Inspection on 13/06/06 for Westfield Care Home

This inspection was carried out on 13th June 2006.

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

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

Other inspections for this house

Westfield Care Home 30/05/08

Westfield Care Home 27/06/07

Westfield Care Home 29/11/05

Westfield Care Home 22/08/05

Westfield Care Home 14/02/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Westfield Care Home Devon Drive Mansfield Nottinghamshire NG19 6SQ Lead Inspector Jayne Hilton Key Unannounced Inspection 13th June 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westfield Care Home DS0000008773.V296661.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. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westfield Care Home Address Devon Drive Mansfield Nottinghamshire NG19 6SQ 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) 01623 427846 01623 429874 Lantraz Co. Limited Mrs Angela Jane Betts Mr Ahmad Ally Toorabally Care Home 45 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (37) of places Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 37 Residents shall fall within registration category OP. 8 Residents shall fall within registration category DE Date of last inspection 29th November 2005 Brief Description of the Service: Westfield Care home provided 45 bedrooms of which 11 are en-suite, providing long term, short term and respite care for older persons. Eight beds are reserved for service users with dementia needs. Situated on Devon Drive in Mansfield, the home was purpose built in 1985. The home has 3 lounges on the ground floor and three on the first floor, which includes a lounge for those service users who wish to smoke. There is a call alarm system throughout, with grab rails and assisted bathing facilities. There is a spacious dining room. Access to the first floor is by means of a lift. Information on fees were not obtained at this inspection. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulation Inspector Jayne Hilton undertook the unannounced inspection, on 13th June 2006. The main focus of the inspection was to assess the key standards. The methodology used included, the examination of three service users care plans and other related documentation. Two service users were spoken with at this visit, one relative and four staff members and Mr Toorabally, provider/manager. Mrs Toorabally joint provider was also present. A sample of records was examined, including accident records, the duty rosta, menus, complaints records and some policies and procedures. A part tour of the environment was included with a sample of bedrooms being viewed. What the service does well: What has improved since the last inspection? There are no aspects to report in this area from this inspection. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 7 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 Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally have the information they need and an assessment is carried out prior to them moving to the home. Service users and their representatives generally know the home they enter will meet their needs. The home does not provide an intermediate care service. EVIDENCE: A statement of purpose was seen in the home and service user guides are displayed in each bedroom, which inform service users of their terms and conditions of residence. Three care plans were examined; all were found to contain an assessment and included information on medication on admission, mental health and foot care. There is a section included to obtain information about the service users spiritual and religious needs but this should be expanded in relation to incorporating equality and diversity needs overall. There was evidence seen that relatives are involved in the assessment process, signatures of both the service user or their representative had been obtained in agreement, on most occasions. Extended community Care assessments Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 9 were also examined and care plans that were devised appeared generally to derive from the assessed needs of the service user. There was however no evidence of a contract or that the provider had informed the service user in writing that the home can meet the needs of individual service users and this is required by regulation. The provider stated that contracts were usually issued once the placement had been confirmed as suitable by the six weekly reviews. The provider is advised of the following regulation. (1) The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so— (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Service users spoken with praised the staff and management and stated that overall their needs were met. As the home provided eight beds for people with Dementia type needs, it is recommended that the registered person improves person focused care for people with Dementia and explore Dementia Care Mapping and environmental changes in relation to visual and colour cues and stimuli. It is also advisable to include a section within the assessment document on mental capacity in preparation of the implementation of The Mental Capacity Act in April 2007. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The service users’ personal and health needs are generally set out in a care plan and service users feel their needs are met. Some good practice recommendations have carried forward. Medication management appears satisfactory. Service users confirmed that their privacy and dignity was respected. EVIDENCE: Care plans were in place and most of those examined were signed by the service user and/or their representative. Care plans and risk assessments were noted to be generally up to date, up until May and were due for review in June The care plans generally indicate whether service users had been offered a bedroom door key or key to their lockable facility, which is signed by the service user or their representative, although some were noted not to have been completed at all. Service users reported that the health care needs of service users were well met. It was noted yet again that care is needed regarding follow-ups of blood test results, the inspector and providers felt that the system for follow ups for blood test results should be further improved, as very often reliance was on the medical practice to inform the home and therefore results/outcomes even Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 11 if tests were negative, were not always then documented and at risk of being overlooked. The district nurse is involved as required and provides support for those with pressure areas and continence and diabetes. Clear records of blood sugar readings are noted in the care records. Chiropody and other health checks are documented in care plans. It is suggested that separate sheets are used for chiropody, GP, dental, optical, district nurse and hospital visits. Where service users present challenging behaviour, care plans should be used in conjunction with monitoring tools and incident records kept separately. Appropriate risk assessments were in place regarding mobility, manual handling, and risk of falls, infection control, tissue viability and nutrition and the reviews of these were up to date. The manual handling assessments did not however reflect the risk to staff as required by the manual handling operations regulations 1992 and the provider is advised to ensure these meet with the regulations. Weight records were found to be generally satisfactory. Accident records were satisfactory. Bedrails are fitted to most of the beds and it was noted that staff had sometimes used them, thinking that this was in the best interests of the service users. The providers stated that there was not any service user with bedrails in situ currently and that staff have been reminded that they are only to be used with appropriate authorisation. The registered provider stated that if these are to be used bumpers will be provided. There was some entries noted in one service users care plan in the daily progress section that indicated that the service user had been found on the bedroom floor after a fall, but there was no record of any of the events in the accident book. Neither had there been any entries made on the evaluation record sheet for falls. The registered provider/manager stated that the matters will be looked into with staff to ascertain the full events and ensure that records were more accurately completed in future. There was an indication that a service user was not happy with the use of a pressure-relieving mattress as this made his bed too high. It is advised that the issue be fully discussed with the appropriate professionals in relation to meeting the service users needs. One service users care plan for tissue viability and pressure area care indicated that the service user needed to be seated upon a pressure cushion when sat in a chair but observation of the service user provided evidence that this was not being always followed. There was no pressure cushion in the vicinity and staff had to look around to find one. Another service users daily notes indicated some dis-inhibitive challenging behaviour, yet there was no care plan in place for this or any indication of how staff must deal with this in a consistent way. A staff member spoken with explained how she would deal with situations but did not refer to following guidance in the care plan. There was some minor omission/updates regarding whether a service user with diabetes was diet or tablet controlled. Medication details are recorded within care plans but a GP visit and prescription update that was noted in the daily progress was not recorded either on the medication list or that the GP had visited on the Healthcare visitors record sheet. One service user who needs stoma care appeared to be managed well with the Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 12 support of the district nurse teams. Three parked wheelchairs were noted not to have footplates in use, although the inspector did not observe them used in this way, when staff were instructed by the provider to address the situation, they had difficulty finding appropriate footplates in the store cupboard. There was evidence in staff personal files that the provider had taken disciplinary steps where staff had been found not to follow safe practice with wheelchairs. Continence issues appeared to be well managed, however a notice posted in the toilet in the main reception area which listed which service user needed which and how many continence aids imposes on the privacy and dignity of service users and should e removed. Medication management was not fully assessed at this visit due to time constraints, however a medication round was observed. Service users were seen to be supported appropriately to take medication and the records and administration seen were satisfactory. Care should be taken when sellotaping back lids to paracetomol boxes that the use by date is not accessible. Evidence was seen in relation to service users having the opportunity to self medicate within care plans although no current service users are able to do this. Staff confirmed that training was provided in medicines management both in house and by an outside trainer. The provider/manager stated that a local training provider undertook competency assessments but there was no evidence of this provided. A member of staff spoken with said she was not aware of any competency assessment being carried out. Records for training were not fully satisfactory. The provider manager stated that this was in hand as there had been a recent change in management of the home and training was booked. The registered provider must ensure that evidence of training records are provided in relation to medicine management and other topics [see also St 30] Service users and a visiting relative confirmed that their privacy and dignity were always respected. Staff was observed to knock before entering service users rooms and privacy and dignity is promoted within care plans and staff induction. Staff members spoken with were able to demonstrate how they maintained service users privacy and dignity. One service user particularly praised one staff member saying that she was very understanding and the staff member as able to relate the feelings of the service user when needing particular hygiene support. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users find the lifestyle experienced in the home generally matches their expectations and preferences and maintain contact with family/friends and representatives. The activities provision needs to be reinstated and improved. Service users receive a wholesome appealing balanced diet in pleasing surroundings and enjoy their food. EVIDENCE: A member of the care staff is responsible for activities. Staff spoken with, the provider/manager and service users confirmed that activities provision had not been good recently and the provider manager produced evidence that some service users had been asked what they would like to do, their hobbies and interests. The assessment provides details of service users hobbies and interests however there was no care plans in place to ensure that service users social and leisure time needs were being addressed. Motivation of both service users and staff were discussed and it appeared that there was a lack of innovation and ideas for stimulation of service users, particularly those service users with dementia. Some ideas were discussed by the inspector to engender some innovation. It may also be helpful for the Providers to join NAPA - the National Association for Activities for Older People (a registered charity) its not expensive, but very effective in helping to improve the activities provided Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 14 in care homes for older people. They also have a Yahoo group site for members, which bring together any member who needs guidance, companionship with other NAPA members, or just to make suggestions & offer ideas. http:/www.guide2caretoday.co.uk/ Service users told the inspector that they could get up and go to bed when they required and were observed to move freely throughout the home. Overall service users confirmed they could please themselves and make choices. The home does now have a policy to support service for maintaining contact with service users friends and family and therefore this is recommended. Community links are in place with age concern and the local school and church. Information on advocacy services was seen on the notice board. Visitors confirmed they were made welcome and service users spoken with confirmed visitors can be seen in private and that staff will assist with use of the telephone, which is in the main reception area or service users, may have their own mobile phone. Service users also confirmed that letters are given unopened etc. Privacy nets/blinds are not provided in bedrooms and as some bedrooms overlook other residential buildings and playing fields, service users should be asked if they wish to have these fitted. The lunchtime meal was partly observed and the ‘four weekly cycle’ of menus examined. The menu offers alternative choices and a record is kept of the choices made. Service users provided contradictory information about whether they have a choice of meals but this was probably because of memory problems rather than lack of choice given. Service users reported that the food was very nice and adequate in portion. Mealtimes observed were unhurried and dining facilities pleasant. Staff, were observed to bend or crouch on bended knee rather than be seated to assist those who needed help with eating. This needs addressing by the Registered Provider. Care plans contain nutritional risk assessments. The Provider manager stated that the menus were going to be reviewed as some service users had requested meals such as egg and chips and egg on toast. One service user spoken with thought more fruit could be on offer and would like more of a variety of menu items. A new cook had started the day before the inspection and was getting used to the systems. Service users and a relative confirmed that ample drinks were supplied throughout the day and that fruit is provided at breakfast and cooked breakfasts on offer at weekends. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are encouraged to make complaints if they are not happy with the service provided. Service users appear to be protected from abuse, neglect and self–harm but as information in this area was not fully clear it was difficult to make a clear judgement. EVIDENCE: A complaint procedure was displayed. A copy of the complaint procedure is also available in the service user guide posted in service users rooms. Service users reported that they felt confident to make a complaint, and would speak with the management if necessary. They felt confident any concerns would be dealt with appropriately. Two applicable complaints’ was recorded in the home’s complaint records since the last inspection one was about staff attitude and the other had come through CSCI and was related to staffing issues. One complaint was upheld and the other not upheld. A Safeguarding adult issue had been raised about a service user who had resided at the home a few months previous and who had been taken into hospital, but the home were deemed not to be responsible for any wrong doing, although the investigating officer had made some good practice recommendations. The abuse procedures state that all allegations must be reported to CSCI under Regulation 37and a copy of the whistle blowing policy was displayed. One staff member was able to fully explain how abuse may be presented and how this Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 16 would be reported on, another spoke of being aware of some conflict between two service users and claim that a service user had said but had not followed the potential allegation through. The service user told the inspector, of some events that was discussed with the provider, but as the information was not clear, the provider manager has been asked to make further enquiries and if necessary liaise with the inspector and make any necessary referrals under the safeguarding adults protocols and arrange for retraining of staff where necessary in abuse awareness and reporting procedures. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The purpose built environment was homely, appeared comfortable, safe and cleaned to a high standard. Furniture, carpeting and decoration was all to an appropriate standard. The home is spacious and well laid out, with ample lounge facilities for those that wish to have quiet time. Maintenance of communal areas was generally good. EVIDENCE: The purpose built environment was homely, appeared comfortable and cleaned to a high standard. Furniture, carpeting and decoration was all to a high standard. The home is spacious and well laid out, with ample lounge facilities for those that wish to have quiet time. Maintenance of communal areas is good. There is a conservatory area in addition to the lounge and dining facilities. Window restrictors are fitted to the ground floor windows. Doors are alarmed. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 18 The home appears to have appropriate facilities to meet the needs of disabled people. A rotunder and sit on scales are provided. Call alarms are sited throughout the home and service users confirmed these were answered promptly. A passenger lift provides access between the ground and first floors. Servicing records were seen for this and for the hoists. Radiators are the low temperature surface type apart from one in the service access area to the kitchen. The bathroom and toilets are adequate but they would benefit from some personalisation. A number of bedrooms were examined and all appeared well equipped, clean and fresh smelling. All were well personalised. Door locks are provided and lockable secure facilities. Records were examined of water temperatures taken; some were recorded above 43 degrees. As stated in previous inspections the caretaker needs to identify that these temperatures are above and note what action has been taken and a retest documented. The kitchen area was noted to be clean, fridge temperatures above the safe temperature should also be recorded in a way, which demonstrates action taken, and retest results. An oscillating fan was being used in the kitchen as a supplement ventilation due to the hot climate weather experienced, however this was observed to be dirty and at risk of oscillating dirt and dust around the food preparation and cooking area. The fan was removed on the day and the provider /manager reported that staff would be instructed yet again to clean this before use and keep maintained. The laundry area appeared tidy and appropriate to meet the needs of the service. Gloves were observed. The Environmental Health Officer had visited in March 2006 and had raised several issues for attention, which most had been addressed. The provider stated that a follow up visit was expected the week of the CSCI inspection. A trip hazard in the first floor bathroom had not yet been completed. A staff room is provided with lockable storage for staff belongings. A service users smoke room is provided for those service users who smoke. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff meets Service users needs and they appear to be trained to a satisfactory level. The recruitment practice is overall satisfactory but there had been an oversight, which a requirement is set in relation to. EVIDENCE: There were thirty-four service users in residence on the day of the inspection and staffing levels were assessed as appropriate. Catering and cleaning and domestic hours also were deemed to be sufficient, however there had been a period of instability due to lots of staff changes and high turnover of staff, which had affected the service provision. The Provider reported that he had taken short-term action to ensure service users catering needs were maintained and this had resulted in a complaint being made to CSCI. A new cook was now in post and all staff working in the kitchen confirmed that they had a recognised certificate in food hygiene. Four personal staff files were examined in relation to recruitment. On he whole these were satisfactory however it appeared that one member of staff had been allowed to commence work prior to the Pova check on the basis of a transferred CRB. The registered provider was given a copy of the update guidance to ensure this oversight does not occur again. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 20 Because several staff left around the same time the status in relation to NVQs has depleted. Nine staff are awaiting enrolment on the Skills for work induction and foundation training. Staff confirmed alongside evidence in staff files that basic inductions are provided. Mandatory training provision is usually provided within six months of employment. Evidence was provided of Manual handling training, fire safety training, food hygiene, Dementia Care, Continence promotion and First Aid was booked on the day of the inspection. Staff spoken with confirmed they had undertaken training in health and safety, infection control and abuse awareness. The registered Provider/manager reported that not all evidence of previous training was accessible due to the previous manager leaving and that a concerted effort was being made to ensure everyone was up to date. Staff spoken with were not aware of the GSCC [General Social Care Councils Code of Conduct] booklet. The registered person must ensure staff are provided with this. Staff confirmed they are paid to attend training. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is deemed fit to be in charge. Service users financial interests of service users but the policy and procedures in relation to finances should be improved. Staff are appropriately supervised and the health safety and welfare of service users is generally promoted and protected, however recent issues highlighted by the Environmental Health Officers visit, and at this inspection suggest that this may be compromised in some areas. EVIDENCE: The registration for the manager of the home currently named Mr AA Toorabally and Mrs Jane Betts as Registered Managers for the home. Mrs Betts has recently left the homes employ and Mr AA Toorabally remains Registered Provider/Manager. Mrs Toorabally has been helping out at the home, but is not a registered manager for this service. The arrangement may cause some Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 22 confusion for staff and visitors and therefore appropriate communication must be shared with all concerned. Service users and relatives praised the providers, saying they did all they could for them; one service user said they “kill you with kindness here” A sample of service users financial records were examined and found to be satisfactory. Valuables kept on behalf of service users are receipted for as written in the policy. The policy needs amending to address that staff must not benefit from making purchases on service users behalf; this is in relation to the use of advantage/bonus cards etc. The Registered Provider undertakes visits under his obligations and a service user survey has been carried out. Only two responses were returned to date. The Provider/manager is advised to extend surveys to visiting professionals and to focus the service user surveys to particular topics and then to feedback the results and any action taken as a result of comments made. There was evidence that staff supervision was in place and that the provider /manager is working to achieve six sessions a year for each member of staff. The Environmental Health Officer had visited in March 2006 and had raised several issues for attention, which most had been addressed. The provider stated that a follow up visit was expected the week of the CSCI inspection. A trip hazard in the first floor bathroom had not yet been completed. On the day of the inspection the following records were examined and found to be satisfactory. Electrical circuit testing, gas safety certificate, portable appliance testing, fire equipment servicing, Lift and hoist servicing and Haccap recording. 2 weeks of the fire alarm tests had been missed recently as the handyman had reduced his working hours but overall good recording had been practiced. Evidence must be provided of a fire safety risk assessment. Garden type plastic chairs were noted in bathrooms, which are not deemed appropriate, as these are not safe to use. Appropriate bathroom perching stools or shower chairs should be used to which meet individual needs. The homes insurance certificate was up to date. There was an issue relating to a dirty oscelating fan in the kitchen. Otherwise the home was found to be clean and hygienic. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 2 Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 24 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 OP2 Regulation 14 Requirement Timescale for action 13/09/06 2 OP7 15,17 3 OP8 15,17 The registered person has not confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. The Registered person must 13/09/06 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; and that they are accurate and kept up to date and followed by staff at all times. The Registered person must 13/09/06 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; and that they are accurate and kept up to date and followed by staff at all times. Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 25 4 OP19 16 5 OP26 16 6 OP38 16 7 OP28 18,19 CSA Section 32 8 OP30 18,19 CSA Section 32 9 OP29 18 After consultation with the environmental health authority, the registered person must make suitable arrangements for maintaining satisfactory standards of hygiene in the care home; After consultation with the environmental health authority, the registered person must make suitable arrangements for maintaining satisfactory standards of hygiene in the care home; After consultation with the environmental health authority, the registered person must make suitable arrangements for maintaining satisfactory standards of hygiene in the care home; The registered person shall make arrangements for providing persons who work at the care home with appropriate information about any code of practice published under section 62 of the Act. The registered person shall make arrangements for providing persons who work at the care home with appropriate information about any code of practice published under section 62 of the Act. The registered person shall not employ a person to work at the care home unless— the person is fit to work at the care home; 13/09/06 13/09/06 13/09/06 13/09/06 13/09/06 13/09/06 Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 26 10 OP19 13 11 OP26 13 12 OP38 13 The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In relation to all aspects identified within standards 19, 26 and 38 of the report. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In relation to all aspects identified within standards 19, 26 and 38 of the report. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In relation to all aspects identified within standards 19, 26 and 38 of the report. 13/09/06 13/09/06 13/09/06 Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3. Refer to Standard OP3 OP4 OP8 Good Practice Recommendations Expand on equality and diversity within the assessment documentation Explore Dementia Care Mapping and improvement in the environment for people with dementia as identified. Use separate record sheets for chiropody, dental, GP, hospital, Optician etc to provide running records of treatments and include a system to ensure blood test results are followed up Use monitoring tools, record incidents and evaluate challenging behaviour alongside care plans. Provide evidence of competency assessments for staff administrating medication The medicine fridge thermometer should be replaced with a minimum /maximum temperature indicator type. Consult with service users about privacy blinds and remove the list of continence aids in the toilet in the reception area Improve the activities provision as discussed. Ensure that a training programme for 2005/2006 is developed. Further develop the policy for service users financial accounts. Extend the formal supervision to 6 sessions per year. 4. 5. 6. 7 8. 8. 9. 10. OP8 OP8 OP9 OP10 OP12 OP30 OP35 OP36 Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westfield Care Home DS0000008773.V296661.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!