Inspection on 20/06/08 for Westfield Nursing Home

This inspection was carried out on 20th June 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 Nursing Home 22/06/06

Westfield Nursing Home 08/12/05

Westfield Nursing Home 10/05/05

Westfield Nursing Home 09/12/04

Westfield Nursing Home 17/08/04

Westfield Nursing Home 27/01/04

Westfield Nursing Home 11/09/03

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Abbey The

Snydale Care Home

Larchfield Manor

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Staveley Birk Leas Nursing Home

Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Westfield Nursing Home Ripon Road Killinghall Harrogate North Yorkshire HG3 2AY Lead Inspector Anne Prankitt Key Unannounced Inspection 20th and 26th June 2008 09:30 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 Nursing Home DS0000028046.V367123.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 Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westfield Nursing Home Address Ripon Road Killinghall Harrogate North Yorkshire HG3 2AY 01423 506344 01423 528185 westfield.house@fshc.co.uk None provided County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Muriel Smith Care Home 31 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 (31), Physical disability (31) of places Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in category (PD) must: i) be over 50 years and ii) require nursing care 21st June 2007 Date of last inspection 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 older people requiring residential or nursing care. 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. The administrator told us on 20 June 2008 that current scale of weekly charges ranges from £386.06 to £525. This does not include the free nursing care contribution where applicable. Additional charges are made for chiropody, hairdressing sweets, toiletries, flowers newspapers and magazines. A brochure and financial advice is sent to people who enquire about the home. People can get more information in the service users’ guide once they are admitted. People can ask the home if they want to see the most recent inspection report completed by the Commission for Social Care Inspection. Westfield Nursing Home DS0000028046.V367123.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. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards from eight people living at Westfield, and four family members. Comment cards were also sent to visiting professionals and some staff, but none were returned. A visit to the home by one inspector. This took place over two days, because the registered manager, from whom information was needed, had planned leave on the first visit. • • During the visit to the home, some people who live at Westfield, some staff and the registered manager were spoken with. Four people’s care plans were looked at, as well as two staff files, some policies and procedures, and some records about health and safety in the home. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Westfield. The regional manager was provided with some preliminary feedback during the first visit. The registered manager was also provided with feedback at the end of the second visit. What the service does well: The registered manager makes sure that staff have information about people’s nursing and personal care needs before they are admitted. This allows staff to have some understanding about the care and support they will need in these areas when they arrive. Relatives said ‘I have spoken to my relative about this and they are very happy with the care they receive’, ‘Generally it would appear that there are staff on duty to handle most problems’, ‘Makes certain they handle each case as sensitive as they can, and ensure comfortable surroundings’, ‘I think they do a very good job’. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 6 The registered manager asks for the support of the community matron so that staff have the training they need to meet the clinical needs of the people living at the home. The home is clean, warm and comfortable. People can bring in their own belongings. This makes their bedrooms more personal to them. Visitors are always made welcome. One commented ‘The staff have always been very welcoming and pleasant when I visit.’ This helps people to main important links with their families and friends. People are supported in maintaining their spiritual needs. What has improved since the last inspection? What they could do better: When asked about whether they got enough information about the home before they were admitted, they said ‘I feel like I did not have much say in the matter’, ‘Don’t remember any information being given’, ‘I didn’t know about the meals service’, ‘They told me about it I think’. People could be consulted more, so that they remain involved in decisions about their future. The Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 7 information collected about people’s social and psychological needs could be sought in more detail, and could be recorded better in their care plan once admitted. Risks to people’s health and welfare could be reviewed and monitored more often so that changes in need can be recognised early. By involving people and/or their families more in the development and review of their care plan, they could be more involved in decisions about their care. Staff should always knock before they enter people’s private rooms so that they can be assured privacy and choice over who enters their room, and when. When people were asked whether staff were available when needed, they said ‘Few and far between’, and ‘Not often. I have to shout’. When asked about their care, comments included ‘I feel I get left out’, ‘I often ask to go to the toilet but don’t get taken’, ‘Staff do care for me, but they sometimes forget that we get confused, and need reminding about what we are doing, and why we are here’. One person said that they sometimes have to ‘shout for help’. Relatives generally agreed that more staff could be available to meet people’s needs. Staff breaks could be staggered to reduce the chance of people who cannot reach their call bells having to wait unduly for attention. Some aspects of medication administration and storage practice could be better managed so that people get medication that has been safely stored, and as prescribed. This includes a more thorough audit, so that discrepancies or shortfalls are recognised and acted upon quickly. People could be offered a more positive choice of menu so that they can be more independent in making decisions about their preferred meal. They could also have better access to their money kept by the home at weekends. People and their families could be reminded about how to complain, and who to. This will help to make sure that any future concerns they may have are directed to the right person. People, and outside professionals who support their care, could be given more opportunity to comment formally about the service through satisfaction surveys. This would assist in making sure that the home is run in people’s best interests, and according to their views. The past employment of prospective staff could be more rigorously checked to make sure that there is no past history which would make them unsuitable to work with vulnerable people. A more thorough check could be kept of what training staff have attended, so that updates can be provided when needed. This will help to assure people that they are cared for by a workforce who know how to work safely. More staff could complete National Vocational Qualifications, which would reinforce good practice in care. Staff should know who is the designated first aider at any time, so that they always know who to ask for assistance should an accident happen which needs first aid attention. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 10 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): 3 and 6 People who use the service experience adequate outcomes in this area. People’s nursing and personal care needs are assessed to check they can be met before they are admitted. But their right to be involved in choosing their home and their contractual arrangements is not necessarily considered. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Before being admitted, the registered manager gets written assessments about people’s current needs from the person’s care manager, or from the hospital staff, depending upon where they are being admitted from. The registered manager or her deputy assess the person if no assessment has been done. This information helps the manager to check whether the home will be able to meet the person’s needs successfully. The assessment is shared with staff who work at the home so that they have some understanding about what help is required when they arrive. Some of Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 11 the assessment information was missing. For instance, within one assessment, the staff member had recorded the person’s wishes upon death and dying, and their individual sexuality as being ‘not applicable’. This had not been followed up following admission. Although nursing and personal needs were adequately assessed, this does not consider the person as a whole. The registered manager said that it was sometimes hard to get information about psychological needs, wishes upon death and dying and sexuality. However, staff must make sure that these areas of care are not overlooked subsequently. The registered manager said people are often too frail to visit the home for a look round before they are admitted. Normally the family, who are sent a brochure and financial information about the home, visit on their behalf. Out of the eight people living at the home who returned their surveys, only two people said they got enough information before they moved in, and two said that they had received a contract. Comments included ‘I feel like I did not have much say in the matter’, ‘Don’t remember any information being given’, ‘I didn’t know about the meals service’, ‘They told me about it I think’. People must be more involved in decisions about their admission. For instance, they could be given a copy of the service users’ guide before they are admitted so they can see whether the home provides what they need. People must also be given a positive choice about whether they want to see their contract. The home does not provide intermediate care. It does however provide one interim bed, which is block purchased by the health authority. People are transferred from hospital into this bed when they become medically stable, until their long term care has been organised. The registered manager relies on the assessment completed by the hospital or care manager when deciding whether the person’s needs can be met by the home. If there are issues which she needs to look into further, she or her deputy visits the person themselves to check that the information they have is correct. Westfield Nursing Home DS0000028046.V367123.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): 7,8,9 and 10 People who use the service experience adequate outcomes in this area. People’s individual care needs are not yet fully reflected in their care plans. This could lead to an inconsistent approach in meeting their needs. The storage, administration and recording arrangements of people’s medication could be improved to minimise risk to people. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There have been some improvements made to the care plans since the last key inspection. The plans give an outline of people’s physical and personal care needs, and explain what staff should do to meet them. Staff have tried to record how each person likes to receive their personal care. This helps to make the care more individual. Assessments are completed to check the level of risk to each person’s physical health, such as the risk from pressure sores and poor nutrition. These are normally reviewed each month along with the care plan, although there were some omissions. For instance, recent falls suffered by one Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 13 person had not been considered as part of their risk assessment to see whether anything further could be done to minimise the risk to them. The registered manager has now had training about how to make care plans more individual. She was already aware that people’s social, psychological and spiritual needs were not always looked at. For instance, one person’s pre admission assessment said that they were anxious and frightened. But ways to alleviate their anxiety had not been considered and written down. The recent questionnaires returned as part of the satisfaction survey completed by the company highlighted that half of the people who returned them were not involved in care decisions. The lack of involvement of people and their families in the development and review of their care plans means that staff have little information about people’s social needs and interests. This makes it more difficult for staff to understand people as individuals. The services of health professionals in the community are sought when the home needs advice. The registered manager has agreed to ask for a review of one person whose needs have changed since they were admitted. This will check whether any further support can be given to help meet these changing needs. People who returned their surveys to the Commission gave mixed views about the care that they get. Three people said that they usually get the care and support that they need. Three said that they sometimes do, whilst two said that they never do. People said ‘I feel I get left out’, ‘I often ask to go to the toilet but don’t get taken’. One person said ‘staff do care for me, but they sometimes forget that we get confused, and need reminding about what we are doing, and why we are here’. Another said ‘I think that I should have more attention like other people do’, and another that they have to ‘shout for help’ to get staff attention. On the day of the site visit, all staff took their break at the same time, and people in the communal area are unable to reach the call bell to request help. The registered manager agreed that staff breaks could be staggered. This may stop people having to shout for help, may delay the time they have to wait for attention, and will protect their dignity. Comments from relatives were generally positive. One said that the home always meets the needs of their relative, whilst three said that this was usually the case. Their comments included ‘I have spoken to my relative about this and they are very happy with the care they receive’, ‘Generally it would appear that there are staff on duty to handle most problems’, ‘Makes certain they handle each case as sensitive as they can, and ensure comfortable surroundings’, ‘I think they do a very good job’. A visiting relative said that ‘care is good’. They said they ‘don’t have to wait too long if care is requested’, and that the staff ’keep in touch’ if they have concerns about their relative. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 14 Staff generally made an effort to maintain people’s privacy. For instance, screening was used when one person was transferred from their chair using the hoist, and ‘Care in Progress’ warnings are displayed on people’s doors whilst they receive care, so staff know not to enter the room. However, one staff member entered an occupied room without knocking first. Although the person was not receiving care, the staff member should not assume that they can enter without the person’s permission. Staff look after most people’s medication on their behalf. The room where it is locked away is small, and the temperature checks done by staff show that the room sometimes gets too warm. Following the site visit, staff have told us that they are monitoring the temperature more closely, and will seek further advice if the room starts to get too hot again. The requirements made at the last inspection were generally met. However, some shortfalls were noted at this inspection. They need to be addressed to reduce potential risk to people: • Although night staff complete a weekly count of the medication, there were too many tablets remaining for one person compared to how many there should have been. This means that either the medication is not being counted properly, or that staff are signing to say they have given medication when they have not. There was no record kept of the medication used by one person who looks after their own. This could mean that important information cannot be passed on in an emergency, if the person is unable to speak for themselves. For some time, one person had not needed two of their medications to be given ‘when required’. Their doctor should be asked to review this, to see whether it is still needed. This will reduce the risk of it being given unnecessarily. The risk assessment for a person who self medicates had not been regularly reviewed to check that they were still willing and able to carry on looking after it themselves. In one case there was a gap of eighteen months between reviews. • • • Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 15 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): 12,13,14 and 15 People who use the service experience adequate outcomes in this area. People can maintain important links with family and friends, but further opportunities could be given to them to make choices in their daily lives. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Since the last inspection, an activities person has been employed for twenty hours each week. She works flexibly, depending upon what social events have been organised for people. She has started to write in the care plans what activities people have joined in with, and whether they enjoyed them. Details about events taking place outside the home were displayed. But the in house activities programme needs to be updated so that people know what activities are available to them, and when. This will allow people to plan their day depending on what they want to attend and look forward to favourite events. One person said ‘I would attend an activity if I thought it was of interest to me’. The activities person was on leave at the first site visit. There had been no activities organised in her absence. Most people in the communal areas slept in Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 16 their chair. On person said that it ‘gets a bit boring’ with only the television for entertainment. However on the second visit, a staff member had taken time to sit with people and gave them nail care. People had also had a visit from the hairdresser. They said that they had enjoyed both activities. Monthly religious services are held at the home to assist in meeting people’s spiritual needs. Individuals are visited by members of their own church, and links are forged with the Roman Catholic priest who visits on request. Visitors are welcome. People can see them in private if they wish. This helps them to maintain links with family and friends that are important to them. One visitor commented ‘The staff have always been very welcoming and pleasant when I visit.’ Staff explained that a cleaner and laundry assistant have been employed, so they no longer have to complete domestic tasks. They said this means that they can spend extra time with people, be more flexible, and provide more choice. Many of the people living at the home spend their day in their room because of their frailty. But one person who spends their day with others said they can choose when they go to bed and when they get up. People are offered three meals each day, and get supper on request. There was a supply of cold drinks in the communal areas, and people in their room had a drink to hand. People were given a choice of hot drinks in between breakfast and lunch. There is no positive choice for the main meal, although one person said ‘There are times when I am offered an alternative if I’m not happy with what is on the menu’. No alternatives were provided on the day of the site visit. The cook said she knew everyone liked what was on offer. The manager is making changes to the menu by referring to the sample menu produced by the company. This does provide positive daily choice, which should be considered. People seemed to enjoy their meal on the day, although their views were mixed. Comments included ‘Could always do with a bit more’, and ‘The food seems fine to me’. Relatives said ‘Kitchen staff make lovely meals and often make drinks’, ‘The meals I have seen served up have always been of excellent quality’. On the first day, the serving was quite small. On the second, it appeared much more substantial. The cook said she sometimes struggles with the budget that she is provided with, but was satisfied that, with careful management, people get a nutritious diet. She confirmed that fresh meat is delivered each week, with fruit and vegetables being delivered twice weekly. The environmental health officer has recently made a routine visit to look at how the kitchen is managed. He made some recommendations about paperwork which the cook is implementing. Otherwise he was satisfied with the systems in place. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 17 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): 16 and 18 People who use the service experience adequate outcomes in this area. People are protected by staff who will take the right action to protect people. But people may not be clear about to complain or who to raise their concerns with. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Although three of the eight people who returned their surveys said that they always knew who to speak to if they were not happy, three did not. And six people did not know how to complain. One person spoken with said that they would benefit from having some written information about how to complain. Relative feedback was also varied. Of the four who returned their surveys, two knew how to make a complaint. One relative spoken with could not remember getting any written information about how to complain, although they had never had any cause to. This mixed feedback reflects the results of the recent satisfaction survey carried out by the company. The registered manager agreed that she should consider giving people and their relatives another copy of the service users’ guide and complaints procedure. This will help to remind them who they should go to, and what action the home would take, in the event of a complaint being made. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 18 Three complaints have been made to the home since the last key inspection. These were documented, and the written information explained what action the registered manager had taken in response to the concerns. Staff spoken with said that they would take all complaints seriously. They knew they must report these to the registered manager so they could be investigated. Staff also knew that they must report, without delay, any abusive behaviour they witnessed, or were told about, towards people living at the home. They knew that under no circumstances could they keep their concerns secret. In turn, the registered manager knows with whom they must share such information, so that any issues can be investigated without delay. This action will help to keep people safe from harm. Some staff have not yet received training in safeguarding. The registered manager must check whose training is outstanding, and make sure that it is provided. This will help to assure people that everyone will act properly should an allegation come to light. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 19 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): 19 and 29 People who use the service experience adequate outcomes in this area. People should benefit from the forthcoming refurbishment which will improve the appearance, comfort and safety of the home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is a converted property situated on the main road. There is a small well tended garden area at the back of the building with outside seating provided. The front entrance of the home is not used. Discussion took place with the regional manager about one aspect of the security of the building. She has confirmed that action is being taken to improve this, and that the work will be completed soon. Until then, staff must remain vigilant about who is entering and leaving the building. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 20 The premises were clean and there were no unpleasant smells. Two people living there said that this was always the case. One person noted improvements now that there is a full time cleaner in post. People were satisfied with their bedroom space, which they had personalised. Many people spend the day in their room. Those visited had access to their call bells so that they could alert staff if they needed to. The home is not ideal for people with problems with their mobility, or for staff who need to transfer people by wheelchair along the corridors, some of which are steeply ramped. The registered manager said that this is always considered when assessing people before they are admitted, to check that it will not be a problem to them. Some areas of the premises are due to be refurbished, starting in August. This includes plans to provide a safe locking device to either entrance leading to the stairs to the laundry and registered manager’s office. The registered manager is certain that this work is not urgent. She has assessed that nobody at the home is currently at risk from accessing these areas accidentally. However, these plans, which have been agreed by the fire officer, should be pursued, because they will reduce potential risk to people. A bathroom to the first floor of the home is out of order following refurbishment, because agreement has not yet been reached about the best way to secure the bath hoist. This means that people who live on this floor have to go to another floor to have their bath. This is not ideal, and the bathroom should be re commissioned as soon as possible. The laundry is located in the basement. There is now a laundress who provides cover five days out of seven. The equipment available was appropriate. Protective gloves and aprons are provided, and staff deliver soiled linen in separate sealed bags. Staff get training about how to control infection. This helps to reduce the risk from cross infection. People’s clothes looked clean and well cared for. The room used for the storage of dressings and other medical equipment, such as the suction machine, is used as a general storage area. It also contains a toilet, which is used regularly. The room contained some hand washing solution which was not locked away, and which could cause harm to people. The registered manager agreed to keep it locked away immediately. She also agreed to contact the infection control nurse for advice, to check that the general storage arrangements for this room do not pose risk to people from cross infection. We have been informed that a visit by the infection control nurse has been organised. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 21 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): 27,28,29 and 30 People who use the service experience adequate outcomes in this area. Staff training and availability could be improved to make sure that people get a consistent service from well trained staff. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three carers and one trained nurse were available to care for twenty people. The registered manager was also on duty but was not included in the numbers. Staff did not appear unduly rushed, and call bells were answered reasonably quickly. People had mixed views about how staff made themselves available. When asked if there were enough staff, one person said ‘Few and far between’, whilst another said ‘Not often. I have to shout’. Relatives commented ‘They need more staff then there would be less stress. There is a lot to do with not enough staff to it’, ‘Like any other home more staff! Particularly after meals. Everyone seems to need toileting at once’. As discussed earlier, staff took their break together. Breaks should be staggered, so that staff are more visible to people, and delays in getting the care people want are avoided. The registered manager said she looks at staff availability in line with the number of people living at the home and their dependency needs. It is her intention to discuss with her regional manager the possibility of extra staff being made available. There are a number of care staff and nurse vacancies. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 22 Agency staff are used to maintain satisfactory staffing levels. The same agency staff are used on a regular basis. One permanent staff member said that this was helpful, because it meant that there were ‘no strangers’ caring for people. This will assist in continuity of care. Staff files contain recruitment and training details, although information about what training they had attended was sometimes missing. The two files looked at showed that appropriate police checks had been made before the staff were allowed to work at the home. This helps to protect people from unsuitable workers. However, the employment history of prospective staff must be fully explored so that any gaps in employment can be explained, and any reason why they should not work with vulnerable people ruled out. New staff have a full induction so that they know how to give good care. But none of the staff are undertaking training in National Vocational Qualifications in Care. The registered manager said that, despite encouragement, staff have not wished to complete the training. Currently, around 30 hold this qualification. It is in the interests of the people living at the home that staff underpin their knowledge with this training. As such, this needs to be pursued, so that staff have a better understanding of why they do what they do. Trained staff get in house training from the community matron to assist them in meeting the nursing needs of the people living at the home. Once trained, they then have to show that they are competent before they are allowed to carry out procedures such as managing nutrition which is fed directly into the stomach, and catheter care. The manager is satisfied that now there is always an appropriately trained and competent nurse on duty to carry out such procedures. She also checks that agency nursing staff are competent to meet people’s different health needs before they are employed. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 23 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): 31,33,35 and 38 People who use the service experience adequate outcomes in this area. People’s wishes and personal interests could be given more consideration when deciding how the home should be run. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She has completed the Registered Managers Award, and gets support and supervision in the running of the home from the regional manager. The regional manager normally writes a report and action plan, which she gives to the registered manager following her statutory visit to the home. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 24 The plans for refurbishment include moving the registered manager’s office space into a more central position within the home. This should help to make her more readily accessible to people, staff and visitors. Staff said the manager was ‘supportive’, and that she communicates with them. The company provides annual questionnaires intended for people who live at their homes. People living at Westfield are not given a questionnaire. Instead, the questionnaire is given to their family. The opinion of people living at the home may differ from those of their family, and should not be overlooked. The views of visiting professionals should also be sought. The results of the survey should be published, together with the action that the home is going to take in response to their comments. The shortfalls identified in the most recent survey completed by the company were similar in some areas to the findings of this key inspection. It is important that the registered manager develops an action plan for improvement so that these shortfalls can be acted upon. Relatives or representatives usually look after people’s finances, although one person is supported to manage their own. The home does look after people’s personal allowances. The administrator requests money from relatives as and when needed. This is placed in a central bank account which keeps track of how much each person has saved. Although this may be people’s preferred choice, it does mean that they have little responsibility for handing their own money. A small float is kept at the home, to which the registered manager and administrator have access. They tend not to work at weekends, so it is more difficult then for people to get their spending money out. Thought should be given as to how people can get their money whenever they may want it. The information provided by the registered manager before the site visit gave details about how the premises are maintained, and equipment serviced. Where these arrangements were not clear, the regional manager has checked and assured us that the work has been completed. This relates to remedial work following the unsatisfactory fixed wiring test in June 2007, testing to check that people are protected from the risk of legionella, and servicing of the gas appliances. The maintenance man carries out certain safety checks each week to make sure that, for instance, the fire alarm is working, and that hot water is kept at a safe temperature. The staff files are not up to date with regards to mandatory staff training. The registered manager keeps these details separate. The information she had compiled did not include the date when mandatory training had taken place, therefore it was difficult to see when it was next needed. Staff’s account of what training they had attended did not always correspond with the list kept. This needs to be rectified and gaps in mandatory training identified and provided. The registered manager was satisfied that there was always a qualified first aider on duty. However, not all staff knew who the designated first aider was. This could cause delay should first aid skills be needed in an emergency. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 13 Requirement People’s risk assessments must be kept up to date so that they clearly explain any current risk to the person, and how this can be minimised. People’s care plans must provide a full picture of people’s overall care, especially with regard to their social and psychological needs, so that they can be properly and consistently supported by the staff who care for them. The way that medication is audited must be made much more robust so that issues including the following are acted upon and remedied quickly: Discrepancies between stock held and records kept need to be identified and the source of the problem dealt with. Shortfalls in the review of risk assessments for people who self medicate must be addressed with the staff responsible for their upkeep. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 27 Timescale for action 31/07/08 2 OP7 15 31/08/08 3 OP9 13 31/07/08 The information held about the medication kept by people who self medicate must be improved. Long term omission of medication prescribed to be given as prescribed must be brought to the attention of the doctor to see whether a review is necessary. Attention to these matters will reduce potential risk to people. The employment history of prospective staff must be fully explored so that any gaps in employment can be explained, and any reason why they should not work with vulnerable people be ruled out. A review of when staff last received mandatory training in: • • • • • Fire safety Moving and Handling Infection control Food Hygiene First Aid 4 OP29 19 26/07/08 5 OP38 13 31/07/08 must be carried out. On completion, staff who need an update must be provided with this so people can be assured that they are being cared for safely at all times. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations Staff should always strive to assess areas affecting people’s social, psychological and personal identity when completing their pre admission assessment, so that people can be assured that these will be reflected in their plan of care following admission. Ways in which people and/or their representatives can be included in the development and review of their care plan should be considered and implemented. This will help to keep people more involved in decisions about their care. Staff breaks should be staggered so that people have better access to them when they need help. This may assist in making sure that people get the care they need when they need it, and will help to retain their dignity. To maintain people’s privacy, staff should always knock before entering their personal accommodation. The company menu plan should be considered at the home so that people get more a positive choice of meals. The food budget should be reviewed to check that it remains adequate to meet the needs of the service. People and their families should be reminded during meetings and by re issuing the complaints procedure about how to complain. This will reassure them that the home has proper arrangements for dealing with any concerns which may be brought to their attention. Arrangements should be organised for those staff who have not attended training in safeguarding adults so that they can receive this training. This will help to protect people by making sure that all staff know what action to take should they ever need to report an allegation of abuse. The plans to make access to the stairways to the registered manager’s office and laundry should be pursued, to reduce the risk from falls down the stairs for people who may accidentally access this area. Work to the recently refurbished bathroom to the first floor should be completed as soon as possible so that people Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 29 2 OP7 3 OP10 OP27 4 OP15 5 OP16 6 OP18 7 OP19 8 OP28 9 OP30 10 OP33 11 OP35 12 OP38 who live on this floor do not have to go to another floor in order to have a bath. More staff need to complete NVQ Level 2 training so that people can be assured that they are cared for by well trained staff whose practice has been updated and assessed. Up to date Individual training files should be in place. These should match the information in the training matrix so the information can be used to identify individual training needs to meet the needs of people living at the service. People living at the service, and the community professionals who support them, should be offered a satisfaction survey. This would give them the opportunity to comment directly about the quality and effectiveness of the service. The collective findings and resultant action should be published, so that people can see what the home does well, and where improvements will be made in response to their views. Ways in which people can have better access to their personal finances when the registered manager and administrator are not available should be explored and implemented. A better system should be implemented so that staff know at any time who the designated first aider is on each shift. This will reduce any delay in assistance being sought should an emergency requiring first aid arise. Westfield Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Nursing Home DS0000028046.V367123.R01.S.doc Version 5.2 Page 31 - 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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