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Inspection on 10/05/05 for Westfield Nursing Home

Also see our care home review for Westfield Nursing Home for more information

This inspection was carried out on 10th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users describe staff as being "approachable, supportive and helpful". Staff and service users feel that they are able to approach the manager with any concerns and would feel confident that these would be addressed. Service users feel they are treated with "respect and dignity" by all staff. Service users were complimentary about the quality of the meals. Call bell requests are responded to within a short space of time.

What has improved since the last inspection?

The morale and atmosphere within the home has improved. There has been some improvement in the quality of the care planning documentation. Service users have benefited from the employment of two domestic staff enabling care staff to spend more time with the service users. Recruitment procedures are more robust to safeguard service users from harm.

What the care home could do better:

Medication systems could be improved so that controlled drugs are not being administered without the presence of a witness so this avoids risks of mistakes. Care plans could include information about how social and emotional care needs are to be met so that all the care needs of the service users are considered. Further additional domestic staff could be employed to maintain and improve the living environment for service users. Staff could undertake fire training so that they have an understanding of fire safety measures to protect the health and safety of service users. Extra qualified nurses could be employed to cover afternoon shifts and weekends to ensure that there are a sufficient number of nursing staff to ensure that the care needs of service users are fully met at all times. The manager could look at ways of enabling service users to have more opportunities to socialise with others both in and outside of the home. Formal staff supervision arrangements could be put in place so that staff are fully aware of their roles and responsibilities in meeting the needs of the service users. The regular recording of the service users` weight would help to ensure that their health circumstances are more closely monitored. Chemical cleaning agents and mop buckets containing dirty water could be attended to at all times to protect the health and safety of service users.

CARE HOMES FOR OLDER PEOPLE Westfield Nursing Home Ripon Road Killinghall Harrogate HG3 2AY Lead Inspector David White Unannounced 10 May 2005 09:30 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. 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 Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Westfield Nursing Home Address Ripon Road, Killinghall, Harrogate, North Yorkshire, HG3 2AY 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) 01423 506344 01423 506344 County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Mrs Muriel Smith Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 09/12/04 Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Westfield House is part of County Health Care Ltd , a wholly owned subsidiary of Four Seasons Health Care Ltd.It is situated approximately three miles north of Harrogate on the east side of the main A61 Harrogate to Ripon Road. The building is a large older style stone built house on three floors including a lower ground floor which has been adapted and extended to provide accommodation for up to 31 service users requiring residential or nursing care. All service users areas apart from the lower ground floor can be accessed by a shaft lift. There is a gravelled area to the front and north side of the home and parking areas provided at the front and back with a lawned area stretching beyond.Westfield Nursing Home accommodates people admitted by virtue of old age and infirmity. Staffing cover is available in the home throughout the 24-hour period each day. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Tuesday 10th May 2005. It was undertaken over 8 hours. The focus was on a number of key standards together with those subject to requirements or recommendations at the last inspection. The inspection incorporated a brief look around the premises. The care records of four service users were examined in detail and these service users were spoken with about the care they receive. A number of other records were also examined. Discussions were held with the registered manager and four other members of staff, which included a nurse and three carers. What the service does well: What has improved since the last inspection? The morale and atmosphere within the home has improved. There has been some improvement in the quality of the care planning documentation. Service users have benefited from the employment of two domestic staff enabling care staff to spend more time with the service users. Recruitment procedures are more robust to safeguard service users from harm. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 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 standard(s) 1, 3 and 6 People are provided with information and are assessed so they can make an informed choice about living in the home. EVIDENCE: The Statement of Purpose has been amended to provide adequate relevant information about the home. The assessment documentation inspected of four service users was of sufficient detail so as to make it possible for the care needs to be identified and which formed the basis for the development of the care plans. Pre-admission assessment forms were supported by an assessment and initial care plan from the placing or funding authority where applicable. Care staff spoken with demonstrated a good understanding of the needs of the service users. The registered manager stated that the home does not provide intermediate care. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Service users are treated in a dignified and respectful manner and in general their care needs are met reasonably well. EVIDENCE: Service users spoken with felt that their care is provided sensitively and in a manner that promotes their dignity. All service users spoken with said that they were “treated with respect” and observation confirmed this. Individual care plans were available for all of the four service users who were spoken with. There had been some improvement in the quality of the care plans from the previous inspection. Each individual service user file contained a range of risk assessments to promote independence and safety. Two of the service users spoken with had pressure sores. The management of these pressure sores was recorded within their individual plans and it was observed that equipment necessary for the promotion of tissue viability and treatment of pressure sores was available. Staff said that they were always provided with the specific equipment required to enable them to be able to carry out their duties. It was clearly recorded when health professionals such as the GP or District Nurse had visited the service users. Service users have access to Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 11 dental and chiropody services when required. The care plans however tended to focus mainly on physical and health care needs and made little reference to the emotional and social care needs of the service users. Two service users commented that they would like to “spend more time out of their bedrooms”. The pre-admission information confirmed that both these service users enjoyed going out in their wheelchairs, however there was no care plan in place to address this need. A service user spoken to was a diabetic, however there was no care plan in place to instruct staff as to how this need was to be met. Care plan information was not always fully signed and dated and should be addressed. Service users spoken with confirmed that call bell requests are responded to within a short space of time and this was observed at the time of inspection. Staff said that there were “good handover systems” in place to ensure that information about service users is passed on to all staff members. Records of regular weighing were not always present and this should be addressed. The medication records were examined. The Medication Administration Records inspected were accurate and up to date. The controlled drugs register showed that on at least two occasions a nurse without a witness had administered a controlled drug. This matter was raised at the previous inspection and remains outstanding. The manager needs to address this. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 12 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 standard(s) 12 and 13 Service users have insufficient opportunities for social stimulation both in and outside of the home. EVIDENCE: The home offers some activities and information in relation to this was displayed in the home. A number of service users were observed to be watching television within their bedrooms. Three of the service users’ spoken with have mobility problems and are confined mostly to their bedrooms. All said that they would “like more opportunity” to be able to spend more time out of their bedrooms. The manager said that service users are offered the option of sitting in other parts of the home but will address the issues raised by these comments. Others commented that it would be nice to be able to spend some time out of the home. Visiting time is flexible to enable service users to keep in regular contact with their family and friends. All the service users spoken to were complimentary about the quality of the meals provided. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 Complaints are dealt with appropriately to safeguard service users’ interests. EVIDENCE: There are adequate policies and procedures in place to deal with complaints and information about the complaints procedure is on display in the home. There have been three complaints made about the home within the last year and the complaints records showed that all complaints had been responded to and dealt with appropriately within agreed timescales. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 14 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 standard(s) 19 and 20 and 24 Investment is required to ensure that the home is safer and more pleasant for service users to live in. EVIDENCE: The home was clean and tidy at the time of the inspection. Accessibility to bedrooms 1 and 2 remain difficult although currently both service users residing in these bedrooms are nursed mainly in their bedrooms. The decoration work to the ceiling of bedroom 5 remains outstanding, as the service user residing in that bedroom does not wish to be moved to enable the work to be carried out. The dining space is currently sufficient to enable all the service users wishing to dine in there to be able to do so. The home has a number of service users requiring nursing care, however there are only six adjustable beds available for people with nursing care needs. The organisation is in the process of looking at re-development planning for the home to improve environmental standards. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 Progress has been made in addressing the domestic staffing issues within the home that has improved staff morale and as a result service users are receiving an improved service. EVIDENCE: Since the last inspection specific domestic staff have been employed and observation showed that the home environment was clean and maintained to a satisfactory standard. Service users confirmed that their bedrooms were cleaned on a regular basis. Staff spoken with expressed satisfaction with their job roles and all felt that “the atmosphere is lovely in the home”. Service users commented that staff are “always helpful and respectful” and one service user described the staff as “marvellous”. The duty rotas showed that although two part time cleaners have been employed there are still some days when there is no domestic staff on duty and the manager confirmed this. When this occurs the care staff are asked to carry out cleaning tasks as part of their daily routines therefore reducing the amount of time they can carry out their care responsibilities. The manager said that advertisements had gone out for the recruitment of extra domestic staff. Duty rotas showed that on some afternoon shifts there had only been one qualified nurse on duty instead of the required two and this also applied to weekend shifts. Whilst acknowledging this both the manager and staff felt that this had not had any detrimental effect on the care provided to service users. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 16 Service users spoken with felt that their care needs were met and commented that call bells were always responded to “quickly”. Three staff files were inspected and these included those of the most recently appointed members of staff, two of which had been employed from overseas. References had been obtained in all cases and the relevant pre-employment checks were carried out. The home has a rolling programme of care staff undergoing NVQ training. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 38 The manager is supported by the senior staff in providing leadership throughout the home. The health and safety practices within the home in general protect service users from harm although there were two exceptions to this. EVIDENCE: The registered manager is well experienced in running the home. She holds staff meetings to keep staff informed about routine and planned developments for the home. Service users and staff spoke in complimentary terms about her skills and abilities. Staff felt she was “approachable and supportive and willing to work hands-on if needed ”. Service users said that they would feel confident that the manager would be able to address any of their concerns. There are no formal supervision arrangements in place currently although the manager is in the process of trying to develop these. The manager has not Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 18 received any form of training to prepare her to carry out her supervisory role. Staff commented that although they do not receive formal supervision they do meet up to discuss issues within the home and this enables support and good practice to be shared. The home has a number of health and safety policies and procedures to safeguard service users. Individual risk assessments were available within service user files. During a look around the environment it was observed that all fire signs on display in the home now provide the necessary information to promote fire safety. A recommendation made during a recent fire inspection visit has also been met. Regular fire drills take place at the home and staff confirmed that one had taken place during the previous week. The home also has a fire safety workbook which, all staff are expected to read. At the last inspection it was required that all staff receive suitable fire training, however this has not been undertaken and needs to be addressed by the manager. During a look around the environment it was observed that some chemical cleaning agents and a mop bucket containing dirty water was left unattended on one of the corridors of the home. The manager addressed this at the time of inspection. An immediate requirement was issued in relation to this matter at the time of inspection. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 x COMPLAINTS AND PROTECTION 1 x x x x 2 x x STAFFING Standard No Score 27 1 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x 1 x 1 Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 20 Yes 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 7 Regulation 15 Requirement The service users plan sets out in detail measures to be taken by care staff to ensure that all aspects of health, personal and social care needs are to be met (previous timescale of 30/11/04 not met). All service users must be given the opportunity for social stimulation both in and outside of the home.. The ceiling in room 5 must be repaired Access to bedrooms 1 and 2 must be improved (previous timescale of 31/03/03 not met).. Monitoring systems need to be put in place to ensure that staff are adhering to procedures for the administration and recording of controlled drugs in the home. The registered person shall ensure that at all times there are a sufficient number of domestic staff working at the home to ensure that the home is maintained in a clean and hygienic state (previous timescale of 09/12/05 not met). Review the staffing arrangements for afternoon and J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Timescale for action 30/07/05 2. 12 12 As from 10/05/05 30/11/05 3. 19 23 4. 20 23 31/08/05. 5. 27 18 31/08/05 6. 27 18 31/08/05 Page 21 Westfield Nursing Home Version 1.30 7. 8. 36 38 18 23 9. 38 13 weekends to ensure that there are sufficent numbers of qualified nurses to meet the needs of the service users. All staff must be appropriately supervised (previous timescale of 09/12/04 not met). The registered person must ensure that all staff receive suitable fire training so that they are able to understand and implement fire procedures (previous timescale 30/11/04 not met). Chemical cleaning agents and mop buckets containing dirty water must be attended to and stored properly at all times so service users are not at risk of harm. 31/08/05 30/06/05 Immediate as from 10/05/05 and thereafter. 10. 11. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 7 8 24 28 36 Good Practice Recommendations Information within care plans should be fully signed and dated accurately. Service users weight should be recorded on a more regular basis. Additional adjustable beds should be provided. 50 of care staff are trained to NVQ level 2 or equivalent by 2005. The manager should receive some training/guidance to prepare for her role as a supervisor. Westfield Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection York Area Office Unit 4, Triune Court Monks Cross, York YO32 9GZ 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 Nursing Home J53_J04_S28046_Westfield_V223744_100505_Stage 4.doc Version 1.30 Page 23 - 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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