Inspection on 25/10/07 for Westdene Residential Home

This inspection was carried out on 25th October 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Westdene Residential Home 02/11/06

Westdene Residential Home 24/01/06

Westdene Residential Home 13/09/05

Westdene Residential Home 22/07/04

Westdene Residential Home 03/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Westdene Residential Home 15-19 Alliance Avenue Albert Avenue Hull East Yorkshire HU3 6QU Lead Inspector Beverly Hill Key Unannounced Inspection 25th October 2007 09:30 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 Home DS0000000875.V353654.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. Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westdene Residential Home Address 15-19 Alliance Avenue Albert Avenue Hull East Yorkshire HU3 6QU 01482 506313 01482 573985 westdene@westdene.karoo.co.uk 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) Mrs Margaret Every Mrs Heather Burns Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2006 Brief Description of the Service: Westdene is a large and extended Victorian House in Hull close to local shops and amenities and on a bus route into the town centre. The home provides care and support to thirty older people with a broad range of needs including dementia. The home has two floors serviced by a through floor lift and stairs, one set of which has a chair lift. The home has twenty-six single bedrooms and two shared rooms. Fifteen of the bedrooms are en-suite. The proprietor has plans to convert one of the shared bedrooms and an adjoining single bedroom into three single rooms of equal size. There are two bathrooms upstairs and a bathroom and shower room downstairs. There are ample toilets throughout the home. The home has two lounges and a large dining room set out with individual tables to seat four to six people at each. There is a monitor in the dining room to alert staff to visitors at the rear of the building. The proprietor has plans to convert one corner of the dining room into a sitting area. The home also has a pleasant quiet area on the landing with chairs, occasional tables and a television. The home has an enclosed garden, a patio area and a car park to the rear of the building. According to information received from the home on 25.10.07 their weekly fees range between £327.50 and £369.23 The home has a £20 a week top up fee. Items not included in the fee are hairdressing and newspapers if people prefer alternatives to the one provided. The manager confirmed that the proprietor paid for service users to have chiropody care. Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 2nd November 2006 including information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to people to gain a picture of what life was like for them to live at Westdene and analysed the surveys returned from them. We also had discussions with the registered manager, the proprietor, care staff members and a visiting professional. Information was also obtained from surveys received from staff members, relatives and a visiting professional. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. What the service does well: People live in a clean and homely environment that is well maintained. Most people had their own bedroom with their own possessions around them. The proprietor is always thinking of ways to improve the living arrangements for people. People liked living at the home, ‘I am very happy at Westdene, I have lived here for two years’, ‘I have a very clean bedroom, I’ve lived here four years and never had a problem, it’s a lovely home’ and ‘I was a little upset at leaving my home but now I’m here I wouldn’t want to live anywhere different’. One relative said, ‘the home was recommended to me by several people because of all the good care that residents receive’. Visitors to the home are welcomed at any time. People told us they really liked the food provided by the home. Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 6 The majority of staff have worked at the home for many years and know the service users well. They told us they liked working at the home. People were complimentary about the staff, ‘they are all lovely’ and ‘the staff listen when my speech is bad’. The home employs an activities coordinator and activities and outings arranged for people are free of charge. The proprietor pays for any transport for outings. The proprietor pays for chiropody treatment for all service users. Although there were some training gaps the proprietor was committed to ensuring the staff team have the required skills. This was reflected in one of the standards related to training. Homes have to aim for 50 of care staff trained to national vocational qualification level 2 and 3 in care. Westdene has 58 of staff trained to this level so has exceeded the standard. Staff were supervised and supported by management. What has improved since the last inspection? What they could do better: Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 7 When the manager completes the homes assessment of peoples needs they must sign it and make sure the service user or their relative signs. This will show that they have been consulted and have participated in the assessment. Also the assessment could have more information about how the person’s problems affect them. When care plans are written from the assessments they must have clearer information for staff about the tasks they need to do otherwise care that is needed might get missed. They also need to be updated properly when situations change. Some people have risks that have been identified such as falls, risks of developing pressure sores or bedrail use. These need to be assessed thoroughly and have clear guidance for staff in how to minimise them. The home has standing scales and has obtained a new hoist that is able to weigh those people unable to stand. Staff members need to make sure this equipment is used and people are weighed monthly to keep a check on fluctuations in weight so professionals can be contacted quickly. The staff must make sure that when creams are administered to people this is recorded. One person manages to self-medicate a part of their medication. This is really good in making sure they remain independent but it needs to be managed properly and agreed with the person how it is to be supervised. The manager and staff could try to reduce the high noise level in the home, which mainly comes from loud and excessive doorbell use by visitors to the home. The homes recruitment of new staff did not follow policies and procedures and some staff were employed before full checks were completed. Good recruitment is really important to ensure only appropriately checked staff members are employed to care for vulnerable people. Although staff had access to training there were some staff that had not completed important mandatory training such as moving and handling. This was really important to make sure staff had the required skills when using equipment or special moving and handling techniques. Although a log was maintained of who had completed courses a training plan needs to be developed of future training courses arranged. The manager must make sure improvements are made in some areas of management such as recruitment of staff, managing situations that pose risks and making sure the Commission are made aware of any incidents affecting peoples welfare. Westdene Residential Home DS0000000875.V353654.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. Westdene Residential Home DS0000000875.V353654.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 Westdene Residential Home DS0000000875.V353654.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): 3 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users funded by care management had assessments of need completed prior to admission and the home obtained copies of these. Those completed by the home did not have full information about the service user’s needs and could mean that important information for decision-making is missed. EVIDENCE: We examined four care files and all those people recently admitted had copies of the assessments carried out by care management and care plans formulated by them. These contained important information on which the home based their decision about whether they could meet needs. The home also completed their own assessments as the manager confirmed that situations could change quickly. These assessments contained basic details and could be built on with Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 11 clearer information as to how disabilities or conditions affect the person, thereby providing further guidance for the care planning stage. This would be especially relevant for service users who were privately funded and did not have the benefit of a care management assessment. Service users or their representative do not consistently sign the homes own assessments. This would have indicated some consultation and participation in the assessment process. They were also not signed by the person completing them, which was usually the manager. The home had produced a standard letter to use when informing people that having regard to the assessment their needs could be met in the home. However in the most recent file examined the letter had not been issued and the manager confirmed they would have been told this verbally. The home does not provide intermediate care services. Westdene Residential Home DS0000000875.V353654.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, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A lack of consistency and clarity with some areas of care plans means that they do not always contain all assessed information and do not always have clear tasks for staff. A lack of risk assessments in some areas means that not all health needs were adequately monitored. These two points mean that service users could be at risk of not receiving the full care they were assessed as requiring. EVIDENCE: We examined four care files and they contained information and assessments to enable staff to formulate care plans. The care plans, termed goal plans, had sections for identified needs, and the tasks staff had to complete to meet Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 13 them. Some of the goal plans reflected the need to respect privacy and dignity and promote independence, for example one referred to asking the service user to do tasks for themselves. Some of the goal plans were more thorough than others. There had been an improvement since the last inspection in one care plan examined. This was for a person with dementia care needs and there was clearer guidance for staff on how they were to support her. However some areas of need on goal plans had generic tasks for staff scripted onto each plan. For example, ‘offer the toilet regularly’ and ‘ensure a safe environment – risk assess’, ‘ensure regular bowels’, ‘cream pressure areas’, ‘ensure correct aids’ and ‘ensure correct continence aids’. This type of wording does not individualise care and give the required clear guidance to staff on how to support each individual with the particular need. Some of the goal plans did not include relevant information that was included in the care management care plan. As staff used the homes care plans for dayto-day use it was important that they reflected all the information professional assessors felt was important. Goal plans were reviewed monthly, however, one of the evaluation records examined stated no falls for the month of May but the accident record identified a fall, and for August it stated the care plan was up to date but the service user had had an admission to hospital. There was information resulting from his admission that should have been put in the care plan. There was evidence that staff completed monitoring forms for professionals in order to provide them with information they needed to make clinical decisions about care. Care files evidenced that people had access to a range of health care professionals and most health needs were met. The manager confirmed that they had a hoist that was able to weigh people and standing scales for more mobile people. However records of weight monitoring were sporadic. Weight monitoring needs to have a more consistent approach. Surveys from three visitors were happy with the care their relatives received, ‘they keep her clean and see to all her personal needs’ and ‘they take care of his physical problems’. The manager had completed some risk assessments for activities deemed to pose a risk to people but this was not consistent and some risk areas had not been addressed. For example, one service user had bedrails in place but a risk assessment had not been completed as to the reasons why they were considered to be the most appropriate form of support for the person. Another person had a clear risk of developing pressure sores, indeed they had been admitted to the home with one, which had cleared up, but a further sore had developed. Although they had a pressure mattress in place and the care plan stated they were to have two-hourly turns at night there had not been a risk assessment completed which would inform the care plan of all the tasks staff Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 14 needed to do to minimise the risk through a twenty-four period. The same care file had a safe working practices form that indicated the person was a low risk of falls but daily notes indicated they had sustained two recent falls and had poor mobility. The moving and handling assessment form didn’t link in to the care plan as the latter just stated, ‘ensure use of correct aids’. The accident records detailed another service user had several falls but a thorough risk assessment as to how staff were to minimise the risk was not in place. One health professional stated there had been a delay in referral to the falls clinic for one person. Staff members spoken with indicated that they had an understanding of how to provide care that maintained privacy, dignity, choice and independence, ‘we work to the care plan’, ‘they do what they want as long as they are safe and happy’, ‘we encourage people to walk about’ and ‘we knock on doors and close doors and curtains when we complete personal care’. Service users spoken with confirmed care was provided well, ‘the staff are all lovely’, ‘they look after us well’ and ‘yes they do respect your privacy and dignity’. There had been one issue highlighted in a survey that had compromised a persons’ privacy during treatment from a professional visitor. This was discussed with the manager to address with the specific staff members. The health professional will also bring any further issues directly to the managers’ attention. This did appear to be a one-off incident. Another professional visitor stated that the times they visited were organised with the home and they saw the person privately in their bedroom. The inspector observed staff members speaking to service users in a genuinely caring way. One staff member was discreetly observed quickly attending to a person who had fallen asleep with their arm hanging down over the side of their chair. They strategically positioned a cushion to support the persons arm and apologised for waking them in the process. The proprietor pays for chiropody treatment for all service users. Generally medication was managed appropriately. It was signed on receipt into the home, on administration and when returned to the pharmacy. Medication was stored in accordance with legislation, and stock control was managed well. However, when staff members transcribe medication onto the medication administration record the full manufacturers instructions must be completed with two signatures and topical products prescribed must be documented when administered. One person managed a part of their medication and whilst this was good in maintaining their independence, a risk assessment and care plan, indicating their ability to do this safely and what the supervision arrangements were, needs to be in place. Westdene Residential Home DS0000000875.V353654.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, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had flexible routines and promoted choice and individual decisionmaking. The meals provided were varied, well prepared and well presented. EVIDENCE: Since the last inspection the home had employed an activity coordinator and evidenced in a separate file what activities had been arranged and who had participated in them. The plan of activities was displayed on the notice board and people spoken with were happy with those arranged. Some people stressed they preferred not to join in and liked to remain in their bedrooms. One survey received indicated there were only activities to participate in ‘sometimes’ and another had ticked, ‘never’. There were no names on the surveys so we were unable to follow this up but it was mentioned to the manager to check out with the activity coordinator who keeps a record. There were several people with dementia care needs with whom the activity coordinator tended to provide one to one support. Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 16 The manager confirmed that the proprietors were generous in paying for all outings and providing transport. She gave an example of a service user transported in a taxi to the coast, as they were unable to access the arranged minibus. Service users spoken with stated their visitors could come at anytime and could be seen in private. They confirmed that there were no set times for rising or retiring, ‘I please myself’, and daily records evidenced instances when people had decided to go to bed late or have a lie in. Staff were clear about how they supported people to make their own decisions and again daily records reflected choices and preferences. These could be identified more in care plans. Staff spoken with were conscious that some service users with memory impairment were not able to make a lot of choices but they stressed they tried to assist this as much as possible. Two people commented on the noise the doorbell and service user call bells made throughout the home, indeed the level of noise within the home was high and impacted on what could be a relaxed atmosphere. We observed and heard visitors pressing the doorbell six and seven times in quick succession and, as the doorbell and call bells were designed to be heard throughout all communal areas and bedrooms, they were very loud. One person said, ‘the bell is noisy, people keep their finger on it’, whilst another said, ‘the bells get on my nerves’. This was mentioned to the manager to investigate and seek a means of lowering the noise levels. There was also a comment made to us about the television, ‘it’s on all day and no-one really watches it’. Service users spoken with and surveys received were complimentary about the meals provided. People stated they had plenty to eat and drink. Comments were, ‘I’ve never had a meal I don’t like’, ‘we get plenty to eat, I like fish and chips on Fridays’, ‘the food is lovely, excellent, I like everything’, ‘I like the food, it’s very nice, you could have something else but I’ve not really asked’, ‘it’s really nice, the menu is on the notice board’, ‘its very good, you get plenty’. Seven of the eight surveys received from service users stated they liked the food, ‘always’ and the eigth person liked the food, ‘usually’. There were always choices at meals and menus were varied. There were plenty of staff around to assist people. The home was able to cater for special health diets, for example, diabetics and individual cultural preferences for others. Some people had their meals liquidised and these were done appropriately with each food group liquidised separately. The cook continued to visit new service users when they arrived to check on dietary requirements and it was suggested that they received assessment information from care staff to compliment this. Westdene Residential Home DS0000000875.V353654.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 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided an environment where people and their relatives felt able to complain. The home protected service users from abuse by staff training and adherence to policies and procedures. EVIDENCE: The homes complaints policy was on display in the entrance and staff were aware of how to record and action complaints. Four recorded complaints were minor in nature and were addressed appropriately. The complaint form in use could be improved to reflect the satisfaction of the complainant. Service users spoken with stated they would complain to the manager, some mentioning her by name, and seven of the eight surveys received from them stated they knew who to complain to or who to speak to if they were unhappy. However service users had not complained to staff about the noise of the door bell even though they told us it was loud. The manager did confirm that people were given the opportunity to discuss any complaints during regular meetings and reviews of their care plans. All three surveys from relatives stated they had no complaints. Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 18 Since the last inspection more staff had undertaken training in how to safeguard adults from abuse with the local authority and the manager confirmed all staff went through policies and procedures and an information booklet during induction The home had policies and procedures in place and the three care staff spoken with during the visit were clear they would report any incidents to the manager, would make sure the service user was alright and document the incident. The manager was aware of how to refer any allegations to the lead agency responsible for investigation. Westdene Residential Home DS0000000875.V353654.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, 20, 21, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a clean and comfortable environment for service users. EVIDENCE: The home continued to be maintained well and was homely in appearance. A new bathroom had been installed since the last inspection with a specialised bath, music system and soft lighting. The home had a schedule of planned work for the year, which included the re-decoration of some bedrooms and replacement of some furniture. Planned targets were met. The proprietor told us about plans to convert one of the shared bedrooms and an adjoining single bedroom into three single rooms of equal size. This indicated the proprietors’ responsiveness to service users requests as one Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 20 person that shared a bedroom told us during the visit, ‘I like living here, I share a bedroom but could do with a bigger room as I have lots of boxes’ and ‘I’d like a single room’. The planned refurbishment would address their current need and preference. Also there were plans to convert one corner of the dining room into a sitting area to provide more choice and quiet areas. The proprietor advised that one person in particular liked to sit in the dining room and a comfortable seating area would benefit them. Communal space consisted of two lounges, a quiet area on the first landing and a dining room set out with individual tables and chairs. Service users could access an enclosed garden and a further patio area. There was a monitor in the dining room to alert staff to visitors at the rear of the building. There were two bathrooms upstairs and a bathroom and shower room downstairs. There were ample toilets throughout the home. Bedrooms had been personalised to varying degrees and service users confirmed they were able to bring in small items to decorate their room. Only two of the bedrooms were shared and this was to be reduced to one in the near future. Most bedrooms had lockable facilities and keys were available. Generally the doors did not have privacy locks although the care file evidenced that service users were asked during admission if they required one. The manager confirmed that since the last inspection three doors had been fitted with privacy locks. The homes laundry consisted of three washing machines and two driers and was locked when not in use. One relative stated, ‘they keep her clothes clean’. Since the last inspection infection control measures had been improved in communal toilets with the installation of paper hand towel dispensers. A tour of the building showed that the home was clean and tidy. One bedroom had a slight odour but the manager was aware of this and was taking steps to address it. Comments about the environment from people spoken with and surveys received were, ‘it’s clean and smells nice’, ‘it could not be any cleaner’, ‘wherever I go in the home its very clean’, ‘the cleanliness could not be better’ and ‘the cleaners are very good’. One relative did comment that they thought some of the carpets could be replaced. However quotes had been obtained for refurbishing the main lounge including the carpet. Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 21 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, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had sufficient numbers of staff to support service users within the home and a high percentage of care staff had completed appropriate national vocational training. A lack of moving and handling training for some staff and out of date certificates for others could mean that staff do not possess sufficient up to date skills in how to move and handle people safely. Recruitment processes continue to lack the robustness required to protect people and could place service users at risk of being cared for by people who may be unsuitable to work with vulnerable adults. EVIDENCE: The home had sufficient staff on duty throughout the day and night. The home had five staff in the morning, four in the afternoon/evening and two at night. The manager and deputy manager were supernumerary. There had been several new staff employed since the last inspection although a core group of staff remained the same. Those spoken with enjoyed their jobs Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 22 and knew the service users well. There had recently been an occasion when the relationship between some care staff and a professional visitor had been strained. The manager was made aware about this during the visit and will discuss with staff to promote professional relationships. Comments from service users and surveys received from relatives were complimentary about the staff, ‘the staff are very nice, they really look after you and I like them all’, ‘they are really nice. I know it just sounds like I’m just saying it but I really mean it’, ‘they are lovely, ‘the staff are pretty good, they look after me well’, ‘one staff in particular gets her puzzle books’, ‘they talk to her and help her in every possible way’, ‘I am happy with the way my mother has been treated, and ‘they take care of my husband and have a laugh and a chat when possible as well as taking care of his physical problems’. Recruitment processes used to employ staff still do not meet the standard required. Three new staff files were examined and in two cases two references were in place. One only had one reference. It was a requirement from the last inspection that the home must have two references in place prior to employment of staff. Two staff had been employed prior to the completion of a check to see if their names were included in the protection of vulnerable adults register; one for three days and another for eight days. In exceptional circumstances it is acceptable to employ staff after the povafirst (register) check and before the criminal record bureau check has been received. The manager stated staff did not work unsupervised during their three month probationary period, however staff must not be employed before the home has received the initial povafirst check. Staff induction met skills for care standards. New staff members worked through tasks and evidence of progress was produced and signed off by senior staff or the manager. During induction staff were given the general social care council code of conduct and safeguarding adults procedures to go through. The home maintained records of staff training and there was evidence of participation in mandatory training and service specific training. A log was maintained of training completed and information given to the inspector indicated that the percentage of care staff having completed national vocational qualifications in care at level 2 and 3 was high at 58 . A further eleven staff were progressing through the course. This was a good achievement and reflected the level of commitment from proprietors, managers and care staff. It was noted on the training log that a number of staff had not completed moving and handling training or required updates. This was an important part of training and staff must have up to date skills to enable them to move and handle people safely. All but very new staff had completed fire training and fourteen staff, first aid. Staff that administer medication had completed accredited medication training and some staff had completed courses or Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 23 awareness sessions in topics such as dementia care, diabetes, nutrition and health, pressure area care and infetcion control. As the home provides support to people with dementia all care staff should receive training in this area. Nineteen care staff had completed training in how to support people when their behaviour is challenging. This was organised in response to surveys from health professionals that indicated staff would benefit from improving skills in this area. The manager needs to use the training records to develop a training plan of how shortfalls and updates are to be addressed. Westdene Residential Home DS0000000875.V353654.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): 31, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally the manager maintained a safe environment for service users and staff, however continued deficiencies in staff recruitment and some areas of individual risk management could place service users at risk. EVIDENCE: The registered manager had worked in social care settings for eighteen years and had completed a National Vocational Qualification in care in 2004 and the Registered Managers Award in 2005. Staff members spoken with and surveys received from them were complimentary about the manager and stated there was always time to discuss issues. Some comments were, ‘there is appropriate Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 25 management support for my needs’, ‘ the home is run very well and efficiently’, ‘brilliant, very direct and approachable’ and ‘gets things done and is hands on’. There was evidence that staff members were supported by the provision of regular supervision, which was an improvement since the last inspection. Staff members spoken with stated that supervision covered any concerns or problems they had, service user issues and training needs. One comment in a survey from a night care worker was, ‘I now only work nights but still have my staff supervision’. The home had a quality assurance system that consisted of questionnaires and some audits and they had been awarded Part 1 and Part 2 of the local authority Quality Development Scheme for care planning and quality monitoring systems. The surveys sent out to visitors to the home had been reviewed since the last inspection in order to gain more relevant information. There was evidence that the proprietor and manager had listened to, and acted on, suggestions made in surveys. Relatives or people themselves managed finances including personal allowances. Any personal allowance held on behalf of service users was stored securely and receipts obtained for any personal shopping completed for them. Individual records were maintained, although not inspected during this visit. People could have lockable facilities in their bedrooms to store items should they choose to. Generally the home was a safe place for people to live in and staff to work in. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarm tests completed. Staff had policies and procedures to guide their practice and safety posters were on display in the home. However some areas of management responsibility needed review including recruitment practices, risk management in some areas, ensuring mandatory training such as moving and handling was completed for all staff and ensuring that the Commission received notifications for incidents affecting the wellbeing of service users. One person had bedrails and protectors in place to prevent them from rolling out of bed. A thorough risk assessment must be in place that reflects up to date health and safety guidance and includes ongoing assessment of the need for them. A check of the bed rails needs to be built into regular maintenance checks Westdene Residential Home DS0000000875.V353654.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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 4 X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 31/12/07 2 OP3 14(1)(d) 3 OP7 15 4 OP7 15 The registered person must ensure the homes assessment documentation is completed thoroughly, and is signed by the individual it concerns or their representative, to evidence consultation and participation, and by the person completing it. The registered person must 31/12/07 ensure that the home formally writes to service users or their representative following assessment stating their capacity to meet the identified needs. The registered person must 31/12/07 ensure that care plans include all the required information, have clear tasks for staff and are evaluated thoroughly taking into account information written in other parts of the care file. This will ensure that staff members have full information, the care plans are updated when needs change and care is not missed. The registered person must 31/12/07 ensure that care plans are consistently signed by the service user or their DS0000000875.V353654.R01.S.doc Version 5.2 Westdene Residential Home Page 28 5 OP8 12(1)(a) 6 OP8 12 7 OP9 13 8 OP9 13 9 OP29 19 10 OP30 18 representative to evidence agreement and consultation and also signed by the person formulating it. The registered person must ensure that the methods of monitoring service users weights available in the home are used and consistent records are maintained. All health care needs identified as presenting a risk must have a risk assessment in place with clear steps to minimise the risk, and links to the care plan and other professionals as required. The registered person must ensure that service users who choose to self-medicate all or a part of their medication do so within a risk assessment and care plan framework. The registered person must ensure that when staff members transcribe medication onto the medication administration record the full manufacturers instructions must be completed with two signatures and topical products prescribed must be documented when administered. The registered person must ensure that when recruiting staff two references are obtained and povafirst checks are in place prior to the start of employment. Stringent supervision to be in place if staff are, in exceptional circumstances, employed after the povafirst check and before the return of the criminal record bureau check (previous timescale of 08/12/06 not met). The registered person must ensure that a training plan is produced that indicates training planned for the coming months DS0000000875.V353654.R01.S.doc 31/12/07 14/12/07 14/12/07 14/12/07 14/12/07 31/12/07 Westdene Residential Home Version 5.2 Page 29 11 OP31 8 12 OP38 13 13 OP38 37 to address shortfalls in mandatory training and updates (previous timescale of 31/12/06 not met). The plan must include dementia care training. The registered person must ensure that the registered manager updates her skills and knowledge in relation to staff recruitment and risk management. The registered person must ensure that a thorough bed safety rail risk assessment is in place that reflects up to date health and safety guidance and includes ongoing assessment of the need for them. A check of the bed rails needs to be built into regular maintenance checks The registered person must ensure that the Commission is informed of all notifiable incidents affecting the welfare of service users. 31/12/07 14/12/07 14/12/07 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 OP14 Good Practice Recommendations The manager should discuss with people that live in the home issues of noise levels from the doorbell, call bells and television and how this affects their quality of life, choice and decision-making. Take steps to address any issues arising from discussions and document them. Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Westdene Residential Home DS0000000875.V353654.R01.S.doc Version 5.2 Page 31 - 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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