CARE HOMES FOR OLDER PEOPLE
Westfield Lodge Nursing Home Weston Coyney Road Weston Coyney Stoke-on-Trent Staffordshire ST3 6ES Lead Inspector
Mrs Yvonne Allen Unannounced Inspection 28th December 2005 11:00 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 Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 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 Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Westfield Lodge Nursing Home Address Weston Coyney Road Weston Coyney Stoke-on-Trent Staffordshire ST3 6ES 01782 336777 01782 598368 westfield.lodge@ashbourne.co.uk the.willows@ashbourne.co.uk Exceler Healthcare Services Limited Ashbourne Homes Limited, Ashbourne Consolidated Group Mr David Forrester Care Home 54 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) Category(ies) of Old age, not falling within any other category registration, with number (54), Physical disability (54), Physical disability of places over 65 years of age (54) Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 54 Physical Disability (PD) - Minimum age 60 years on admission. Date of last inspection 1st September 2005 Brief Description of the Service: Westfield Lodge is a purpose built nursing home admitting service users over 65 of age that require personal and nursing care. The home was built about 17 years ago. Accommodation is to two floors, bedrooms are single occupancy and some have an en-suite facility consisting of toilet and wash hand basin. There are three lounges - one to the first floor and two on the ground floor. There is a separate dining room. The two floors are accessed via a passenger lift. There is a central kitchen and laundry. There are bathrooms and toilets sited on both floors. There is limited garden area but a small conservatory opens out on to a smallgrassed area with a high-level flowerbeds and seating area. There is parking space for several cars. The home is situated two miles from Longton town centre and a short walk allows access to bus routes. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over three hours by one inspector. The inspection took place on 28/12/05 and it was pleasing to see that both the manager and administrator were on duty at this time of year supporting the rest of the staff working at the home. Discussions took place with the manager and verbal feedback was given at the end of the inspection. Not all standards were assessed this time but those not assessed or not met on the last inspection were examined at this inspection. The inspection focussed on discussions with residents, staff and two visiting relatives. A tour of the home was undertaken with the manager and relevant records and documentation were examined. What the service does well:
The home is well managed and management is open and inclusive with residents and staff feeling included in the running of the home. Positive comments received confirmed that staff and residents felt supported. Quality Assurance within the home is good with evidence of monthly company audits on going and auditing of other services having taken place. As discussed with the manager at the time, these must now be developed to include the views of residents and/or their families. The support and efficiency of the administrator at the home was evident. Records of the maintenance of resident’ finances were very good and audit trails could easily be achieved. Staff training was evident with mandatory training on going, and monitored on a monthly basis. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Recruitment of new staff is in need of attention. Past employment history must be examined and references obtained from the last employer. Two written references must be obtained. Employee files were difficult to inspect and would benefit from being arranged in a more orderly fashion. Urgent attention is now required to the redecoration and refurbishment of the home and to the provision of more storage space. The manager has suggested some changes to the use of two rooms on the second floor in order to create more storage space and this was acceptable by the CSCI. This will be achieved via a variationto registration being submitted to the CSCI. Mal odours must be eliminated from the home. Attention must be given to ensuring that policies and procedures are readily accessible and up to date. This must include the development of a policy on death and sudden death so that the nurses on duty have this information at hand. The provision of therapeutic activities needs to be redressed. The programme in place at the home is not effective and does not allow for individual needs to be met. The manager is aware of this and will be addressing the activity programme. The first floor is still not used to its full capacity with most of the residents dining downstairs and, as a consequence, insufficient room available to accommodate them in the dining room. This was discussed with the manager who had some good ideas in relation to developing the communal room on the second floor to incorporate dining facilities. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 7 There were three previous requirements which had not been addressed by the home and which have been raised again in this report. This is concerning and the providers must ensure that all requirements are addressed within the timescale agreed. 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 Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 This busy nursing home provided staff in adequate numbers and skill mix to ensure that the needs of residents were met. Reviews and re-assessment of individuals ensured that needs were met on a continuous basis. EVIDENCE: Several residents were spoken to during the inspection all of whom confirmed that their needs were being met by the staff at the home. One of these residents had been accommodated in the home for 17 years. She stated that her needs were being met and that she had noticed improvements in the way the home was running. The same resident had expressed concerns about staffing levels at the last inspection but she confirmed that these had now improved. Two visitors were spoken to at the time of the inspection. These did not share the same contentment as the resident. They felt that, at times, there was insufficient staff to meet residents’ needs. They commented that all the staff were very friendly and approachable but were “run off their feet” at times.
Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 10 Examination of the staffing rota identified that the staffing numbers provided were adequate providing there was a full staff complement. There was one resident who was exhibiting mental health needs and was proving very challenging for the staff to manage. Discussions with the manager revealed that this resident was about to have a review of her needs and would be moved to another home which could meet her needs if the assessment indicated that this was required. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 11 The systems for the administration of medication are good and ensure that residents’ medication needs are met. The policies and procedures relating to care of the dying and following death, including sudden death will need to be implemented to ensure that the needs of residents and their families can be met with dignity and respect. EVIDENCE: The home had purchased a new drugs trolley since the last inspection and previous requirements had been dealt with. The inspector observed the lunchtime medication being administered by the two trained nurses on duty. This was carried out professionally and according to requirements. Medication Administration Record sheets were examined and had been completed as required. Medication was stored correctly and in accordance with pharmaceutical guidelines. The procedure for the receipt, storage administration and disposal of controlled medication was examined and found to be in order. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 12 The manager could not access the home’s policy on death and care of the dying at the time of the inspection. There was not a policy or procedure in place for what to do in the event of a sudden or unexpected death. The two nurses on duty were both relatively new to the home, and when the inspector asked what they would do in the event of a sudden death the manager stated that they would ring him or the deputy manager - whoever was on call. This is unacceptable and policies and procedures must be developed in relation to death and sudden death. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 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 and 14 The programme of therapeutic activities must be developed in order to ensure that individual needs are met. Autonomy and choice is maintained for residents throughout the daily routines of the home. EVIDENCE: Arrangements for entertainment were in place. On the day of the inspection there was an entertainer visiting the home during the afternoon. Residents spoken to confirmed that different entertainers visit the home from time to time. The programme of activities had been improved upon but needs further development in order to ensure that individual needs of the residents are met. This was discussed with the manager at the time who stated that he would be developing this in the near future. A member of staff spoken to also stated that the programme of activities and entertainment for the residents in the home is in need of improvement.
Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 14 Discussions with residents at the time of the visit confirmed that their personal choices and preferences are catered for. These are documented in individual care plans and evaluated on a regular basis. Comments from residents included – “if I want a lie in in the morning I just tell them” and “I have a bath in the morning as I prefer this.” When questioned about the food residents commented that if they didn’t like what was on offer they could have something else prepared. The manager held residents/relatives’ meetings and minutes were seen of these. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 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 and 17 Residents and their families could be assured that any concerns they had would be listened to, taken seriously and acted upon and that their legal rights would be upheld. EVIDENCE: There was a clear and accessible complaints procedure displayed in the home. This contained the contact details of the local CSCI office including the telephone number. It was pleasing to see that the CSCI had received no complaints directly since the last inspection. This was a noticeable improvement. The manager explained how he deals with concerns and complaints received at the home. These were seen written down and included investigations and actions taken. The legal rights of residents are upheld as much as possible. The manager explained how one resident was using advocacy services and two used the services of a solicitor. The manager had completed the electoral role for the home and stated that residents usually voted by post at election times. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 16 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, 25 and 26 The environment is in need of attention in relation to redecoration and refurbishment and the home is not used to its full potential. EVIDENCE: A tour of the home was undertaken with the accompaniment of the manager. Very little had been done in relation to improvements to the environment since the last inspection and there were outstanding requirements. The carpet in the main ground floor lounge had not been replaced and the windowpanes where the seals have gone had not been replaced. There was still a mal odour around the entrance to the home. The manager had tidied up the home both inside and externally and work had been carried out to make the fire exits safer for residents to use. However there is still a considerable lack of storage space provided at the home and extraneous items have to be stored in inappropriate areas of the home. The first floor is not used to its full potential.
Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 17 The manager wanted to address this and had applied to the CSCI to alter two toilets on the second floor in order to make more storage space. These were inspected at the time and the arrangements for this proposal were found to be acceptable as this still left adequate toilet facilities for residents, many of the rooms in that area being en suite. It is recommended that this proposal be brought to the attention of the residents and their families before going ahead in case of any objections. The home is looking worn and tired generally and is in need of redecoration and refurbishment. It is a requirement that the communal rooms on both floors, the lounge on the ground floor and the lounge/dining room on the second floor, are redecorated without delay. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 18 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, 28, 29 and 30 Residents are cared for by a skilled staff team but more care must be afforded to staff recruitment in order to ensure the on going welfare of the residents in the home. EVIDENCE: At the time of the inspection there were 45 residents accommodated in the home, 11 were in receipt of personal care and the remaining were receiving nursing care. The staff on duty for that day were two trained nurses from 8am to 8pm, supported by 8 care staff from 8am-2pm then 6 care staff from 2pm-8pm. Night duty consisted of one trained nurse and 4 care staff. The manager was working supernumery and the administrator was on duty in the office. The maintenance person was on duty until 2pm. The kitchen staff were supplied by an outside company and there were two domestic staff on duty and a laundry person part time. There were no activity hours supplied that day, although entertainment was taking place by an outside entertainer. The staffing rota was examined and found to be in keeping with the existing staffing notice. Comments received from residents confirmed that the staffing arrangements at the home had improved since the last inspection.
Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 19 The use of agency staff had diminished as the staff team had built up at the home. Discussions with a senior care assistant revealed that the staff moral was very good and observation of team working confirmed this. NVQ training for care staff was underway at the home. 2 care assistants were already trained to NVQ level 2 and above and 17 care assistants were undertaking the NVQ training course. The recruitment procedure was inspected. Two files were examined of trained nurses who had been recruited recently. One of the files was incomplete, with no CV in place. The employment history was incomplete and therefore could not be explored. The other employee did not have a written reference in place. There was no reference in place from the last employer either. This was discussed with the manager at the time and it is a requirement that the recruitment procedure is tightened up. CRB and POVA checks had been carried out as required. There was a staff training and development programme in place. The manager explained how he has to complete monthly training statistics for the company. This includes mandatory training such as moving and handling, fire safety, health and safety, food hygiene and residents’ welfare. The manager stated that a new training manager was due to visit the home in the near future to discuss arranging the following staff training – documentation, challenging behaviour, whistle blowing and customer care. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 20 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, 32, 33, 34 and 35 The home was managed in an open and inclusive manner and was run in the best interests of the residents. EVIDENCE: The manager was settling in very well at the home. He had the support of an efficient administrator and deputy manager. Staff stated that they felt supported by the manager and that he was approachable and accessible. It was obvious that the manager had brought about changes in the home for the benefit of both residents and staff. The manager is currently undergoing NVQ level 4 in Management and had almost completed this. There was evidence of regular meetings having taken place for all staff and residents/relatives. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 21 The auditing of services within the home was evident. Audits had included a training audit, food safety audit and a pharmacy audit carried out by the local PCT. The financial viability of the home was not assessed fully. The Southern Cross Company had recently purchased the home. The manager was satisfied that the home was financially viable. The administration of residents’ finances was examined. The administrator maintained these effectively and all records examined were found to be in order. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 x 2 2 x x x x 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 x 2 x Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 11 Regulation 12(2)(3) Requirement A policy must be developed in relation to care of the dying, following death and sudden death. Activities must be geared around individual preferences and abilities The carpet in the main ground floor lounge must be replaced. PREVIOUS REQUIREMENT There was a mal odour on entrance to the home. PREVIOUS REQUIREMENT The remaining windowpanes where the seals have gone must be replaced or new seals provided. PREVIOUS REQUIREMENT It is a requirement that the communal rooms on both floors, the lounge on the ground floor and the lounge/dining room on the second floor, are redecorated without delay. All required information must be contained within employee files. This must include two written references, one of which must be from the last employer, and a
DS0000026971.V275763.R01.S.doc Timescale for action 20/02/06 2 3 4 5 12 19 26 25 16(2)(m)( n) 23(2)(d) 16(2)(j) 23(2)(d) 20/02/06 20/02/06 20/02/06 20/02/06 6 19 23(2)(d) 20/02/06 7 29 19(4)(5) & Sch 2 20/02/06 Westfield Lodge Nursing Home Version 5.1 Page 24 full employment history. 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 29 Good Practice Recommendations Employee files were difficult to inspect and would benefit from being arranged in a more orderly fashion. Westfield Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Lodge Nursing Home DS0000026971.V275763.R01.S.doc Version 5.1 Page 26 - 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!
