Inspection on 30/07/08 for Westerley

This inspection was carried out on 30th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Westerley 15/03/07

Westerley 02/03/06

Westerley 18/08/05

Westerley 23/03/05

Westerley 25/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Westerley King Edward Road Minehead Somerset TA24 5JB Lead Inspector Kathy McCluskey Unannounced Inspection 30th July 2008 11:30 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 Westerley DS0000016017.V368364.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. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westerley Address King Edward Road Minehead Somerset TA24 5JB 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) 01643 702066 01643 708978 minehead@lwpt.org.uk The Leaders of Worship and Preachers Homes Mr Vaughan Clive Ogden Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated 21. Date of last inspection 15th March 2007 Brief Description of the Service: Westerley is a large detached property, set in spacious and beautifully maintained gardens. The home is situated close to the centre of Minehead, where there are all local amenities. The home is registered with the Commission for Social Care Inspection to provide care and accommodation for up to twenty-one people over the age of 65 years, who require assistance with personal care. The home is not registered to provide nursing care. The home also provides day care which is not regulated or inspected by the Commission. The Registered Manager is Mr Vaughan Ogden. The Registered Provider is Mutual Aid Homes trading as LPMA Homes. The home cares for people within a Christian community and accepts requests for assessment from all Christian denominations. A short Christian service takes place in the home each morning. Accommodation is provided over two floors. There is a passenger lift, two assisted bathrooms and a call system available. All areas of the home have been well maintained and furnished to a high standard. We were provided with information which identified the current fees levels as between £441 and £518 per week. All rooms have en-suite toilet facilities and an additional supplement of £7 per week is incurred for the provision of an ensuite with bath/shower. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 5 A rebate of £30 per person is given for married couples sharing a double bedroom. People meet the costs of personal items/toiletries, private chiropody, newspapers and hairdressing. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over one day (7hrs) by CSCI regulation inspector Kathy McCluskey. The registered manager and deputy manager were available for the majority of the inspection. We were given unrestricted access to all parts of the home and records required for this inspection were made available to us. We were able to speak with ten people living at the home and two members of the care team. The home completed an Annual Quality Assurance Assessment (AQAA) for the Commission. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Extracts from the AQAA have been incorporated within the report as appropriate. As part of this inspection the Commission sent comment cards to a percentage of people using the service, staff and healthcare professionals and we received one completed comment card from a healthcare professional and three from members of staff. Responses have been included within this report. We would like to thank all involved, for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: During this inspection there was no evidence that the home were not meeting the needs of the people living there and the management team and staff Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 8 demonstrated a good understanding of peoples’ needs and preferences. People living at the home told us that their needs were being met. Although this is positive, the home’s care planning systems/documentation do require improvements. We found that care plans did not always identify peoples’ needs and information for staff as to how the needs should be met were insufficient to enable them to ensure a consistent and person centred approach to care. The home need to ensure that care plans are developed from appropriate assessments such as moving and handling, nutrition and risk assessments. The home need to review the current ‘generic’ care planning documentation as this gives limited information and does not promote individualised care. Some of the wording on the generic care plans is inappropriate and needs to be reviewed and removed. We were able to see evidence that people have access to appropriate healthcare professionals but care plans need to be in place to fully reflect any current healthcare needs. Again, these need to contain detailed information for staff. Given the psychological needs of some people currently at the home, the home need to ensure that staff have the skills to meet these peoples’ needs. It has been recommended that staff are provided with appropriate training in dementia care. Appropriate care plans also need to be in place to ensure individuals’ needs can be met in a consistent manner. Formal activities are limited but nobody living at the home expressed concerns about this. It has been recommended that consideration is given to enabling all people at the home to have the opportunity to attend social events within the home and to access resources within the local community. The registered manager informed us that from August 2008, an additional carer will be on duty during the morning and that their role will be to facilitate activities for people. Progress will be followed up. Meals were noted to be attractively presented but the home need to ensure that this is the case for soft diets. During this inspection we observed the cook preparing a soft diet and that ingredients had been blended together and served in a pudding bowl. We recommended that ingredients are served separately to enable individuals to distinguish different tastes. This should be attractively presented on an appropriate plate. Staffing levels appeared appropriate to the current needs of the people living at the home. The home does need systems in place to ensure that staffing levels continue to remain appropriate. This could be achieved by regularly reviewing dependency levels of the people at the home. People would benefit from an increase in care staff time if the home ensured that domestic and catering staff were on duty over the weekend period. Currently, cover is only provided during the week and catering and domestic duties are undertaken by the care staff at the weekend. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 9 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. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 10 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 Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 11 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 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home ensures that people are fully assessed prior to a placement being offered. People are given the opportunity to ‘test drive’ the home before making a decision to live there. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide, which give information about the home and services offered. We were told that there had not been any changes to these documents since the last inspection. These documents were therefore not re-examined at this inspection. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 12 People thinking about moving to the home are assessed by the registered manager and the deputy manager to ensure that the home is able to fully meet the assessed needs of the individual. Assessments from healthcare professionals are obtained where available. The home’s completed AQAA states; ‘Prospective service users are encouraged to visit the home with their family members prior to a pre-admission assessment’ ‘The manager and deputy visit prospective service users in their own home or in hospital in order to make a comprehensive assessment of their needs’ ‘We often have to decline if we feel that we can’t provide the care that they need’ ‘We offer respite care if people are not sure if they are ready to make the commitment and this allows people to make a more positive decision as to residency or not’. Admission is then offered on a trial period of one month. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 13 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 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff are aware of peoples’ needs and people feel that their needs are met, but the home’s care planning systems require improvements to ensure that care needs are clearly identified with clear instructions for staff so that care is delivered in a consistent manner. Care plans also need improvements to ensure that they enable staff to deliver a person centred approach to care. The home follows satisfactory procedures for the management and administration of peoples’ medication. The home ensure that people are treated with respect and that their right to privacy is upheld. EVIDENCE: Four care plans were examined at this inspection. Two related to people with more complex needs such as dementia and diabetes. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 14 Care plans did not contain any assessments such as moving and handling and nutrition. No assessments were in place from healthcare professionals and it was therefore difficult to ascertain how care needs had been established. The home uses a generic care planning format which uses headings such as ‘washing and dressing’, ‘bladder’, ‘behavioural’ and ‘psychological’. Under each heading are ‘multi-choice’ options, which can be highlighted. This system does not detail how staff are expected to meet the individuals’ needs and does not take into account their wishes/preferences. There was no evidence that the individuals’ and/or their representatives had been involved in the care planning process. The current care planning system does not promote a person centred approach to care and does not contain sufficient information about a person’s assessed need and there are no instructions for staff as to how each assessed need should be met. Some examples are as follows; In one care plan, under the heading of ‘communication’, ‘severe limitations’ had been highlighted with a written entry stating; ‘very confused and has difficulty making self understood’. No further information had been recorded and there were no instructions for staff as to how this should be managed. There was no care plan for this person in relation to their dementia. The current care planning documentation identified only that this person needed ‘constant care’ No further information had been recorded. The care planning documentation must be reviewed as some of the headings and ‘multi-choice’ options contain inappropriate wording. Some examples include; ‘Anti-social behaviour’, ‘attention seeking behaviour’ and ‘manipulative behaviour’. A very basic risk assessment was in place for a person who was at risk of falls. The action recorded to reduce the risk of falls stated; ‘unable to restrict movement so deemed to be acceptable risk’. No moving and handling assessment was in place and under the care plan heading of ‘moving and handling’ it had been recorded; ‘encourage to use frame’. In summary, there was no plan in place to reduce the risk of falls. We were able to see that the individual had access to appropriate healthcare professionals. The home maintains a separate record for people’s contact with healthcare professionals. We noted that one individual had been seen by a district nurse in May 2008 after a sore had been noted on their leg. Records indicated that the district nurse visited on a regular basis to dress the leg. The most recent entry recorded as 28/07/08 when she ‘redressed legs’. We examined the care plan for this person and noted that it contained no reference to this. We examined the care plan relating to a person who required insulin to manage their diabetes. We had previously been informed that the individual administered their own insulin and that staff checked the person’s blood sugar levels twice a day. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 15 The care plan documentation in place was the same as previously mentioned. The front sheet of the care planning documentation stated that ‘blood sugar readings are historically erratic’. The only information available to staff was action they should take if readings were above or below certain readings. There was no further information for staff to follow should the individual not respond to intervention and there was no information for staff on the signs and symptoms of hyper or hypoglycaemia. The care plan did not reflect the fact that the individual administered their insulin or how this should be reviewed/monitored by staff. There was no reference to the fact that staff were required to check the person’s blood sugar levels twice daily. Under the heading of ‘feeding’, for this person it stated; ‘Type 1 diabetes. Needs special diet’. No further information had been recorded so it is not clear how staff would be aware of what was meant by ‘special diet’. Records were available relating to the individual’s weight. Only two entries were available for 2008, which related to May and July. During this period, the individual had lost 5 pounds. There was no evidence that systems were in place to monitor this and no care plan was in place. Weight records were only available for the two months identified above and we noted that on both occasions, not all people had been weighed. It has been recommended that peoples’ weights are monitored on a monthly basis with systems in place to alert staff to any significant weight loss or gain. Care plans should be raised to address any concerns. Daily entries are maintained for each individual. It is recommended that night staff also record entries as to the well being of people during the evening/night. One entry made by the day staff stated that the person had slept during the morning as they had a ‘bad night’. Although improvements are required in the home’s care planning procedures, it was evident, through discussion with two staff on duty, the registered manager and deputy manager, that all had a very good knowledge as to the needs and preferences of people living at the home. This was also confirmed by the ten people spoken with during the inspection; ‘I have the help and care that I need’, ‘The staff are kind and helpful’, ‘Staff are very kind and helpful, obliging and attentive’. Neither staff member spoken with had received training in dementia care. Although the home is not registered to accommodate people with dementia, given the needs of three identified people, it has been recommended that the registered person arranges appropriate training in dementia care for staff We examined the home’s procedures for the management and administration of peoples’ medication. The home uses the Boots monitored dosage system (MDS) with pre-printed medication administration records (MAR). We checked all available MAR charts and found them to be appropriately completed. Photographs were in place for each person to aid identification. We were Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 16 informed that nobody at the home was currently prescribed a controlled drug. We were informed that only senior staff who have received training, administer medication. We spoke to ten people using the service during this inspection and without exception, all commented on the kindness of staff and stated that staff treated them with respect and that their privacy was respected. We were able to see that people’s post had been left for them to open. We noted that interactions from staff were kind and respectful and it was evident that people were referred to in their preferred form of address. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Limited social activities are provided and this area could be further improved to enhance outcomes for all people living there. People are provided with very good opportunities to fulfil their spiritual needs. People are able to choose how and where to spend their day. Meals are freshly cooked in the home and people are offered choices. The presentation of soft diets need some improvement. EVIDENCE: We were informed that activities are currently organised by care staff. The registered manager stated that in August the number of care staff on duty during the morning would be increased to three to allow one member of staff to be responsible for activities. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 18 The home’s completed AQAA stated; ‘Entertainment is provided by our very able social committee during the autumn and winter months which is varied and very well received’ ‘During the summer months regular activities are provided and we have quizzes and word games – we have jigsaws, scrabble, cards and DVD’s’. We were informed that each weekday morning, a small religious service is held for people. This is led by either staff, people living at the home or visiting preachers. The home’s completed AQAA states; ‘People are able to choose to attend church every Sunday and free transport is provided for two churches’. During the inspection we were provided with a programme of activities for July and August, which is displayed in the home for the people living there. This identified a selection of activities arranged for a Wednesday. Activities listed included a quiz night, scrabble, memory box, word games and indoor darts. We spoke to ten people during this inspection and asked them about the activities on offer. The general consensus was that they were ‘quite satisfied’ with the in-house activities. Some people stated that they preferred to ‘do their own thing’ rather than join in with the activities. ‘There is plenty going on if we want it’. A number of people were keen to tell us about the forthcoming outing to Triscombe where they are going for a cream tea. We were informed that this was an annual outing which was organised and funded by the church. Many of the people spoken with were able to access the local community either independently or with friends. One person told us that they enjoyed going to the library and that ‘the bus stops right outside of the home’. Many people were observed ‘coming and going’ throughout the day. Some people said that they were dependant on staff to assist them to access the community; ‘we don’t get to go out on trips but staff will always help me to an appointment’, ‘I don’t mind if I don’t get out, the gardens here are so beautiful’. We did not observe any activities taking place during this inspection. Staff record any information on the daily record sheets. These contain basic information about how the individual has been during the day and what they have done. Outcomes for people could be measured by the home if they maintained a separate record relating to activities/social contacts. This should provide information about the activity/social contact and should include a recorded outcome; i.e.: did the individual enjoy the event etc. The home should also ensure that they obtain a social/life history for people so that staff are aware of people’s social interests and preferences. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 19 In comment cards completed for the Commission and under the heading; ‘How could the home improve?’ we received the following comments; ‘Provide more outside activities, organised day trips and trips to local resources’. The home’s AQAA stated; ‘People are able to accept visitors if they choose, at any reasonable time and in private’ People spoken with during this inspection confirmed that their visitors were made to feel welcome and that they could choose where to see their visitor. The home provides visitors with meals as requested and a list of charges are clearly displayed in the home. To comply with fire regulations, all visitors to the home are required to sign the visitors book on arrival and departure. People told us that they could choose how and where to spend their day. This was evident during the inspection. People were observed moving freely around the home, with some preferring the privacy of their own bedrooms. People confirmed that they choose what time they wish to retire to bed or get up in the morning. They told us that ‘staff will wake you up with a cup of tea in bed in the morning if you wish’. People spoken with appeared very contented with their life at the home. We asked each person spoken with how life at the home could be improved. No comments were received. Meals are freshly prepared and cooked in the home’s kitchen. The home employs a cook. The kitchen appeared well equipped and clean. Staff in the kitchen were observed wearing appropriate protective clothing. The home’s dining room is spacious and very comfortably furnished. We noted that tables were very attractively laid and that there was great attention to detail. People were alerted to lunch being served by the ringing of a hand bell. We observed people making their way to the dining room in a relaxed manner. When all were seated the registered manager said grace. People are able to help themselves from the serving dishes provided on each table. People told us that the food was; ‘very good and very plentiful’, ‘We are always offered a choice and the staff ask us each morning’, ‘We have milky drinks and snacks in the evening if we want it’. The home need to improve the presentation of soft diets to enable people to distinguish different tastes. Currently the home are blending the main meal together and serving in a dessert bowl. The home should also consider obtaining divided plates rather than using a bowl. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 20 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 Good. This judgement has been made using available evidence including a visit to this service. The home has effective systems in place which enable people to raise concerns. The home has procedures in place to ensure people are not placed at risk of harm or abuse. EVIDENCE: The home displays a complaints procedure which clearly identifies the processes to be followed. This needs to be updated to reflect the new contact details of the Commission in Bristol. The home’s completed AQAA told us that the home had received one complaint since the last inspection, which had been appropriately investigated. No complaints have been raised directly with the Commission. We spoke to ten people during this inspection and all confirmed that they would not hesitate in raising concerns if they had any. We were told that the management and staff were ‘very approachable’ People also told us that the registered manager encouraged their views through regular meetings. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 21 The home confirmed that it has a range of policies and procedures available to staff relating to the protection of vulnerable adults. The registered manager confirmed that the home had an up to date copy of Somerset’s Safeguarding Adults Policy which is made available to staff. The home’s recruitment procedures are robust and include checking prospective employees with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults Register (POVA). We spoke to two staff and both confirmed that they were aware how to raise concerns through the whistle blowing policy. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 22 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, 22, 23, 24, 25 & 26 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People live in a home which is well maintained and comfortably furnished. The home promotes a homely feel and people are able to personalise their bedrooms. People have access to large and beautifully maintained gardens. The standard of cleanliness is good and the home has procedures in place to reduce the risk of the spread of infection. EVIDENCE: During this inspection we randomly viewed five bedrooms, all bathrooms and all communal areas. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 23 All areas seen were noted to be decorated and furnished to a very good standard. People were observed utilising all areas of the home and the atmosphere was very relaxed. The home promotes a ‘homely’ feel. People were keen to tell us about the gardens; ‘The gardens are absolutely beautiful and there are some lovely walks and even people in wheelchairs can access them’, ‘I love spending time in the garden, it is so beautiful’. After lunch many people chose to sit in the ‘garden room’, which looks out on to the beautifully maintained gardens. Grab rails are appropriately sited throughout the home to assist people to mobilise. The home has a passenger lift, which is large enough to take a stretcher, which gives access to the first floor. The narrow corridors on the first floor may prove difficult for people in wheelchairs. We were informed that there were no people currently living at the home with this level of mobility difficulty. The home has one mobile hoist which is only used to assist people who have fallen. We were informed that there was nobody at the home who required the use of a hoist to transfer. The home has two unassisted bathrooms and two bathrooms which have an assisted bath and level access shower facilities. A call bell system is installed throughout the home to enable people to summon staff assistance. People spoken with told us that the did not need to use this facility but were confident that staff would respond if they did. People told us that they were ‘very happy’ with their bedrooms. Bedrooms seen at this inspection were very comfortably furnished and it was evident that people are able to personalise their rooms to their own taste. People told us that staff respect their privacy and that they ‘always knock before entering’. People also said that they could lock their bedrooms if they wished. They also told us that they had lockable storage in their rooms for any personal items. We were able to see that windows on the first floor had restricted openings to ensure that people were not placed at any risk. Wardrobes are secured and radiators are a low surface heat type to ensure the safety of people living there. On the day of this inspection, all areas of the home seen were very clean and fresh smelling. People told us that the home was ‘always clean’. We were able to see that staff hand washing facilities had been appropriately sited throughout the home. We also saw a good supply of plastic aprons and disposable gloves for staff. Kitchen staff were also noted to be wearing appropriate protective clothing. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Current staffing levels appear appropriate to the needs of people living at the home though this should be kept under review. Arrangements need to be made to ensure that adequate domestic and catering staff are available to cover a seven day period. The home follows robust staff recruitment procedures. The home ensures that staff are appropriately trained though staff would benefit from some training in dementia care. EVIDENCE: At the time of this inspection, 20 people were living at the home. The registered manager informed us that current staffing levels were as follows; 0700-1430hrs – 2 carers 1400- 2130hrs - 1 assistant manager and 2 carers 2100 – 0700hrs – 1 senior carer and 1 carer – both waking. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 25 The registered manager stated that he and the deputy manager worked a ‘shift pattern’ doing the week and that they were in addition to the allocated care hours. In addition to care staff, the home employs three domestics who work 08301130hrs Monday to Friday. The registered manager stated cleaning duties were undertaken by the care staff at the weekend. We were also informed that the home employs one cook who works weekdays only and that care staff are also responsible for the preparation, cooking and serving of meals at the weekend. Night staff are responsible for attending to peoples’ laundry. Serious consideration should be given to reviewing the domestic and catering hours to provide adequate cover over a seven day period given that there are only two care staff on during the morning and three in the afternoon. As previously mentioned, the registered manager advised us that as from August, care staff will increase to three in the mornings to allow staff more time for activities. The registered manager stated that due to last minute staff sickness, they have ‘on occasions’ worked with one carer at night with both the registered manager and deputy (who live on site) on call. We were informed that the manager’s accommodation is linked up to a call system which can be easily accessed by the staff. The registered manager confirmed that all night shifts in August were adequately covered. We discussed the appropriateness of one member of staff at night. We were informed that there were currently no people at the home who required assistance at night. We spoke with two members of staff, one of whom had worked nights at the home. Both confirmed that staffing levels were ‘not a problem’ and that ‘we are able to meet peoples’ needs’. We spoke with ten people at living at the home and they did not express any concerns about staffing levels at the home during the day or at night’ One person said; ‘The night staff always come up and say hello when they come on duty, to check we are alright and to let us see who is on duty’. ‘The staff are wonderful and will do anything for you’, ‘They are very kind and willing’ ‘I feel very well cared for’ Three members of staff completed comment cards for the Commission and in response to the question; ‘Are there enough staff to meet the individual needs of all the people who use the service?’ all responded ‘usually’. We received one additional comment; ‘We have good staffing levels but sometimes there is the usual holidays and sickness but overall we have plenty of staff’. We advised the registered manager that it was his responsibility to ensure that staffing levels were reflective of the dependency levels of the people living at the home. He acknowledged this and confirmed that staffing levels would be increased as required. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 26 As there was no evidence at this inspection that people’s needs were not being met by the numbers of staff on duty, a good practise recommendation has been made that the registered person regularly reviews dependency levels and increases staffing levels as appropriate. The completed AQAA provided us with information which confirmed of the 15 permanent care staff employed, 10 have obtained a minimum of an NVQ level 2 in Care. This equates to 67 which exceeds the 50 recommended in the National Minimum Standards. We examined two staff recruitment files at this inspection and found them to contain all required information including evidence of an enhanced criminal record check (CRB) and protection of vulnerable adults check (POVA). We were able to see evidence that newly appointed staff follow a 12 week induction programme which follows the Skills for Care Common Induction Standards. We met with two members of staff during this inspection and both confirmed that they had received a thorough induction programme. Both stated that they felt they had received all the training necessary to meet the needs of people living at the home. Both confirmed that they were never asked to undertake a task that they hadn’t been trained to do. It was established that staff felt that they would benefit from some training in dementia care. It has been recommended that appropriate training in dementia care is arranged. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 27 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 & 38 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home has effective management systems in place where the views of people living there are sought. The home has effective systems in place to ensure the health & safety of persons at the home. EVIDENCE: Staff and people spoken with during the inspection were very complementary about the registered manager Mr Ogden. All confirmed that they found Mr Ogden ‘very supportive’ and ‘very approachable’. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 28 Mr Ogden is supported by a deputy manager and through discussions and observations, it was apparent that both have a very good knowledge and understanding of the needs and preferences of the people living at the home. People living at the home told us that they had regular meetings where the registered manager ‘encouraged their views’. People told us that they felt ‘listened to’. We were provided with minutes of the most recent meetings and contents confirmed the comments made. Regular meetings are held for staff and staff told us that they felt well supported. Three staff members completed comment cards for the Commission and all responded ‘Regularly’ to the question; ‘Does your manager meet with you to give you support and discuss how you are working?’, ‘The manager is very easy to approach to discuss our wok as well as him talking to us’ ‘I feel I get plenty of support with everything’. We were able to see that the quality of the service provided is regularly monitored through the required ‘Regulation 26’ visits. Copies of monthly reports were made available to us at this inspection. We were informed that the home manages small amounts of money on behalf of people who have requested this. The registered manager confirmed that he does not act as financial appointee for any person at the home. We sampled records relating to financial transactions and found them to be well maintained. Two staff members sign to confirm transactions and receipts are obtained. We examined the following records relating to the home’s procedures relating to health and safety. We also toured the premises and spoke to staff. FIRE SAFETY – The home maintains records which indicate that appropriate in- house procedures are followed to ensure the home’s fire alarm system remains in good working order. Systems are serviced annually by an outside contractor. The AQAA completed by the home stated that an up to date fire risk assessment was in place. We did not examine this document at this inspection. Staff confirmed that they had received up to date training in fire safety. Training records seen also confirmed this. GAS SAFETY – The home has an up to date annual Landlords Gas Safety Certificate dated 31/10/07 EQUIPMENT SERVICING – We were able to see that the home’s bath hoists, lift and mobile hoist had been serviced on a six monthly basis in accordance with required LOLER regulations. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 29 REDUCING THE RISK OF SCALDS Bath hot water outlets have been fitted with thermostatic valves to ensure that water is delivered at a safe temperature. We were able to see evidence of regular temperature checks. Radiators are a low surface heat type. Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 30 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 “ ” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 31 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. Standard OP7 Regulation 15(1) Requirement The registered person must ensure that care plans are drawn up following appropriate assessments and that they reflect all assessed needs, including psychological needs. Care plans must contain sufficient information for staff to enable a consistent approach to care. The registered person must ensure that each individual and/or their representative are given the opportunity to be involved in their care planning and review process. The registered person must ensure that detailed assessments and care plans are in place to ensure that peoples’ healthcare needs can be fully met in a consistent manner. This relates to the management of diabetes, falls and wound care. Timescale for action 10/09/08 2. OP7 15(2)( c) 31/08/08 3. OP8 13(4)( c) & 15(1) 10/09/08 Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 32 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. 4. Refer to Standard OP7 OP7 OP8 OP12 Good Practice Recommendations It is strongly recommended that the home’s care planning systems are reviewed in relation to some of the terminology used. Night staff should record any information pertaining to a person using the service, on the daily record sheet. The home should ensure that people are weighed on a monthly basis and systems should be in place to alert staff to any concerns. The range of social activities available to service users should be reviewed. This was recommended at the last inspection. Consideration should be given to this to ensure that all people at the home have the opportunity to attend social events within the home and to access resources within the local community. To ensure better outcomes for people, the home should obtain a social/life history for people and should also maintain records for each individual relating to any social event/contact. The home should ensure that soft diets are attractively presented so that they look appetising and allow the person to distinguish different tastes. The registered person should ensure that the dependency levels of people living at the home are regularly reviewed and that staffing levels are increased as appropriate. The registered person should ensure that staff are provided with appropriate training in dementia care. Serious consideration should be given to increasing domestic and catering hours to ensure that adequate cover is available over a seven day period. It is recommended that staff supervision should conform to National Minimum Standards. This was raised at the last inspection and was not assessed at this inspection. 5. OP12 6. 7. 8. 9. 10. OP15 OP27 OP27 OP27 OP36 Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Westerley DS0000016017.V368364.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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