitchen is regularly kept clean in order to reduce the risk of cross contamination of food. Sluice areas demonstrated control of infection procedures and included a sluicing disinfector. The home provides infection control training to staff so that they are aware of the importance of prevention.
Care Homes for Older People Page 23 of 34 Care Homes for Older People Page 24 of 34 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with sufficient numbers of staff to meet their needs, adequate training is also provided to staff to protect the residents. Evidence: Rotas of nursing/care staff were checked randomly and complied with the requirements of the Staffing Notice. During this inspection we looked at the employment history of the last two members employed from application, interview, employment, induction and on-going training and sampled the employment and training records. This to ensure that employment practice is robust following an anonymous compliant we received about the home. Employment records of new staff contain references as required set out in the legislation. It was agreed that written references should be obtained to support the verbal references noted in one of the files. All staff had signed a declaration of criminal conviction. The home operates an equal opportunities employment policy. All the staff had been issued written terms and conditions. The AQAA states that all
Care Homes for Older People Page 25 of 34 Evidence: staff have been given job description, employee handbook and health and safety hand book. The Nursing and Midwifery Council validations of Registered Nurse qualifications have been carried out and were in order. No volunteers work at the home. A positive approach to staff training and development was evidenced. 6 staff had undertaken training in infection control, 1 Diabetes, 8 Dementia awareness, 4 Mental Capacity awareness, 2 in PEG feed training. 4 on a Wound Care update. Other training attended comprised Male and female catheterisation, Medication, Strokes and Epilepsy, Venepuncture and Basic Stoma care. As the home is catering for the needs of residents suffering from Dementia there is a need for a robust and ongoing training plan in this key area. This will help to ensure residents needs are met by trained as well as experienced staff. Staff have attended mandatory training such as food hygiene, fire safety, first aid and moving and handling in order to meet the mandatory requirements. We noted that staff were undertaking fire training update on our follow up visit to the home. New staff had attended an Induction programme, which evidenced training and learning. The AQAA also stated that the care home has appropriately qualified workforce with at least 50 of care staff holding National Vocational Qualification (NVQ) at level 2. Care Homes for Older People Page 26 of 34 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced Acting Manager. The best interests of service users are considered. Records are stored securely. However a number of health and safety issues were identified for attention. Evidence: At the time of the unannounced visit the Acting Manager Joel Awe had not submitted application to the CSCI to become the Registered Manager. Mr Awe told us he had obtained application pack from the Commission for Social Care Inspection and that it would be completed as soon as possible. Mr Awe claimed that the Commission had obtained an Enhanced Criminal Record Bureau Disclosure as a part of the registration process. The home has no registered manager for quite some time. It is expected that Mr Awe would apply to be registered as the manager of Westcroft. Mr Awe is a registered general nurse and had recently completed the Registered
Care Homes for Older People Page 27 of 34 Evidence: Managers Award. Mr Awe has attended other clinical courses relevant to the care of older people. For example Dementia, skin and wound care and has been booked to attend Tissue Viability training update on 21/04/09. Mr Awe has been working at the home for four years and stated that his knowledge of the home and his experience would enable him to support staff in ensuring that changes are made where necessary in order to provide better outcomes for the residents living at Westcroft. A team of registered nurses, the provider and the homes administrator support him. Throughout the inspection process the acting managers focus was on Westcroft as the residents home and all aspects of the service addressing the needs and wishes of the resident. On the day of the visit there was a happy and friendly atmosphere at the home. Residents, staff and the visitors we spoke with told us that the manager is good and would listen. Mr Awe has line management support from Mrs Uter in respect of providers monthly audits. We noted that the home has residents/relatives meeting during which people are informed about any areas in which the home were first of all doing well and secondly needed to improve. The last meeting was held 24/11/08 and issues discussed were the complaints procedure, in house activities, the newsletter, fire procedure, suggestion box and exit procedures. Survey forms returned to the Commission from relatives and residents confirmed that they feel able to consult with any member of staff in the home on the whole, in order to deal with any concerns that they have or to talk about issues of importance to them. The home is also monitored through quality senior management meetings during which the senior management of the home review various aspects of the services provided at the home and draw up an action plan on how to deal with issues of concern. Reports of these meetings were regularly sent to the Commission for social Care Inspection. The AQAA stated that there is a quality management system audited at least annually. The system is based on the nationally recognised Registered Nursing Home Association (Mark of Excellence). There is also an annual quality of service questionnaire through which the views of the stakeholders are sought. The AQAA also stated that the results of the surveys and meetings are published/prominently displayed at the home notice board. This was not inspected. Care Homes for Older People Page 28 of 34 Evidence: The home has built a new office at the back of the home. Mrs Uter stated that the idea is to create more room for the administration of the home and to use the old office as a staff room. At the time of this visit the home was still transferring the records from the old office to the new one. In addition to those records already referred to in the body of the report, the following were seen and were satisfactory. Fire Log. Gas Servicing certificate. Portable electrical appliance testing. Electrical Installations Certificate. Passenger Lift servicing. Hoists servicing. Generic risk assessment. Accident records. Liability insurance certificate. It was agreed that all Notifications must be forwarded as required by this regulation, to the CSCI. In relation to residents money, the AQAA stated that residents are encouraged to control their money and that any residents money kept at home is fully accounted for and is securely stored. There are policies and procedures in relation to employment, medication, protection of vulnerable adults from abuse, care planning, induction and ongoing training. There whas been regular staff supervision with related records. These were noted in the staff files viewed. While we recognise that the home undertakes health and safety audits, has an ongoing refurbishment, employs a maintenance person and generally has good practice to safeguard the well-being of residents and staff, including Movement and Handling and
Care Homes for Older People Page 29 of 34 Evidence: Safety training. However, risk of injuries to residents will be reduced if the following equipments were to be repaired; the oxford mini hoist with flaky rust on the legs, the bath hoist seat with flaky rust at the ends and one arm of the stair lift chair with broken pad exposing some sharp ends. We have issued a requirement in relation to the above. In addition items identified under medication management, and the environment require attention as these impact upon the health and safety of residents and staff at the home. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 17 The registered person must 13/03/2009 ensure that records are kept of all prescribed medicines given by staff. This refers to records for food supplements and topical preparations To make sure that these are given as prescribed 2 19 23 Ensure the dry food storage area is kept clean at all times. To reduce the risk of cross contamination of food in the kitchen. 20/03/2009 3 26 23 Ensure that adequate numbers of cleaners are regularly working at the home. To ensure that all the residents bedrooms are clean at all times. 31/03/2009 Care Homes for Older People Page 32 of 34 4 38 23 Repair or replace the broken 13/03/2009 area with exposed sharp ends on one arm of the Stair Lift chair. To prevent injury to the residents using the stair Lift. 5 38 23 Repair rusty areas noted in the oxford hoist legs and bath hoist chair. To prevent injury to residents. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 9 It is recommended that systems are put in place to allow medicines supplied in standard packs to be audited. This is so that staff can check that they have been given correctly. It is recommended that clear information is available to staff about when some medicines prescribed when required should be given. This is so that residents can be confident that they will be given these medicines in a consistent and appropriate way. It is recommended that the home make arrangements to provide the residents with a regular hairdresser to meet their needs. 2 9 3 12 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - 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!