Inspection on 22/08/05 for Westfield Care Home

This inspection was carried out on 22nd August 2005.

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 13/06/06

Westfield Care Home 29/11/05

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Westfield Care Home Devon Drive Mansfield Nottinghamshire NG19 6SQ Lead Inspector Jayne Hilton Unannounced 22nd August 2005 at 9:30 am 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 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 and Care Homes for Adults 18 – 65*. 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 C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Westfield Care Home Address Devon Drive Mansfield Nottinghamshire NG19 6SQ 01623 427 846 01623 429 874 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Ahmad Ally Toorabally Mrs Angela Jane Betts Care home only (PC) 45 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Dementia (DE) Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 37 Residents shall fall within registration category OP 2 8 Residents shall fall within registration category DE Date of last inspection 14/2/05 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. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection, was undertaken by Regulation Inspector Jayne Hilton and Business Relationship Manager Carolyn Merry on 22nd August 2005 between 9.30am and 3pm. The main focus of the inspection was to assess the requirements set at the previous inspection. As the manager was on holiday the focus of the inspection was changed slightly in order to establish that appropriate management arrangements were in place. The methodology used included, the examination of three service users care plans in detail, two other care plans for selective information and other related documentation. Six service users were spoken with and two relatives. The Registered Providers Mr & Mrs Toorabally and the manager did attend for part of the inspection. Four care staff and the cook, were also spoken with. A sample of records were examined, including accident records, staff personal files, the duty rosta, water outlet temperature records, fire safety risk assessments, menus, complaints records and some policies and procedures. Some aspects of the building were assessed in relation to previous requirements set. What the service does well: Service users have the information they need and an assessment is carried out prior to them moving to the home. The service users’ personal and health needs are generally set out in a care plan and service users feel their needs are met. Medicines management appears to be generally satisfactory. Service users and relatives praised the staff and management and stated that overall their needs were met. The service users confirmed that their privacy and dignity was respected, and that the lifestyle experienced in the home matches their expectations and preferences in relation to exercising control of their lives and in the participation of activities. Service users receive a wholesome appealing balanced diet in pleasing surroundings. Bedrooms examined were noted to contain personal items belonging to service users. Service users reported that the food was very nice. Service users and relatives reported that an ample supply of drinks is provided 24 hours a day, and there was evidence of a jug of juice in one service user’s room who was ill in bed on the day of the inspection. 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. The purpose built environment was homely, appeared comfortable, safe 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 and bedrooms was good. Service users needs are met by, the numbers of staff provided. There appears to be an adequate level of induction and training for staff. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: There was no satisfactory evidence that all service users had been offered a choice of menu items in conjunction to what was listed on the menu and this is recommended. Staff, were observed to be standing to assist those who needed help with feeding which is not acceptable practice. Care plans contain nutritional risk assessments, however there were no detailed records of food taken or refused. The staff confirmed that where service users are ill in bed that care charts are implemented for this purpose, however on the day of the visit, a service user who was confused whether she had taken any food from the following day, did not have any such record in place. Some gaps in information in the assessment documentation require addressing, and service users or their representative need to agree to the assessment and plan of care. The care plan documentation however needs to be improved both in completion and accuracy and also in relation to effective monitoring and evaluation processes. A requirement is set to ensure that care plans are devised for all of the individual’s specific needs. The status of accident reports was found to be generally poor and a requirement is set for this. A further requirement is set in relation to seeking medical advice where service users suffer head injuries in relation to a fall. There was an issue raised by the registered provider of a recent Regulation 37 notification, whereby a service user had wandered out of the home and was later found with some injuries a distance away from the home. The information on the notification, and information in the service user’s file did not clearly correlate, and the registered provider must ensure that the CSCI are provided with all of the necessary details of the events and any action taken. The staff had dealt with the event at the time, however in the manager’s absence had not informed the provider of the incident until the following day. There were some obvious issues identified around the roles and responsibilities of staff and in relation to clarity and consistency of communication between care staff, manager and providers. There needs to be fewer assumptions and more systems in place in relation to reporting procedures. Improved documentation is required in relation to induction and training. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 7 Formal supervision should be extended to 6 sessions a year. The health and safety poster needs to be completed. As the home has a registration category for 8 beds for people with dementia, and there have been several instances of service users wandering, the exterior security should be looked at. It is recommended that the gardens and pathways be gated. 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 C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3, Service users have the information they need and an assessment is carried out prior to them moving to the home. Some gaps in information require addressing and service users or their representative need to agree to the assessment and plan of care. Service users feel their needs are met. EVIDENCE: The home has produced a statement of purpose and service user guide. Evidence of these was seen in service users rooms. Three care plans were examined in detail all were found to contain an assessment, however these had not been fully completed in every occasion. Information was noted to be missing for medication on admission, mental health and foot care. Although it was reported by the provider that relatives are involved in the assessment process, signatures of both the service user or Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 10 their representative had not been obtained in agreement, on every occasion. Extended community Care assessments were also examined and care plans that were devised appeared generally to derive from the assessed needs of the service user. There were some gaps however and these are covered in standard 7 of then report. A newly admitted service user, who had previously been in the home for respite care, had not been reassessed for any changing needs or updated. It appeared that the reason for this was that the service user had been readmitted whilst the manager was on leave and care staff may have been unclear about who was taking responsibility for this. The issue is covered in Standard 28 of the report. It was also observed that the contact information was not completed for details of the social worker. It was clarified that the service user did not have an allocated social worker as was privately funded, however this should still be stated, rather than just left blank. In the absence of the manager this information may be crucial for staff. It is good practice to identify on the foot care section where diabetes is diagnosed or questioned. Service users and relatives praised the staff and management and stated that overall their needs were met. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The service users’ personal and health needs are generally set out in a care plan and service users feel their needs are met. Medicines management appears to be generally satisfactory, although this was not fully assessed. The care plan documentation however needs to be improved both in completion and accuracy and also in relation to effective monitoring and evaluation processes. A requirement is set to ensure that care plans are devised for all of the individual’s specific needs. The status of accident reports was found to be generally poor and a requirement is set for this. A further requirement is set in relation to seeking medical advice where service users suffer head injuries in relation to a fall. Service users confirmed that their privacy and dignity was respected. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 12 EVIDENCE: Care plans were in place but not all of those examined were signed by the service user or their representative. At the previous Inspection, relatives reported that they had been involved in the devising of care plans, however they were not sure they had continued to be informed, as service users’ needs changed and plans reviewed. The registered provider reported that relatives are informed on a regular basis when service users needs change, and there was evidence of social worker placement reviews, however it is recommended that a system is devised whereby relatives can provide details of their personal preference of how much involvement they want in relation to their relatives care and provide their signature with this. Care plans and risk assessments were noted to be generally up to date, however some had not been reviewed since May and June 2005 and one service user did not have care plans in place for assessed needs of and dementia and diabetes. These should be reviewed at least monthly. The care plans did not indicate whether service users had been offered a bedroom door key or key to their lockable facility and this should be in place. It was found that one service user who was case-tracked had not had any progress notes written for two days. Relatives and service users reported that the health care needs of service users were well met. Care is needed regarding follow-ups of blood test results, although there was evidence that the requirement from the previous inspection had been met, 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 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. It is recommended that the actual blood sugar readings are noted in the records of blood sugar monitoring tests. Two service users were noted to have had a problem or history of with depression, one did have a care plan devised for this and the other had reference to this within a care plan for mobility. The inspector has assessed the requirement set at the last inspection in relation to this as met, however further development is needed for continual monitoring and evaluation of service users’ mental health needs and how those service users needs, will be maintained and on a daily basis. 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. There was evidence that the manager had tried to pattern the behaviour incidents of one service user, however there was no documentation in place for this. Appropriate risk assessments were in place regarding mobility, manual handling, and risk of falls, infection control, tissue viability and nutrition, however the reviews of these were not up to date. Weight records were found Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 13 to be generally satisfactory, however the nutritional assessment and evaluation of this of one service user who had lost weight had not been updated, neither were there any comments made by staff in order to prompt this. This highlighted that the actual process of evaluation is not being carried out appropriately. Some important information about service users’ allergies and injuries were not highlighted as significant information and could well have been overlooked. It is recommended that a system for highlighting important information be devised. From the examination and cross referencing of accidents noted in the daily report and accident record book, there were several accidents not recorded. This is a serious breach and a requirement is made in relation for this. It was also noted that one service user had an injury to the head as a result of a fall and that staff had not sought advice from a healthcare professional or for example the NHS helpline. A medication round was partially observed and satisfactory practice was seen regarding signing for medication after service users had taken their medication. There was no evidence of a minimum /maximum thermometer in the medicines fridge and staff were using the integral door indicator to record the temperature. The manager reported that an appropriate thermometer had been purchased and would investigate why it was not in use. There were records of room temperature records for storage of other medication. The manager reported that she had commenced with undertaking competency assessments of staff who administer medication, but evidence of this was not available as the information was held in the managers briefcase at home. Staff reported that, medicines training was provided in house and that, distance learning packages of medicine management was obtained if funding allowed. [Training issues are covered in standard 30 of the report] There were medication histories seen in some care plans, however these were not always kept up to date. One service user’s medication information was ‘cross referenced’ with the current mar chart [medicines administration record], which did not correspond, and as mentioned earlier in the report the assessment documentation did not always contain medication details. Service users confirmed that their privacy and dignity were always respected. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with asssistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 15 Service users find the lifestyle experienced in the home matches their expectations and preferences in relation exercising control of their lives and in the participation of activities. Service users receive a wholesome appealing balanced diet in pleasing surroundings. There are some good practice recommendations in relation to the above standards. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 15 EVIDENCE: The activities provision was not fully assessed at this inspection due to time constraint, however there was evidence that the activities provided and who participated were documented. Photographs of events were also seen. The assessment documentation does cover social and spiritual needs, however a social or history profile of service users should be obtained and included as part of the assessment information and used in conjunction with the activities programme. It was reported by the provider that a day trip was arranged for the day after the inspection. 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. Bedrooms examined were noted to contain personal items belonging to service users. One service user’s financial issues were discussed with the manager and providers and it is recommended that they seek further involvement of the service users social worker in seeking a resolution to the problems identified. The lunchtime meal was observed and the ‘four weekly cycle’ of menus examined. The menu offers alternative choices and although there was evidence that the cook provides a vegetarian option, this appeared to be for the same people on a daily basis. Service users provided contradictory information about whether they have a choice of meals. There was no evidence that all service users had been offered a choice of menu items in conjunction to what was listed on the menu and this is recommended. Service users reported that the food was very nice. Service users and relatives reported that an ample supply of drinks is provided 24 hours a day and there was evidence of a jug of juice in one service users room who, was ill in bed. Store cupboards and cold storage facilities appeared to hold an ample and fresh supply of food. Mealtimes observed were unhurried and dining facilities pleasant. Staff, were observed to be standing to assist those who needed help with feeding which is not acceptable practice. Care plans contain nutritional risk assessments, however there were no detailed records of food taken or refused. The staff confirmed that where service users are ill in bed that care charts are implemented for this purpose, however on the day of the visit, a service user who was confused whether she had taken any food from the following day, did not have any such record in place. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 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, however there needs to be fewer assumptions and more systems in place in relation to reporting procedures. EVIDENCE: A complaint procedure was displayed and this was placed above the visitor’s book during the inspection. A copy of the complaint procedure is also available in the service user guide posted in service users rooms. The format for recording complaints is still to be indicated whether the complaint was upheld or not upheld. Service users and relatives 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. One complaint was recorded in the home’s complaint records since the last inspection and was related to laundry issues. Standard 18 was not fully assessed at this inspection and the recommendations made at the previous inspection are therefore, carried over to be assessed at the next inspection. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 17 There was however an issue raised by the registered provider of a recent Regulation 37 notification, whereby a service user had wandered out of the home and was later found with some injuries a distance away from the home. The information on the notification, and information in the service user’s file did not clearly correlate, and the registered provider must ensure that the CSCI are provided with all of the necessary details of the events and any action taken. Although the provider quite rightly pointed out that the home is not a secure unit, he has taken steps to look at the security of the building and will consult with the fire authority about fitting some appropriate security measures to prevent further occurrence of this kind. The provider reported that staff were closely monitoring the service user in the interim. The staff had dealt with the event at the time, however in the manager’s absence had not informed the provider of the incident until the following day. There were some obvious issues identified around the roles and responsibilities of staff, and in relation to clarity and consistency of communication between care staff, manager and providers. There need to be fewer assumptions and more systems in place in relation to reporting procedures. The missing person procedure was examined, and clearly needs to be updated regarding action to be taken in the absence of the manager. At the previous inspection it was noted that a policy is available for adult protection, and a file copy of the Nottinghamshire adult protection reporting procedures was seen. The home’s policy should state that the home will follow the Nottinghamshire reporting procedures and that all allegations must be reported to CSCI under Regulation 37. There were also concerns about vandalism to the home from missiles thrown from the nearby playing fields. The manager reported that there had been no further reported incidents since the last inspection. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25, 26 The purpose built environment was homely, appeared comfortable, safe 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 and bedrooms was good. Some recommendations are to be carried forward, to be assessed at the next inspection. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 19 EVIDENCE: At the previous inspection the following issues were identified but not assessed. The following will be assessed at the next visit; Toilet and bathing facilities were ample with assisted bathing facilities provided. The bathroom and toilets would benefit from some personalisation. The home appears to have appropriate facilities to meet the needs of disabled people. A new rotunder was observed being used. Sit on scales are provided. Call alarms are sites throughout the home, attention is required regarding ensuring that these are in reach of the bath at all times and not tied up. A passenger lift provides access between the ground and first floors. The laundry facilities appear satisfactory, although staff need to be reminded which washer has disinfecting temperatures for infection control. The issues that were assessed at this visit are as follows: 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. [See standard 7 re issuing of keys] Radiators are the low temperature surface type apart from one in the service access area to the kitchen. This has now been made safe by removing the temperature valves. Records were examined of water temperatures taken, some were recorded above 43 degrees. The caretaker needs to identify that these temperatures are above and note what action has been taken and a retest documented. 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 and bedrooms was good. There is a conservatory area in addition to the lounge and dining facilities. A set of French doors has been fitted with new hinges recently. Window restrictors are now fitted to the ground floor windows. There were no cracked panes of glass throughout the home as a result of the vandalism. The privacy locks on bathrooms that needed attention have been repaired. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Service users’ needs are met by the numbers of staff provided, and recruitment practices in the home were noted to be much improved. There appears to be an adequate level of induction and training for staff but improved documentation is required in relation to this. Clarity is needed regarding staff roles and responsibilities, particularly in the absence of the manager. EVIDENCE: The staffing numbers for 32 service users appeared satisfactory. Night cover was also much improved. New staff are registered with Peoples College for principles and practice of care training which consists of a twelve week induction package and provides a baseline for mandatory training. Unfortunately there was no record of this on the premises, although the staff members undertaking this training were able to confirm attendance. The home has experienced a high level of staff turn over. On the day of the inspection the person in charge of the shift had only Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 21 five months’ experience in a care position, and although clearly committed to the role, the inspectors were concerned as to the level of responsibility placed on the staff member in the managers absence. The registered provider had been spending weekdays at the home in the manager’s absence and had arranged for the manager of another of their homes to step in when they went away for the weekend recently. There was however some gaps communication in relation to staff roles and responsibilities and clearer guidance for staff is needed. There needs to be fewer assumptions and more systems in place in relation to reporting procedures. The immediate requirement set at the previous inspection in relation to staff personal files had been met. On further examination of a sample of newly recruited staff member’s personal files, these were found to be satisfactory. A criminal records disclosure for the hairdresser was also seen. A staff member reported that she was due to start NVQ 3 shortly. The inspector was not in receipt of the pre inspection questionnaire at this visit and will assess NVQ standards fully at the next inspection. There was evidence of food hygiene training for most care staff, a couple of new staff had not yet managed to attend this. The inspector has requested that a training programme be devised for the next inspection which indicates what has been provided over a twelve month period and also identifies areas of any gaps in individual staff members’ training needs. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s polies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36, 38 Standard 36 and 38 were not assessed at this inspection and will be reviewed at the next visit. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 23 EVIDENCE: The following recommendations made at the last inspection were not assessed at this visit and will be carried forward for assessment at the next inspection. Formal supervision should be extended to 6 sessions a year. The health and safety poster needs to be completed. As the home has a registration category for 8 beds for people with dementia, and there have been several instances of service users wandering, the exterior security should be looked at. It is recommended that the gardens and pathways be gated. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 24 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 3 2 x 3 3 4 3 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 3 3 x 3 3 3 Score Standard No 7 8 9 10 11 Score 2 3 2 3 x Standard No 27 28 29 30 3 2 3 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 x 36 2 37 x 38 2 Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 OP7 Regulation 14,15 Requirement Ensure the assessment documentation is fully completed and that there are specific care plans in place for all of the identified assessed needs of service users. Ensure that all accidents are appropriatly documented. Timescale for action 22/10/05 2. 3. OP8 OP8 12, 13,14,15, 17 12, 13 22/10/05 4. OP18 17, 37 Ensure that medical advice is 22/10/05 sought and documented where service users suffer a head injury as a result of fall. Ensure that accurate information 22/10/05 is documented in relation to incidents and notification to the CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 OP7 Good Practice Recommendations Ensure service users assessments and care plans are agreed by the service users or relative, and contain their signature to evidence this. C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 26 Westfield Care Home 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. OP3 OP3 OP7 OP7 OP7 OP7 OP8 OP8 OP8 OP8 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. OP8 OP9 OP12 OP14 OP15 OP15 OP15 OP15 OP18 OP18 Ensure assessments are reviewed for respite care service users on every admission. Identify where service users are diabetic in the footcare section of the assessment. Provide written evidence of relatives involvement in the review of service users care plans. Ensure care plans and risk assessments are reviewed monthly. Ensure important information about service users is highlighted within care plans. Ensure that service users are offered keys to their bedrooms and lockable facilities and that this is documented or risk assessed as not appropriate. Use separate record sheets for chiropody, dental, GP, hospital, Optician etc to provide running records of treatments. Use monitoring tools, record incidents and evaluate challenging behaviour alongside care plans. Safety bumpers should always be used with bedrails. Ensure that authorisation sheets which fully inform service users and relatives of the risks, are in place for the use of bedrails and non-use of footrests; and are signed by the relative. Further develop the system for ensuring blood tests are followed up. The fridge thermometer should be replaced with a minimum /maximum temperature indicator type. Include a social/personal history in service users care plans. Seek further information from the identified service users social worker in relation to the issues discussed. Be proactive in the provision of meal options and provide daily option record sheets. Provide a daily menu on the dining tables each day, to inform service users of the meal options for the day. Staff should be seated when assisting service users with eating. Provide records of service users actual nutritional intake, particularly when concern has been raised. Update the missing persons policy to include clear information to staff of arrangements in absence of the manager. Add to the abuse policy that the reporting procedures as laid down by the Nottinghamshire Committee for Protection of Vulnerable Adults will be followed, in the event of an incident of abuse. C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 27 Westfield Care Home 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. OP18 OP21 OP22 OP26 OP28 OP28 OP30 OP30 OP36 OP38 OP38 Add to the abuse policy that all potential or incidents of abuse are notified to CSCI under Regulation 37. Personalise the toilet and bathrooms. Ensure call alarms are not tied up and out of reach of service users when in the bath. Ensure staff have clear instructions regarding washer disinfection temperatures. Ensure staff are clear about their roles and responsibilities particularly in relation to the absence of the manager. Ensure there are fewer assumptions and clarity and consistencey of communication between care staff, manager and providers. Ensure there is a formal record and evidence of Skills for work induction and foundation training on each individuals file. Ensure that a training programme for 2004/2005 and 2005/2006 is developed. Extend the formal supervision to 6 sessions per year. Complete the health and safety poster. Conduct a security review of the exterior of the home to address the incidents of wandering. Westfield Care Home C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Naottingham 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 C53 C03 S8773 Westfield V244394 220805 stage 4.doc Version 1.40 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. 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