Inspection on 29/02/08 for Westfield Lodge Nursing Home

This inspection was carried out on 29th February 2008.

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

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

Other inspections for this house

Westfield Lodge Nursing Home 20/02/09

Westfield Lodge Nursing Home 08/08/06

Westfield Lodge Nursing Home 28/12/05

Westfield Lodge Nursing Home 01/09/05

Westfield Lodge Nursing Home 26/01/05

Westfield Lodge Nursing Home 04/08/04

Westfield Lodge Nursing Home 17/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Westfield Lodge Nursing Home Weston Coyney Road Weston Coyney Stoke-on-Trent Staffordshire ST3 6ES Lead Inspector Yvonne Allen Key Unannounced Inspection 29th February 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westfield Lodge Nursing Home DS0000026971.V351178.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 Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 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 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) Joanne Eardley Care Home 54 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.V351178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 54 Physical Disability (PD) 54 Physical Disability over 65 (PD)(E) 54 The maximum number of service users to be accommodated is 54 2. Date of last inspection 8th August 2006 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. The range of fees charged by this home will be included in the Service User Guide. Additional charges are made for hairdressing, activities and private chiropody. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the commission, undertook this inspection over one day with one inspector. The inspection visit was unannounced and the Providers were not aware that we were visiting on that day. The Providers of the home had completed an Annual Quality Assurance Assessment (AQAA) prior to the visit and this has been referred to in this report. We met with the people who live at the home and one set of visitors, and their comments and views have been included in this report. We met with staff members, including the acting manager and their comments have also been included. We walked around the home and looked at some of the bedrooms, all the communal areas, and the kitchen and laundry room. Prior to this inspection visit, we had been informed that the Registered Manager for the home had been suspended and that one of the senior nurses was acting up as manager in the interim period. Discussions were held with the Responsible Individual (RI) who was visiting the home. She was supporting the acting manager in her managerial duties. Two managers from other homes within the organisation also accompanied the RI on her visit. We examined relevant records and documentation. Verbal feedback was given to the acting manager and responsible individual at the end of the inspection visit. There were no immediate requirements left. All the key standards were assessed and overall judgements have been made for each outcome. They give an overview of what it is like for the people who live in this home. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home could develop more innovative ways of helping prospective individuals to choose a home that will meet their needs and preferences. It could develop clear information to help them understand what specialist services the home can provide. This might be an information pack, which includes photographs, the home’s newsletter and an introductory letter written by people who live in the home. The Service User Guide will need to include the range of fees charged by the home so that prospective residents will be made aware of how much they need to pay to stay at the home. Although the interim arrangements for management of the home are satisfactory, this is only a temporary arrangement and the Providers will need to ensure that a Registered Manager is working in post at the home. This will ensure that the home is run in the best interests of the people who live there. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 7 Whilst there is a programme of activities and evidence that some effort is being made to offer one to one therapy, more could be done to meet the social and therapeutic needs of those individuals who do not attend organised activities. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 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.V351178.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are welcome to come and visit and are given basic information about the home. The Service User Guide will need to contain the range of fees so that people are aware of how much they will need to pay. The information pack given to prospective residents could be developed further in order to be more specific to the home. EVIDENCE: We looked at standards 1,3 and 4. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 10 In their AQAA the Providers say – “We provide a brochure informing people with information regarding the company and more detailed information regarding the home. Anyone who enquires about the Home is offered a brochure and also invited to come and view the home at their own convenience. Anyone who calls without an appointment is most welcome and will be dealt with in the same professional manner. Opportunity is given to ask questions about anything regarding the Home. Service users are invited to come for lunch or part of the day to get a feel of the home before admission. All service users are assessed by either the Home or deputy manager before admission. Any queries regarding suitability of the Home to service users needs are discussed with relatives, social workers and other healthcare professionals prior to accepting any service user for admission. Process ongoing to ensure service users needs are met at all times” They go on to say that the evidence for this is contained in – “Pre admission documentation. Statement of purpose and Service User Guide made available to all clients. We operate a philosophy of Care which is on display. Service User files which have contract in”. The home has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. The Service User Guide will need to include the range of fees charged so that people wanting to come into the home will be fully aware of the charges they will be expected to pay. The nurses at the home consult the assessment information to see if they can meet the prospective resident’s needs before they make the decision to accept the application for admission and offer a place. Evidence suggests that prospective residents should have a needs assessment before they go to live at the home. For most of the residents the home has received copies of the summary and care plans from the assessments carried out through care management arrangements. For residents who are self-funding the home is able to demonstrate how they have undertaken the assessment. They are generally undertaken satisfactorily. Staff have the necessary specialist skills and ability to care for individuals who are admitted. A random selection of 5 care plans was examined. There was evidence of pre admission assessments – carried out by trained individuals from the home. 1 was an emergency admission with no assessment from the home but a Social Worker Assessment was in place received prior to admission. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 11 Discussions with 3 residents, including 1 who had lived at the home since it was opened, confirmed that they see people coming to look around the home. One of the residents said that she had visited the home with her family before she made up her mind to come and live there”. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. EVIDENCE: We looked at standards 7,8,9 and 10. In their AQAA the Providers tell us – “All service users have a individualised care plan in place which is regularly updated and amended as required. It includes their social,physical,mental and religious needs. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 13 All residents are asked either at pre assessment or on admission about self medication. Those who wish to self medicate have a locked drawer in their room in which to store it and have risk assessments in place. Medication is also audited to ensure they are complying with prescribed medication. medications reviewed regularly. All staff knock on closed doors before entering and address service user by their given name or any other title they wish to be called. All clients have their own single rooms and can stay in their room if they wish. All clients/relatives are aware of all choice and rights that they have and we attempt to meet all those choices. We actively encourage clients to discuss any issues or wishes with regard to death and dying if they choose so that it can be documented and at time of death their wishes carried out”. They say that the evidence for this is contained in “Individualised care plans which cover all activities of daily living. Staff training in resident welfare Introduction of Community Pallitive Care Nurse who, whilst working alongside our staff, will aim to keep the service user in their choice of environment for the end of life and also offer extra help and support to staff and relatives 24 hours daily. Also provide training and skills updates and support for trained staff Regular audits. Visual observation of all staff members during their daily working routine and interaction with clients and their relatives”. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each person centred plan or health action plan. They give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Examination of 5 care plans identified that risk assessments and a plan of care had been developed for each identified need. Plans were specific to each individual and there was evidence of personal choices and preferences documented. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff respect privacy and dignity and are sensitive to changing needs. Observation of care practices and interaction of staff with residents identified that staff were respectful and attentive. The people who live at the home stated that staff were “caring” and “all very good”. Care plans reflect preferences and choices in respect of the activities of daily life in the home. Observation during the visit confirmed that these were upheld and delivered wherever possible by the staff. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 14 We were informed that the home has now developed a good healthcare support network. Residents have access to healthcare and remedial services. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. Residents have the aids and equipment they need and these are well maintained to support them and staff in daily living. This was all evidenced within the care plans and the people who we spoke to confirmed the above This includes good GP practice support. The acting manager said – “GP support has vastly improved”. Other healthcare professionals who supported the home include - tissue viability nurse specialists who will visit the home (on a three month trial basis), a caseload manager from the local hospital visits monthly, palliative care lead nurse who visits. District nurses visit people who are receiving personal care only in the home. This includes an “out of hours” district nurse service. The Practice Nurse visits to administer vaccinations such as for influenza. Diabetic Reviews are organised by the Surgery. A care plan was examined in respect of a resident whom we had seen at the last Random Inspection, a few months ago. We had been concerned that this resident was not eating and did not appear to be receiving much assistance from the staff. Examination of his plan identified that the home had acted quickly and effectively and had paid close attention to meeting his nutritional needs. The gentleman had gained a substantial amount of weight and his health had improved dramatically. When we spoke with him he said that he was “well looked after and had no complaints”. Care plans were evaluated and reviewed regularly. There were some signatures from residents and representatives of agreement with the plans. However there was limited evidence of residents and/or representatives being included in the evaluations and this should be encouraged. We spoke with another three residents whom we had previously met with at other inspection visits. They all felt that their needs were being met at the home and that all the staff were caring and attentive. One of the residents did comment “there needs to be more staff”. Examination of the staff duty identified that staff numbers appeared to be sufficient at the time. We spoke with a visiting professional – a Social Worker from the Mental Health Team. He confirmed that he is happy with the services provided to his client Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 15 and the care given to him. He also stated that he would make it known if he was unhappy. It was identified that there were no care plans specifically designed for individuals admitted for respite care. It is recommended that these be developed to ensure that specific individual short-term needs are met. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. The home respects and understands the rights of residents in the area of health care and medication. They work with individuals regarding any refusal to take medication. Residents are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication on their behalf. Thought has been given to providing safe but sensitive facilities for keeping medication. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Only nurses administer medication. We observed the lunchtime medication round and this was administered as per policies and procedures. Examination of relevant records including Medication Administration Record (MAR) charts identified that these had been completed as required by the administering nurse. The nurse told us that, although medication is administered by nursing staff, individuals are able to self medicate if they wish following a suitable risk assessment. There was no one self-medicating in the home at the time of the inspection visit. We met a gentleman who we had met previously and he was receiving continuous Oxygen therapy. He remained happy with the care provided to him and had his bedroom arranged to suit his needs. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally staff are aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. EVIDENCE: We looked at all the standards for this outcome. In their AQAA the Providers tell us – “We aim to offer a wide range of activities for all our service users whether they be on a group or one to one basis. We have visiting clergy from differing denominations that will visit either people on a group or individual basis. We encourage service users to maintain links with their local churches by either them continuing to attend services if able or their clergy visiting the home. We Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 17 try to take service users out as often as is possible and vary the client group who go on trips. We encourage clients to maintain links with their family and friends and operate an open visiting policy. We also offer privacy to those clients who wish to spend time alone with their partners. Relatives are also invited to join in with any of the activities or trips in the home. We also offer privacy for any client wishing to use the phone and in fact some service user have his or her own landline or mobile phone. We offer a wholesome balanced diet in a surrounding of their choice and always offer to provide an alternative choice if something they do not like. We also invite relatives especially married partners to stay and share a meal with their loved one.” They say that the evidence for this is contained in – “Our activities notice board which shows details of up and coming events, trips and day to day activities. Photographs of differing events and entertainment that has happened. Individual service user folders with any work they have completed. Visual evidence, when people come in and visit and see activities taking place. Residents’ and relatives’ comments. Improved dining experience and choice of dining area. More pleasant surroundings in which service users eat their meals. More comprehensive choice of menus and alternatives.” People living at the home are given the opportunity to take part in a variety of activities both within the home and in the community. Where possible, staff gather information on community-based events and try to make individual arrangements for people to attend. Policies, procedures and guidance promote individual independence and the right to live in a flexible environment where their choice of routines and activities are met when possible. Systems for checking practice are not always evident. The home tries to be flexible and attempts to provide a service that is as individual as possible, using its staff and resources effectively. Not all residents are consulted on how the home can work to provide them with a flexible lifestyle, the home recognises this and plans to make some changes. The food in the home is of satisfactory quality, well presented and meets the dietary and cultural needs of people who use the service. Staff are trained to help those individuals who need help when eating and are sensitive in their approach. We were informed that the home employs an activities person who also works at the home as a care assistant. This individual works 6 hours per day from Monday to Friday organising activities and entertainment. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 18 The activities co-ordinator was not on duty at the time of the inspection visit but discussions with the acting manager identified that there was a structured programme of activities and entertainment in the home. This was displayed on the notice board in the entrance to the home. There was also evidence in the form of photographs of trips out and activities within the home. Examination of 5 care plans identified that individuals are assessed as to their abilities and preferences in respect of social and therapeutic activities. Hobbies and interests which individuals had before entering the home are facilitated as much as possible. Trips out to local places of interest are arranged and links with the local community are maintained. Individuals go out with their families and friends. One of the residents enjoys visiting the local pub on occassions. One gentlemen gave us a sample of his Kareoke singing which he used to do before coming into the home. He was especially good at the Elvis impression and stated that he would like to continue with his singing. It is recommended that the home organise a Kareoke evening so that this indivudal and others who are interested are able to join in and enjoy the event. This was discussed with the acting manager and she stated that they might be able to organised such an event between the 4 homes in the group. There were some individuals who were unable to attend the entertainment or join in with activities either due to limited physical abilities or because they did not like large groups. Whilst there was evidence that some effort is being made to offer one to one therapy, more could be done to meet their social and therapeutic needs and this should be developed further. There was evidence, contained in care plans that spiritual needs and wishes are promoted. We were told that the local Clergy visit the home from differrent denominations and that Church services are held regularly at the home. Residents spoken to confirmed this. Visitors were observed coming and going at the time of the visit. We spoke with one set of visitors and they were very happy with the care afforded to their relative in the home and stated “He couldn’t be any better cared for”. The dining arrangements have been improved since the last Key inspection. Some individuals are served their meals in the dining area on the second floor whilst the rest are accommodated in the ground floor dining room. One or two individuals are served their meals in the area immediately outside the dining room by the front window. On speaking to them it was clear that they preferred to take their meals here and had requested not to go into the dining room. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 19 Some individuals were seen taking their meals in their own bedrooms. The lunchtime meal appeared appettising and there was a choice of the main menu. Choices were being offerred with some individuals having differrent from the main menu. Discussions with the Head Cook identified that special diets are catered for and she always tries to accommodate food preferences. Since the last key inspection menus have been reviewed and the introduction of “home baking” amongst other things has improved these. When asked about the meals provided at the home the comments received from the people who live there were mainly positive. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation that has their protection and safety as a priority. EVIDENCE: We looked at standards 16 and 18. In their AQAA the Providers tell us – “That any complaints are dealt with promptly and efficiently and that any service users relatives or friends are listened to and taken seriously. That policy and procedures are followed correctly.Offer an open door policy so that anything can be brought to the managers attention at any time and dealt with there and then thus reducing number of complaints. That staff are trained in resident welfare and know how to spot signs and symptoms of differing types of abuse and how to report them.” Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 21 They state that they evidence this by – “By our low level of complaints that we have received”. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. There was a clear complaints system in place. This was on the wall in the entrance to the home and was also contained in the Service User Guide. This procedure will need to contain the new address of the CSCI Birmingham office. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the home always responds within the agreed timescale. The home learns from complaints, and it is rare that a complaint about the same issue is made twice. We had received one complaint directly since the last Key inspection. This anonymous complaint had been received on 17/04/07 and was in relation to staffing shortages at the home. We carried out an unannounced visit to the home following receipt of this complaint. There was found to be a staffing shortage and an immediate requirement was left to address this. The Providers dealt with this requirement within the timescale and no further complaints had been received. The acting manager stated that she is now in charge of dealing with any concerns as they arise and complaints are referred to the Responsible Individual (Regional Manager). Discussions with residents and the two visitors identified that any concerns they have had about the home have been dealt with quickly. They said that they would know who to go to should they have any more concerns. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the home know when incidents need external input and who to refer the incident to. There is a clear system for staff to report concerns about colleagues and managers. Staff that ‘blow the whistle’ on bad practice are supported by the service. Staff spoken to knew about this policy. The home understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The outcomes from any referral are managed well and issues resolved to the satisfaction of all involved. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 22 Training of staff in safeguarding is regularly arranged by the Home. Other training around dealing with physical and verbal aggression is also made available to staff as needed. The staff members spoken to confirmed that they had received training in safeguarding and the recognition and reporting of abuse. Examination of 4 staff files confirmed that this training had taken place. The acting manager confirmed that she is familiar with the local policy and procedure in relation to Vulnerable Adults. Examination of care plans and discussions with staff members identified that staff understand what restraint is and alternatives to its use in any form are always looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary. People are involved in the decision making process about any limitations to their choice in this area. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. Staff are very carefully selected to work at the care home and undergo Criminal Record Bureau and Protection Of Vulnerable Adult checks before being offered employment at the home. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The home is a comfortable, pleasant and safe place to live. EVIDENCE: We looked at standards 19 and 26. In the AQAA the Providers state – Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 24 “The environment is purpose built with separate lounges and wheelchair access to garden. Passenger lifts give easy access to the first floor. Digital locks provide secure entrance.Some bedrooms have en suite facilities and there are sufficient communal bathing facilities with bath hoists. Service Users are encouraged to bring personal items from home including furniture and pictures which make the rooms more homely. A call bell facility is available in each bedroom,bathroom and lounge. Equipment for safe moving of residents is provided and well maintained. All residents have a moving and handling careplan. All staff moving and handling training. There is wheelchair access to all areas. On admission the service user has a choice of rooms to occupy. The home is clean and odour free. It is well heated,lit and ventilated; hot water is available at all times.The laundry facilities comply with requirements”. They state that they evidence this by – “Domestic and maintainence records. Visual inspection. Comments from relatives and clients.Training records. careplans, policies and procedures. Specialised equipment, lift for wheelchair access.” Where appropriate the lay out and design of the home allows for small clusters of people to live together in a non-institutional environment, although this might not consistently be translated in practice. Bedrooms are all single and some have ensuite facilities. Residents are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers and of good quality. The home is clean and tidy and smells fresh. The management has a good infection control policy. They seek advice from external specialists, such as NHS infection control staff, and encourage their own staff to work to the home’s policy to reduce the risk of infection. We toured the home and visited a number of bedrooms, at random. We looked at all the communal areas and the kitchen and laundry room. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 25 It was pleasing to note that there had been improvements to the environment made since the last inspection. These had included all new carpets along the corridor areas and new flooring in the dining room as well as painting and decorating. We were told that there were new chairs on order also. It was noted that on the toilet door opposite room 14 the lock did not work and the toilet roll holder was broken. This was reported to the acting manager who stated that she would put it down for the maintenance person to address. The home was clean and well presented with no mal odours. The kitchen was clean and tidy and maintained in accordance with environmental health regulations. There had been some new kitchen equipment purchased since the last inspection. The laundry was also maintained in accordance with infection control guidelines. The people who live at the home were observed using all the lounges and seating areas. Some were sat in the front entrance to the home and one gentleman commented that he liked to sit there and watch the “comings and goings”. It was noted that outside the dining room in front of the front window, residents were seated in one long row all facing the window. The seating arrangements in this area did not encourage socialising and appeared institutionalised. Also there was one resident who was very anxious and was shouting and disturbing the other residents. Alternative seating arrangements, maybe into small groups, might help those people with dementia care needs feel more settled. Bedrooms had been personalised and adapted to meet the needs of the people who were living there. One of the residents was on continuous Oxygen therapy and, as such needed everything at hand. His room had been adapted to suit his needs with the call bell within easy reach when he needed it as well as everything else he needed. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 26 Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who live there, in line with their terms and conditions, and to support the smooth running of the home. EVIDENCE: We looked at all the standards for this outcome. In their AQAA the Providers say – “That our home is run to correct staffing levels at all times and has the correct skill mix of staff. That the manager is in the building for the majority of the time and is flexible with the working hours so can be available when needed. That all staff have clear CRB check and 2 satisfactory references before they are allowed to commence employment and that they follow a comprehensive induction plan. That staff training is provided and staff have supervision and appraisals to moniter their compentencies”. Their evidence for this is – Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 28 “Staff rotas. Training, supervision and appraisal files.Certificate of registration from CSCI displayed showing name of registered manager. Staff personnal files with references and CRB clearance.” People have confidence in the staff who care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. All staff receive relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff recruited confirm that the home was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness and there is little use of any agency or temporary staff. At the time of the inspection visit there was a total of 46 residents accommodated in the home with 12 of these residents in receipt of personal care and the remainder nursing care. There were 2 nurses on duty all day from 8am until 8pm. There were 7 care assistants on duty from 8am until 2pm and then 5 from 2pm until 8pm. Throughout the night there was 1 nurse on duty with 4 care assistants. There was a good skill mix of care staff with over 50 of care assistants being trained to NVQ levels 2 and above. Examination of the staff rotas over a period of 4 weeks confirmed the above staffing numbers. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 29 As well as the nurses and care staff there is a housekeeper who is supported by a team of domestic and laundry staff. There is a head cook and a second cook who are supported by kitchen assistants. There is a full time administrator and a part time maintenance person, who have both worked at the home for several years. There is a part time activities co-ordinator employed. The Registered Manager had recently been suspended and the deputy manager is working as acting manager. This is a supernumery role. The Regional Manager offers good support and visits the home at least one a month. Comments received from the people who live at the home were that the staff are very caring and helpful. Some said that they thought there should be more staff. One individual commented that “the spark has gone out of the staff” and that “something has changed”. He went on to say the “all the staff are good”. We spoke with 4 staff members who felt that the recent issues in relation to management had caused some unrest and that staff moral had been affected. However, on the day of the visit, staff appeared to be working together well as a team. We looked at 4 staff files and the corresponding documentation in respect of staff recruitment, induction and training. All were satisfactory and the required checks had been carried out prior to individuals being offered employment at the home. We spoke with 2 nurses who stated that they felt well supported at the home in respect of their training needs. We spoke with a care assistant who had been recruited very recently and was on induction training. She was working alongside a senior care assistant who was her mentor. She confirmed that she had had CRB and POVA checks before starting to work at the home and that she felt that her induction training had been “very good so far”. There is a structured staff-training programme in place at the home and training is geared around meeting the specific needs of the people who live in the home. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 30 Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 31 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. There are effective quality assurance systems in place. Temporary management arrangements are satisfactory but the Providers will need to ensure that there is a Registered Manager in post as soon as possible in order to ensure smooth running of the home. EVIDENCE: We looked at standards 31,33,35,36 and 38. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 32 In their AQAA the Providers tell us – “Home manager is a RGN and has 14 years experience in elderly care: she is undertaking the Registered Managers Award. Policies and procedures provide guidance and ensure we work within the law and best practice. There is effective communication throughout the home with staff and management meetings. Residents meet formally but have access to the manager at any time. Personal Allowances reconciled weekly to ensure accuracy; Resident fund managed effectively and balanced on a weekly basis; residents have access to their records as they wish. Health and safety has a high profile within the home with quarterly meetings and a daily focus on problems.” Their evidence to show how they do this – “Good staff morale; minute from meetings; Managers surgery; training records complaint file. Personal allowance/resident fund reconciliation. Policy and procedures. Supervision records.” The acting manager is qualified and has the necessary experience to run the home. She is aware of the need to keep up to date with practice and continuously develop management skills, although it may be difficult to attend regular formal training courses. The acting manager trains and develops staff who are generally competent and knowledgeable to care for the residents. The home focuses on the individual, takes account of equality and diversity issues, and generally works in partnership with families or close friends, as appropriate, and professionals. The home has a statement of purpose that sets out the aims and objectives of the service. The acting manager, supported by the Regional Manager, is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the service. The evidence to support the comments made is satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done in the last year, or how it is planning to improve. The AQAA gives us some limited detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. The data section of the AQAA was completed, although there are some inconsistencies. The acting manager is aware of the need to promote safeguarding and has developed a health and safety policy that generally meets health and safety requirements and legislation. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 33 People manage their own money where possible, although the service is not proactive in developing skills in this area. This means that some people could be more independent than they are currently. Individuals have access to their records whenever they wish. As outlined previously, the Registered Manager had recently been suspended and the deputy manager is working as acting manager. This is a supernumery role. The Regional Manager offers good support and visits the home at least once a month. At the time of the inspection visit the acting manager was on duty and working supernumery. The Regional Manager and 2 other Registered Managers from within the Company joined her during the day. Discussions with the acting manager, who was employed as deputy manager of the home, identified that she felt well supported in her new temporary role. She told us that the Regional Manager visits regularly and helps her with managerial duties including ongoing quality assurance audits. The acting manager is a first level nurse with adequate experience in management and nursing care of the elderly. She went on to tell us that she is currently doing a “mentorship course” at Keele University with a view to the home taking Student Nurses in the near future. The acting manager is also the only Moving and Handling Trainer for the home. Examination of the staff training records for mandatory training identified a few gaps and it is recommended that the Providers supply another Moving and Handling Trainer for the home in order to ensure that all staff are kept updated. Discussions with the people, who live in the home, plus 2 visitors, identified that they had no concerns about the management of the home. They were aware that residents’ meetings are held from time to time and felt that they are kept informed of any changes. 2 of the residents, who had lived at the home for several years said that they felt “included” and that if they had any suggestions they were always listened to, not just at meetings but “could go and see the manager at any time in her office”. Discussions with the staff members identified that they too felt supported and that the present acting manager was very approachable. There was evidence of formal staff supervision sessions taking place and these had been recorded. There was a good rapport noted between the acting manager, staff and people who live in the home. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 34 The home has an effective quality assurance system in place with regular auditing of all the services provided. Evidence of these audits was seen during the visit. The views of residents are sought from time to time in the form of surveys – some of these completed surveys were seen. The Regional Manager carries out her own audits monthly when she visits the home. We looked at the system for the maintenance of personal allowances. The administrator told us that individuals are encouraged to handle their own finances wherever possible. If this is not possible, then the next of kin or representative is asked to do this. The system for monitoring personal allowances is computerised. Each individual has their own running balance, receipts of expenditure and records of monies received are documented. It is therefore possible to carry out an audit trail at anytime. This account was for all the residents together and was a non-interest accruing account. There was one individual who had a large amount of monies in this account, where no interest on her savings was accruing. We spoke with this resident and discussed her options with her, she decided that she would like an advocate who could advise her further with a view to assisting her with her finances. This was discussed with the acting manager who confirmed that she would access an advocate for this lady. The acting manager was responsible for maintaining a healthy and safe environment for the people who live and work in the home. Records relating to the maintenance of the home had been kept by the maintenance person. These were seen to be up to date. The required checks and servicing of equipment, including fire detecting and fire fighting equipment had been carried out and recorded. Staff had received training in fire safety and other mandatory training such as moving and handling, infection control, control of hazardous substances and food hygiene. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 35 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 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 3 x 3 Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 36 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 OP1 Regulation 5(1) b Requirement The Service User Guide must contain the range of fees charged by the home so that prospective residents are aware of how much they will need to pay in order to stay at the home Timescale for action 20/05/08 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 OP1 Good Practice Recommendations The home should develop more innovative ways of helping prospective individuals to choose a home that will meet their needs and preferences. It should develop clear information to help them understand what specialist services the home can provide. More could be done to meet the social and therapeutic needs of individuals who do not attend organised activities. The seating arrangements in the area located outside the main dining room do not encourage socialising. Smaller, more informal groups would be more appropriate. The development of care plans designed specifically for DS0000026971.V351178.R01.S.doc Version 5.2 Page 37 2 3 4 OP12 OP19 OP7 Westfield Lodge Nursing Home individuals on respite care would help to ensure that shortterm care needs are monitored and met. Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westfield Lodge Nursing Home DS0000026971.V351178.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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