Inspection on 17/01/06 for Westdene Residential Care Home

This inspection was carried out on 17th January 2006.

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

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

Other inspections for this house

Westdene Residential Care Home 18/07/06

Westdene Residential Care Home 21/06/05

Westdene Residential Care Home 13/01/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Westdene Residential Care Home 1 Rye Close Worthing West Sussex BN11 5EG Lead Inspector Mrs G Davis Announced Inspection 17th January 2006 04:30 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 Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 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. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Westdene Residential Care Home Address 1 Rye Close Worthing West Sussex BN11 5EG 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) 01903 247808 Mr Mohammed Khalil Dulloo Mr Mohammad Khalil Dulloo Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: Westdene is a Care Home registered to accommodate up to 14 service users in the category of OP (Old Age). The establishment is a large detached property, which has two rear extensions enclosing a small sunny courtyard. One of the extensions offers a conservatory, which provides a sitting area leading off from the dining room. There is a bathroom, which has an assisted bath and a shower situated on the ground floor. Single Bedrooms that are mainly of generous proportions are provided for the residents on two floors, a stair lift has been fitted to facilitate those with mobility problems access to the first floor. All bedrooms have ensuite w.cs. and wash-hand basins. There is a large paved garden to the front, which offers a sunny aspect for service users to sit in the summer. Situated in a quiet cul-de-sac just off the sea front in Worthing, the home is approximately half a mile from the town centre with all its amenities. The Registered Provider is Mr M.K. Dulloo who also manages the home. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of the two inspections (minimum) that an inspector must make in a year. On this occasion this inspection was announced and took place at 16:30, in order for the Inspector to see the residents’ afternoon and evening routines. At this inspection those standards not inspected on the previous inspection were assessed. Where standards have not changed from the previous inspections this report records that the findings were the same. Prior to the inspection a questionnaire had been sent to the registered manager and information from this has been used in the report. Feed back surveys had been given to residents, relatives and other visitors to the home to allow them to comment on their opinions of the care home. Ten have been received back from residents – seven from relatives. All were positive in their comments regarding the service that Westdene provides. “I spent one week at Westdene and I couldn’t have been treated with more kindness”. At the Inspector’s time of arrival the residents were just finishing their evening meal and were being helped to their chosen place for the evening. Most opted to go to their own rooms and watch television. As it was later in the day there were no visitors to the home during the inspection. The residents spoken to during the course of the inspection confirmed that they were satisfied with the care that they got. One person said “ I don’t think I could do it better” another “ I enjoy being here very much”. Observation of the body language of those residents who were unable to give the inspector verbal opinions confirmed that they were content and comfortable with their surroundings and the carers supporting them. The staff members were seen to be discreet and deferential in their interaction with the residents. A tour of the home took place. Staff and care records were inspected as well as the Home’s Statement of Purpose, Service Users Guide and some of the Policies and Procedures. All of the staff on duty, and most of the residents were spoken to during the course of the inspection. Two requirements and one recommendation have been made following this inspection. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? Individual care-plans and files and other administrative systems have been re organised. Staff information is collated into individual files and all confidential information is stored in a secure location. A new cook has been employed. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2.4. All prospective residents, or their representatives, have a number of opportunities to make an informed choice about whether Westdene can provide the care they need and each service user admitted is provided with a written contract/statement of terms and conditions. Prior to admission a senior member of staff would undertake an assessment of need. Prospective service users, their relatives and friends have opportunities to visit and assess the suitability of the home. Intermediate care is not provided. EVIDENCE: Westdene has a comprehensive Statement of Purpose and Service User Guide. All prospective residents, their families and their Care Managers are given a copy at the time of enquiry and a copy has been given to the Commission for Social Care Inspection. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 10 There was evidence of a preadmission assessment of need, this was recorded in a central record book and the inspector pointed out to the manager that this information should be retained on each individual’s personal care file. Everybody concerned with the prospective resident is encouraged to visit the home as often as they like and a four-week trial period is used to allow the new resident to settle in and make sure that they are happy with the situation. All residents who have been admitted since the new ownership have been provided with a contract/statement of terms and conditions. However the inspector advised the registered manager that he should provide all residents with a new contract to reflect their changed circumstances. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9.11. Residents or their relatives/representatives are involved with the drawing up of their care plans, which contain detailed information of how the care and health needs of the residents should be met. The administration of medication is carried out appropriately and includes the opportunity to self medicate. From evidence gathered it would appear that the staff group respect the privacy and dignity of the people living at Westdene. EVIDENCE: Where residents are not able to be involved with the drawing up of their care plans, then the residents relative or advocate would be involved. All of the residents had a personal plan of care but the manager intends to change the format of presentation to a form that is easier for staff members to use and less complex. All of the residents spoken to confirmed that they considered that the staff members treated them with respect and observed their privacy. “They knock on my door before they come in” There are comprehensive policies concerning how to help someone dealing with grief, loss and bereavement and appropriate policies for the guidance of staff members. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The care plans contain a record of all the preferences and interests of the resident, which is facilitated by the staff group. Contact with friends, relatives and local community ties are encouraged. The home undertakes appropriate consultation with the residents. A wholesome and balanced diet is provided to the residents. EVIDENCE: All residents, relatives and friends were very complimentary about the staff group and the care that they or their relatives received. It was confirmed that the home facilitates opportunities for the residents to maintain their friendships and family ties. When asked the residents said that they were, in the main, content to continue with the quiet pursuits that they favoured such as reading and watching television. One resident was able to walk to the Marine Gardens next door and watch the Bowls matches Regular Saturday meetings over a glass of wine give the residents the opportunities to contribute to the decision making process. A new cook has been engaged and all residents bar one were complimentary about the meals provided. There is an eight - week menu with a wholesome Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 13 and varied diet. Vegetables and fruit are delivered twice weekly by a local greengrocer. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The residents or their representatives are sure that they can trust the home to protect them as far as possible from bad practice and unacceptable behaviour from others. EVIDENCE: Many of the residents would be able to complain and those spoken to were quite clear as to how to make a complaint if they needed to. The home has policies and procedures in place to ensure that action is taken if a resident or their representative was worried and a complaint book is provided to record any issue that might arise. The home has clear instructions for staff members as to what to do if abuse of a resident is suspected. The members of staff that were spoken to were aware of the correct procedure regarding the Protection of Vulnerable Adults (POVA) but had not been given any formal training in POVA . The recruitment files examined showed that all the checks to ensure proper security screening on all applicants had been carried out on those members of staff recruited since the home has changed ownership. The home has ensured that each person has an advocate and would ensure that all are supported to maintain their legal rights. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20.21.22.23 The home provides homely surroundings. It is mostly decorated and furnished to a reasonable standard and regular maintenance ensures the safety of the residents. As well as a choice of communal day space it provides each resident with an en-suite single room that has been furnished to meet their wishes and needs. Specialist equipment to support those with poor mobility is provided. There was a good standard of cleanliness. EVIDENCE: During the course of the inspection the majority of rooms were visited to make sure that the environment was safe and comfortable for people who live there. All rooms are single and have ensuite facilities. It was seen that many residents had brought personal possessions into the home, including small items of furniture, ornaments and photographs. Aids to mobility were provided to those that required them. There are small areas to the rear and fore of the home for residents to sit in the sun in the summer. On the day of inspection, Westdene was clean, and free from offensive odours. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 16 Risk assessments regarding the safety of the building were in place. Policies and procedures were available for staff about the control of infection, and the safe disposal of clinical waste. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28. Westdene has an adequate number of staff members with appropriate training and skills to provide competent care to the residents at all times. There are robust recruitment procedures in place. EVIDENCE: A random selection of staff files was looked at including the most recently appointed member of staff. All the required security checks had been carried out and evidence of identity and qualifications were available. However the manager had yet to obtain the verbal references in writing and was awaiting the outcome of the CRB application. The inspector reminded the manager that the care worker should not be allowed to work alone with the residents until the references and CRB had been cleared. Appropriate induction training had been undertaken with the newest members of staff. Other in-house training in service related topics had been undertaken by the remaining staff members. The Manager is undertaking the Registered Managers’ Award. The rota demonstrated that there was an adequate number of staff on duty at all times. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32.33.34.36.37. Residents 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 responsibilities fully. Systems are in place to protect and safeguard the residents. Formal supervision of staff members is not carried out. EVIDENCE: The registered manager has the skills and competence to discharge his responsibilities fully. He is undertaking the Registered Managers Award currently. Feedback from both residents and relatives indicate that Mr and Mrs Dulloo have provided an environment that is perceived as comfortable, safe, and run in the best interests of the residents. Policies and procedures are in place to ensure the smooth running of the home. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 19 Arrangements have been put in place to make sure that each individual or their representative manages their own finances. The manager facilitates one person to deal with his own finances and all records relating to that person were in order. A weekly get-together over a glass of wine is used as an opportunity to for residents to contribute to the forward planning of the home. The registered manager has not yet introduced a formal supervision system for the care staff but carries out an ad-hoc ongoing monitoring of the standard of care. Records are in place that evidence that the health and welfare of the residents is safeguarded, this is further reinforced by the policies and procedures that have been introduced by Mr Dulloo for the guidance of staff members together with the Health and Safety training that the staff members have had. Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 x X 3 3 3 3 X X x STAFFING Standard No Score 27 x 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 3 x 2 3 x Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP2 OP36 Regulation 5.1.( c ) 18.2. Requirement Each person must be provided with a statement of terms or contract The registered person must provide appropriate supervision of care staff on a bi-monthly basis Timescale for action 31/03/06 31/03/06 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 Refer to Standard Good Practice Recommendations Written references must be obtained for all staff members Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westdene Residential Care Home DS0000061453.V268144.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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