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Inspection on 03/11/06 for Westcroft Nursing Home

Also see our care home review for Westcroft Nursing Home for more information

This inspection was carried out on 3rd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

Creams identified as not used for the person prescribed for have been removed. All residents are in the process of having the option of NHS chiropody. Previously they were paying for only a private service. This has not happened yet, but all have been registered at local clinic with the chiropody service. Portable heaters in the conservatory and a bedroom have been removed in the interests of safety. The home must ensure adequate heating continues in their absence. An extension to the call system identified in a bedroom has been provided. An extension required in another bedroom has been identified in this report. All bedrooms should be checked to ensure access to the system at all times. Consents have been obtained from some relatives as required for the provision of bed-guards.An adequate supply of library books is now provided for a resident who reads regularly and had run out of reading material on the last inspection.

What the care home could do better:

The home must review the use of all communal areas to maximise the use for all residents. Cleaning routines in the dining area must be improved and some redecoration there carried out as required. The call system must be available in bedrooms at all times and residents aware of the system and how to use it. Fire doors must not be propped open. Suitable self-closing devices must be fitted where doors are required to be left open. Adequate temperatures must be maintained throughout the home at all times. The effectiveness of the central heating system must be reviewed. Photographs of residents should be added to the medication records. All medication must be labelled and mirrored on MAR sheets to indicate the time and dose. Allergies to penicillin must be recorded on MAR sheets and monitored. Fluid intake charts must accurately record daily intake, checked by nurses and referred to GP where they fall below the daily minimum required to sustain hydration. All residents must be weighed monthly. If there are concerns about weight loss, this must then be weekly. Tissue viability records must be provided to required professional standards. They must include body maps, measurement, grading (Sterling) and treatment regimes. Records must be updated when dressings are changed. Plastic feeder cups must be appropriately sterilised or replaced. Shared bedrooms must be occupied only by 2 residents who have made a positive choice to share. Staff must always speak in English when in the presence of residents.

CARE HOMES FOR OLDER PEOPLE Westcroft Nursing Home 5 Harding Road Hanley Stoke-on-trent Staffordshire ST1 3BQ Lead Inspector Peter Dawson Key Unannounced Inspection 3 November 2006 08:00 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 Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westcroft Nursing Home Address 5 Harding Road Hanley Stoke-on-trent Staffordshire ST1 3BQ 01782 284611 01782 215265 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) None Pradeep Arvind Patel Mr Devdutt Meethoo Care Home 28 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (27), Physical disability over 65 years of age (3) Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11 January 2006 Brief Description of the Service: Westcroft Nursing Home is a small nursing home providing personalised care for up to 27 people. IT is located close to Hanley town centre and is a large pre-war house with purpose built 2 storey extension. There are 17 singe and 5 shared bedrooms, 18 having en-suite facilities. There are 2 bathrooms (one assisted) and walk-in shower room. There are 3 lounges, a conservatory, separate dining room and the usual office, kitchen and laundry facilities on the ground floor. Bedrooms are located on both floors and there is a shaft lift access to the first floor. The home provides care with nursing for up to 27 people, 3 of who may have a physical disability, 6 a mental disorder and 6 dementia care needs. The home is staffed by nurses at all times and supported by care assistants and supportive auxiliary staff. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by 1 inspector on 1 day over a period of 9 hours from 8a.m. – 5pm. A pre-inspection questionnaire had not been returned to the Commission prior to the inspection and had not been received at the time of writing this report. The inspection commenced at 8 a.m and it was informative to be involved in the staff handover at that time. A resident had been returned from hospital after several days at 7pm the previous evening. He was monitored during the night with staff recording the usual nursing observations (blood pressure, pulse, temperature). He was clearly unwell and because of the concerns of the nurse on duty the paramedic service were called again and he was readmitted to hospital at 7 a.m. A member of staff escorted him to hospital. There was an inspection of the whole of the communal areas and sample of bedrooms. A range of documents were inspected including, care plans, handover notes, medication records, accidents, complaints, staff files, staff rotas and other documents relating to the inspection process. The maximum number of people were in residence (28), the majority were seen and approximately 12 spoken to during the inspection. Feedback questionnaires were not given to residents by the home but were given to relatives. Four were received from them directly by the Commission. All four indicated satisfaction with the care and service provided at Westcroft. One relative in summary commented “Our mum has been at Westcroft for 4 months, during that time she has put on weight, is very well looked after and her clothes are always clean. All the staff are very pleasant, very caring, polite and helpful and always make us welcome when we are there, we could not have wished for a nicer place for her” One visiting relative was seen, she is a regular visitor, closely monitors her husbands care at Westcroft where he has been for 3 years. She was entirely happy with the care he received and highly satisfied with the attitude and work of all care staff. She said that she was kept informed of any events/changes affecting the health or welfare of her husband. Many improvements have been made to the environment since the last inspection, more work still required. A complaint investigation by the Commission has highlighted those areas of the environment requiring change. Some have been made, other are required as outlined in this report. Some areas of clinical operation require improvement. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 6 Fees charged at Westcroft were reported by the Manager to be £450 per week. What the service does well: What has improved since the last inspection? Creams identified as not used for the person prescribed for have been removed. All residents are in the process of having the option of NHS chiropody. Previously they were paying for only a private service. This has not happened yet, but all have been registered at local clinic with the chiropody service. Portable heaters in the conservatory and a bedroom have been removed in the interests of safety. The home must ensure adequate heating continues in their absence. An extension to the call system identified in a bedroom has been provided. An extension required in another bedroom has been identified in this report. All bedrooms should be checked to ensure access to the system at all times. Consents have been obtained from some relatives as required for the provision of bed-guards. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 7 An adequate supply of library books is now provided for a resident who reads regularly and had run out of reading material on the last inspection. What they could do better: The home must review the use of all communal areas to maximise the use for all residents. Cleaning routines in the dining area must be improved and some redecoration there carried out as required. The call system must be available in bedrooms at all times and residents aware of the system and how to use it. Fire doors must not be propped open. Suitable self-closing devices must be fitted where doors are required to be left open. Adequate temperatures must be maintained throughout the home at all times. The effectiveness of the central heating system must be reviewed. Photographs of residents should be added to the medication records. All medication must be labelled and mirrored on MAR sheets to indicate the time and dose. Allergies to penicillin must be recorded on MAR sheets and monitored. Fluid intake charts must accurately record daily intake, checked by nurses and referred to GP where they fall below the daily minimum required to sustain hydration. All residents must be weighed monthly. If there are concerns about weight loss, this must then be weekly. Tissue viability records must be provided to required professional standards. They must include body maps, measurement, grading (Sterling) and treatment regimes. Records must be updated when dressings are changed. Plastic feeder cups must be appropriately sterilised or replaced. Shared bedrooms must be occupied only by 2 residents who have made a positive choice to share. Staff must always speak in English when in the presence of residents. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 9 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 Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is adequate information regarding Choice of Home. Pre-admission assessments and subsequent reviews are carried out as required. EVIDENCE: There is a statement of purpose and service users guide available in the reception area of the home for use by residents and visitors. The documents reflect clearly the aims and objectives and level of service provided. They give sufficient information to make an informed decision about suitability of the home. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 11 Sponsored residents have contract provided by the Local Authority. Self funding resident are given a statement of terms and conditions by the home (seen on previous inspection). There is a pre-admission needs assessment tool used in all instances prior to admission. In relation to 2 recently admitted residents the assessment was good. A Care Management Assessment had also been obtained in relation to both people. Residents do not often visit the home prior to admission, usually due to hospitalisation or relative feeling it may be unnecessary/inappropriate. Reviews of placement are carried out after the initial 6 week “settling in” period. For funded residents they are arranged by social workers. In relation to a recently self-funded resident a review had been carried out by the home with the family on the previous Saturday. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recording of health care issues is poor. An improved standard of recording of clinical interventions to required professional standards is required. Previous requirements have been made in relation to these matters. EVIDENCE: The care plans of 2 recently admitted resident and one long-term resident were inspected. Care plans were based upon detailed information provided from the homes pre-admission assessment and Care Management Assessment. They were reviewed on a monthly basis. There were inadequacies in the recording of some health care issues: Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 13 There is one resident with pressure damage. He had been appropriately assessed as high risk on waterlow assessment, provided with alternating mattress (the home have 5 Airwave mattresses), turned 2 hourly and food/fluid intake chart put into place. Clinical recording of the pressure area treatment was poor and in general note form. A requirement is made that pressure area sores are recorded to agreed professional standards. This must include body charts, mapping, grading, treatment and progress. In the absence of this information it was impossible to quantify the progress being made. This requirement was also made in the report of the inspection of the home dated 22nd June 2005 and must now be implemented. In relation to hydration the fluid intake chart of a resident over a period of 4 days showed intake of 550ml, 400ml, 550ml and 450ml. This was clearly well below the required daily fluid intake to sustain hydration. There appeared to be no drinks administered at night time between 8 pm and 8 a.m, although night staff records showed the resident had been turned/checked/changed twice generally during the night. Night staff must be instructed to provide drinks to residents awake during the night and intake recorded on the charts. The home are required to ensure that daily food/fluid intake charts are accurately recorded and signed by staff, are totalled and checked by nursing staff and where intake falls below required minimum levels the matter is referred urgently to the GP. It is strongly recommended that drinks are provided in all bedrooms, or are at least readily available and located near to all bedrooms. In relation to a resident with concerns about food intake/weight, she had not been weighed regularly. Previous requirements have been made in relation to this matter and it is a further requirement of this report that all residents should be weighed monthly and where there are concerns about weight loss, this must be weekly. Other aspects of health care recording seen were adequate. Interventions by health care professionals are recorded chronologically and accurately. Three people are currently seeing a Consultant Psychiatrist on an out-patient basis. The GP service provided to the home is reported to be good. This has been confirmed in previous written feedback direct to the Commission by the GP. Other wound care interventions at this time include 2 people with leg ulcers (records not seen). One resident requires daily insulin given by staff. Charts showed regular monitoring of blood sugar levels. The home traditionally paid for a private chiropody service for all residents, this recently changed and residents were then paying privately for the service. A requirement of the last report to provide all residents wishing it, a servic from the NHS. This has been partially met. Referral has been made to the local health clinic for a service to be provided. The private service continues until this is available. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 14 There is a fairly high dependency level - 15 people are reported to required the use of hoist and 10 are double incontinent. It is reported that 19 people have bed-guards fitted as safety measure. This is a large number and further checks of risk assessments should be carried out to review them. Bed-guards are a potential restraint and should only be used where positive risk is established. The medication system was inspected. Supply is in MDS form (blister packs) from Boots Chemists. All medication given had been signed for accurately with no omissions. Medication received is check appropriately and disposal in line with recent legislation. There were no individual photographs of residents with MAR sheets and these should be provided as a necessary check when administering medication. Care records had showed a resident “allergic to penicillin” this should be marked clearly on the MAR sheets as a further check to the GP and Pharmacist. Diazepam was recorded on the prescribed bottle and also the MAR sheet as “taken as prescribed by the doctor”. This is inadequate - instructions on the bottle and MAR sheet must state the times and dose to be given. Requirements have been made previously and in the last report in relation to prescribed creams. On this visit a cream prescribed 3 years ago was in a bedroom and will be removed and destroyed immediately by the Manager and further supply obtained. Arrangements in place to protect privacy and dignity were observed to be satisfactory. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Social activities, residents choices and meals are provided to a good standard Review of the communal area usage would increase choice for residents. This is referred to in Standards 19 - 26 EVIDENCE: Dependency levels are high which may sometimes limit choices which may be made because of high physical needs or mental health needs. The home nevertheless attempt to provide the required or chosen lifestyle which is limited only to ensure safety. The home provides an excellent activities programme. Two staff lead activities with specific time allocated for that purpose. Many activities are provided 1:1 for residents with limited concentration span or socialisation. Many small group activities are provided inside and where possible, outside the home. This service is good. The staff providing have knowledge of the total needs of residents from their work as nurse/carer. All activities are recorded giving an Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 16 accurate picture of the residents involvement. This is a positive strength in this home which enhances quality of life for many residents. Activities workers listen to and act upon the suggestions and requests from residents in this area. An activities board with photographs showed and recorded the events which take place in the home. Contacts with families are promoted and an accepted vital part of the care process. Many relatives visit daily and comments received during previous inspections were very positive about the care provided, commitment of staff and close working with relatives. On this visit a relative was spoken to whilst visiting her husband. She is a regular visitor and known to the inspector when her husband was in a previous home and she had concerns about the quality of care provided there. She stated upon this occasion that her husband has been at Westcroft for 3 years. She is a regular visitor and she is entirely happy with the care provided to him. She is kept informed of any changes in his condition or welfare and she spoke highly of the staff commitment in the home – she is a former Registered Nurse. There was evidence of chosen and preferred lifestyles being known to staff and accommodated within the homes routines. At the start of this inspection (8 a.m.) there were 2 residents up, dressed and having had breakfast were in the dining room. They both said their choice was to rise early (6. a.m.). Residents were seen later rising throughout the morning for breakfast without hurry or pressure. Several residents had breakfast served in their bedrooms. Some had breakfast in the lounge from ‘overbed’ tables. Choice of later rising is an important choice for residents. This can affect some other areas of care such as medication and mid-day meal timing to synchronise with this. These matters were discussed and arrangements sufficiently flexible to accommodate late rising, administration of medication and mid-day meal provision. Several residents access their room throughout the day, some stay there for most of the day and are provided with meals, medication etc. in their rooms. This was confirmed by a resident who has been at Westcroft for 3 years. She is on the first floor, moves around the home, but prefers her own company and to use her room as a base throughout the day. The mid-day meal was seen served in her bedroom. In relation to food provision. All residents spoken to stated that they were happy with the type, quality and quantity of food provided. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 – 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A complaints procedure is readily available in the home. The arrangements for reporting abuse have been tested and found satisfactory. EVIDENCE: There is a complaints procedure covering all required aspects of Regulation 22. There is a copy of the procedure displayed prominently in the reception area of the home. No complaints have been received directly by the home. However one extensive complaint has been received and investigated by the Commission since the last inspection. This complaint related to the following matters: Inadequate staffing levels. The size of the lounge area and number of residents occupying the area. Inadequate dining furniture to accommodate the number of residents. Poor standard of décor and furnishings, including bedding. Mal-odours in the home. Inadeqaute bathing facilities. Some areas of the complaint were upheld, others were not. Work has been done to improve some of the matters highlighted. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 18 Matters still outstanding are mentioned in this report and subject to requirements. At the time of the investigation of the complaint 5 further requirements were made mainly relating to the environment. These have been addressed with the exception of one. It is that fire doors must not be wedged open. This is subject to a further requirement of this report. There is apolicy/procedure relating to reporting abuse which is knownt o staff. Information outlines the various definitions of abuse. There is a copy of the vulnerable adults procedures in the home. The home procedures were recently tested in this matter and concerns about possible financial abuse correctly referred to the Social Worker. This indicated good staff awareness of abuse issues. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 – 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The environment is safe. The communal space is adequate, the way it is used for the benefit of residents is not. Considerable work has been done in the home since the last inspection and more is needed. Infection control could be improved in some areas. EVIDENCE: Many aspects of the environment have required changes and action as outlined in previous discussions with the Manager and Proprietor. They are referred to in previous inspection reports. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 20 A recent complaint from a member of the public further highlighted many of these areas requiring improvement. The use of the communal areas has been a subject of much debate on past inspections. There is a main lounge area, separate dining area, conservatory and second “quiet” lounge. The main lounge accommodates the majority of residents but a recent complaint indicated there was nowhere for visitors to sit and residents were “packed” into one area. This mirrors the inspectors view. The other 2 lounge areas accommodate few people intermittently. The conservatory is used as the smoking area (there are presently 2 smokers) and the smaller lounge used as a quiet area intermittently by 2-3 residents. For the majority of the time these areas are unused whilst the majority of residents are located in the inner lounge with little natural light and no views of the garden or external area. The dining area accommodates 4 separate tables with space for up to 16 people. Meals are provided (following previous recommendations – in 2 sittings). Some residents receive meals in the main lounge area and some in their bedrooms, others have meals served in the lounge areas with over-bed tables in front of them. This accommodation is adequate in size but not in it use. Half the space is used intermittently only for a minority of residents, whilst the majority are accommodated in the other half (main lounge area). A requirement of this report is for the home to review the use of the total communal areas to maximise the use for all residents.- Under Regulation 23 (2) (a) “the physical design and layout of the premises must be used to meet the need of service users” The home should consider all options including use of separate lounge areas continuously for all. Relocating the smoking area. The use of some or all of the 4 communal areas with integral lounge/dining facilities. This would improve the presentation of the home, maximise use of facilities and improve quality of life. At the time of this inspection many communal areas and some bedroom areas were inadequately heated. Residents complained that they were cold. In the interests of the health and welfare of all residents adequate/ambient temperatures must be maintained in the home at all times. Many chairs in the lounge areas are worn, scratched and of poor appearance. These should be renovated or replaced. Apparently 6 new chairs for the lounge area are on order. There have been some considerable improvements to the environment since the last inspection. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 21 Many areas have been re-decorated, this includes corridor areas on the first floor and the main stair-well. All the ground floor areas have been re-carpeted including lounge, dining room, conservatory and some bedrooms. Since the last inspection 40 new UPVc double glazed windows have been fitted with restrictors, this completes the double glazing of all windows in the building. The kitchen was inspected and standards were satisfactory. It was noted that 2 large serving trolleys in the dining area and the mid-wall rails near to them needed extensive cleaning to improve appearance and to ensure good infection control. The dining room has been fitted with new carpet and curtains since the last inspection and the area redecorated some months ago. Some parts of the room require attention to decoration, mainly damage to woodwork/paintwork due to wheelchair damage. There is an assisted bathroom on the ground floor and 2 separate toilets near to the communal areas. All bedrooms on the ground floor have en-suite facilities. There is one bathroom and 1 walk-in shower room on the first floor and two additional toilet areas. 18 of the 22 bedrooms have en-suite facilities. The issue of adequate bathroom/toilet areas was raised in the recent complaint, but the home has the required number of toilets for the number of residents. Facilities are adequate. There are 6 shared bedrooms. One accommodates husband and wife. A recently admitted resident spoken to does not wish to share a bedroom and particularly with the person he does share with. The Manager confirmed that he will be allocated the next single bedroom available. (There are no vacancies at this time). The standards state “Where rooms are shared, they are occupied by only 2 service users who have made a positive choice to share with each other “ this has clearly not happened in this case. Plastic feeder cups being used and seen in the kitchen area had stains which were not removed by the dishwasher. They should be sterilised or replaced. The call system is available in all rooms in the home. A recently admitted resident was unaware that he could use the call system in his bedroom. This was inspected and the call point on the wall could not be reached from his bed. An extension to the call system is required. The Environmental Health Officer visited the home recently. It was reported that there were no requirements. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and training of staff is satisfactory. Recruitment procedures ensure protection of residents. EVIDENCE: The staffing levels have remained the same and comply with previous staffing notices issued. The number of weekly area hours are 686. Since the last inspection the number have been increased by 14 per week. This is to allow additional time due to the high dependency levels, particularly the large numbers of people requiring feeding 1:1. There are 2 nurses and 4 care staff on duty from 8-3. 1 nurse and 3 care staff on duty 2 – 10 although as stated above additional hours have been allocated on this shift to assist residents with high dependency. At night time there is 1 nurse and 2 care staff. At the time of this inspection on the 8 – 3 shift there were actually 2 nurses and 6 carers (one had escorted to hospital at 7 a.m.) Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 23 Additionally there are adequate numbers of catering, laundry and domestic staff in support of care hour duties. A handyperson is also employed. A recent complaint questioned the level of staffing in the home. The number of hours is, in fact adequate for the assessed dependency levels of this resident group. Staff training has generally been good. There has been recent training in dementia care and mental health awareness to ensure the needs of residents in those areas are adequately met. A member of staff is an approved trainer in moving & handling and all staff have received this training although it was surprising to see a resident being transferred from a wheelchair to a chair in the lounge area in an unsafe way. It is important that all staff comply with approved moving and handling techniques. 8 of 15 staff have completed NVQ2 training or above. Two are currently studying. The home meets the required 50 of NVQ trained staff. At the time of the investigation of the complaint the competence of the nurse in charge to understand English was questioned. The staff handover at 8 a.m. witnessed during this inspection was good and was lead by the particular nurse in question, her command of English was adequate. Of more concern was a comment from a resident who said that in his presence 2 staff spoke in their own language together. The first language of all residents is English and staff should always speak English in the presence of residents. Staff records were sampled relating to 2 recently appointed staff. One commenced duties the previous day. All required records were in place as required under Schedule 2. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Safe working practices ensure the safety of residents. EVIDENCE: The Registered Manager is a qualified nurse and has considerable experience in providing a service to older people. He is presently studying the Registered Managers Award. The proprietor has a presence in the home on most days. The Manager has the necessary job description and authority to manage the home and there Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 25 appear no conflicts in their joint presence. The proprietor allows the Manager to manage and the Manager allows the proprietor to oversee the home – the partnership works well. The Manager takes a positive lead in the home and has a positive hand-on role in this relatively small nursing home. Residents have direct access to both Manager and Proprietor on a daily basis allowing any concerns to be expressed. The atmosphere in the home is relaxed there is a courteous relationship between all staff members and with residents. Visitors are always welcomed into the home and treated in a friendly and professional way. There appears an open and positive atmosphere. Residents financial records were inspected on the last visit but not this one. At that time the home were advised to open bank accounts for all residents and it was suggested that 2 staff sign all expenditure. These suggestions have been put into place. A Health & Safety audit has been completed by a private company since the last inspection. Time did not allow the documents to be read. Fire records were seen. All checks and tests required in relation to equipment had been carried out as required. A requirement to ensure fire doors were not propped open made at the time of the recent inspection had not been implemented. Fire doors were seen propped open during this inspection. A further requirement is made in this report. Doors were propped open in some communal and some bedroom areas. Self-closing devices must be fitted if doors need to be left open due to resident need or request. Moving & Handling training has been provided for all staff by the homes own trainer but approved techniques must continue to be used to ensure resident safety. There are adequate numbers of first aid trained staff to ensure one on duty at all times. All notifications required under Regulation 37 have been notified to the Commssion. This included a particularly high number of deaths (12 in the last year) – 7 in hospital and 5 in the home. These were discussed and were generally anticipated. None were referred to the Coroner. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 2 3 2 1 3 1 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x x x 2 Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 31/12/06 31/12/06 31/01/07 31/12/06 1 2 3 4 OP8 OP19 OP19 OP22 12 23(1) (2)(a) 23(2)(d) 12(1) 5 6 7 8 9 10 OP38 OP25 OP9 OP9 OP9 OP8 23(4)(a) & (b) 23(2)(p) 13(2) 13(2) 13(2) 12(1) All residents must be given choice of NHS chiropody. Previous requirement not met. Review use of the communal areas to maximise use for all residents. Cleaning routines in dining area to be improved & redecoration carried out as required. The call system msut be available in bedrooms, extensions fitted and residents aware of its existence. Fire doors must not be propped open. Suitable self closing devices fitted where required Adequate heating temperatures must be maintained in all communal and bedroom areas Photographs of residents should be provided on MAR sheets The dose and times must be recorded on MAR sheets for diazepam. Allergy to penicillin must be recorded on MAR sheets Fluid intake charts must accurately record daily intake & DS0000026970.V315815.R01.S.doc 31/01/07 04/11/06 30/11/06 04/11/06 04/11/06 04/11/06 Westcroft Nursing Home Version 5.2 Page 28 11 12 OP8 OP8 12(1) 12(1) 13 OP27 13(5) appropriate referrals made to GP where daily intake is not met. All residents must be weighed monthly and weekly where there are concerns about food intake Tissue viability assessments and treatments must be recorded to required professional standards and include body mapping, size, grade and treatment of sores. Ensure all staff comply with approved moving & handling techniques 04/11/06 04/11/06 04/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP26 OP23 OP27 Good Practice Recommendations Plastic feeder cups should be appropriately sterilised or replaced. Shared bedrooms must be occupied only by 2 service users who have made a positive choice to share. Staff should always speak English whilst in the presence of residents. Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westcroft Nursing Home DS0000026970.V315815.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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