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Inspection on 22/06/06 for Westfield Nursing Home

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

This inspection was carried out on 22nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

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

The home offers a good standard of care which service users commented on. One relative said `it is wonderful here and the staff are very kind and caring`. Service users are protected by the home`s recruitment procedures. Staff only commence employment when appropriate checks have been carried out. The home provide a good standard of food.

What has improved since the last inspection?

Service user care plans are reviewed and evaluate on a monthly basis, this ensures needs are been consistently met. Service users feel safe in the home. There is an adult protection procedure in place and staff have now received training in this area. The manager is aware of the action to take if an allegation of abuse is made. This helps to safeguard service users from harm. The home complies with fire safety and service users doors are free to close when the fire alarm sounds. This protects service users in the event of a fire.Evidence that the gas appliances are safe in the home has been provided to the CSCI. The unguarded pipe work has been boxed in to ensure service users safety. The registered manager has completed her NVQ Level 4 in management. This enhances the care which is provided through a greater awareness of how to manage the home effectively.

What the care home could do better:

Service users do not live in a clean environment, there are no permanent domestic staff and many areas of the home were dirty. This is unpleasant for service users and they are put at risk of cross infection. Service users do not have access to a range of social activities and therefore they are often bored and unstimulated. The wallpaper on the ceiling of one of the shared room needs replacing urgently. Service users have the right to live in a well maintained home. Service users laundry is not handled in accordance with the homes infection control procedures. This is partly due to a lack of infection control training for staff, and the fact that the laundry is located in the cellar. This could put service users at risk.

CARE HOMES FOR OLDER PEOPLE Westfield Nursing Home Ripon Road Killinghall Harrogate North Yorkshire HG3 2AY Lead Inspector Jo Bell Key Unannounced Inspection 22nd June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westfield Nursing Home DS0000028046.V298985.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.V298985.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 Mrs 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.V298985.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 8th December 2005 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 service users requiring residential or nursing care. The current scale of charges ranges from £391-£470. Additional charges are made for chiropody, hairdressing and newspapers. 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 DS0000028046.V298985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit took place at the home on 22nd June 2006, this took one inspector 7.5 hours, and is part of the key inspection process. Prior to the site visit a pre-inspection questionnaire had been completed by the manager. During the visit seven service user surveys were filled in with assistance from the care staff. Discussions took place with service users, relatives and staff. At the site visit there were 24 service users residing at the home. A tour of the premises took place and a range of documentation was checked. The home provides a good standard of care where staff have a clear understanding of how to meet individual needs. Whilst the environment is homely, there are areas which need improving. Many of the requirements from the last inspection have been actioned, however, there are outstanding issues regarding infection control and the cleanliness of the home. There is a refurbishment planned in the near future which will enhance the environment for service users and staff. What the service does well: What has improved since the last inspection? Service user care plans are reviewed and evaluate on a monthly basis, this ensures needs are been consistently met. Service users feel safe in the home. There is an adult protection procedure in place and staff have now received training in this area. The manager is aware of the action to take if an allegation of abuse is made. This helps to safeguard service users from harm. The home complies with fire safety and service users doors are free to close when the fire alarm sounds. This protects service users in the event of a fire. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 6 Evidence that the gas appliances are safe in the home has been provided to the CSCI. The unguarded pipe work has been boxed in to ensure service users safety. The registered manager has completed her NVQ Level 4 in management. This enhances the care which is provided through a greater awareness of how to manage the home effectively. 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 DS0000028046.V298985.R01.S.doc Version 5.2 Page 7 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.V298985.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 was not assessed as the home do not provide intermediate care) Quality in this outcome area is good. Service users needs are discussed and recorded through the detailed assessment process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service users assessments were checked these were all completed by the registered manager. There are some service users who are self funding whilst others are funded through social services. An assessment from the care manager is obtained when needed. The manager stated that a full assessment always takes place prior to admission. This incorporates activities of daily living, social physical and psychological needs. This information was comprehensive and staff spoken with felt individual needs could be met. One registered nurse said that even though she does not carry out the assessments they are detailed enough to inform the care plans. Service users and their relatives confirmed assessments had previously taken place. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. Service users care needs are met, health and personal care is delivered in a dignified manner and staff are knowledgeable in the medication procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service users care plans were inspected. These were all completed in a comprehensive manner. One service user needed nutritional support due to previous weight loss, a nutritional assessment was completed and a referral to the speech and language therapist had been made. A care plan discussing the care needed was in place. The service user had bed rails in place this had been consented to. However, in discussions with staff it was clear that other solutions need to be considered prior to using bed rails. The service user had signed the care plan which was reviewed on a monthly basis. The chef was spoken with who was aware that a fortifying diet was needed, this was communicated via the carers. Access to healthcare needs are available which include the GP, dentist, chiropody and occupational therapist. One service user was admitted following a stroke. Food and drink was provided using a special tube into the stomach. This was clearly documented, risk Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 10 assessments for the prevention of pressure sores was in place, moving and handling assessment and nutritional assessment. The staff discussed how this persons needs are being met. Specific care plans had been reviewed and evaluated. In discussions with the service user and her friend it was apparent that they were very pleased with the care in the home. They thought the staff were very pleasant and they were always treated with respect and dignity. Observations during the day confirmed that privacy is maintained and that staff have a good rapport with the service users. A discussion took place with a service user who was recently admitted into an ‘interim’ bed. This is for a trial period and the service user may become a permanent resident following a 4-6 week period. This is funded through North Yorkshire County Council. This person was being cared for in bed due to problems with mobility and requiring regular dressings to the legs. This person was spoken with. Care plans were in place, and risk assessments clearly identified the potential hazards to this service user. Relatives of the service user said they were involved with the care plan and consent had been obtained regarding the use of bed rails. The manager said the care would be evaluated at the end of the 4 week period following a review. The service user said she like the home and her relatives felt the care was good, although some more activities would be beneficial. Access to healthcare was discussed and observed through a visit from the optician. However, it was evident that this experience could have been improved. The person from the opticians came into the lounge and without introducing herself produced a pair of glasses for a service user who was sat in her chair. The service user had to strain her neck and head to speak to the person as she was stood over her discussing the glasses. The member of staff assisting did confirm that it is usual practice to take the service user into a private area for any healthcare intervention. The registered manager also on a separate occasion witnessed the poor attitude of the healthcare professional and said she would speak to the person concerned. During the site visit 5 out of 7 surveys completed stated that service users always receive the care and support needed, whilst 2 out of 7 stated they usually receive this. The medication system was inspected, this was found to be robust. One persons self medicates and this was clearly documented. Whilst the medication room is small this was found to be clean and tidy. The medication charts were accurate and controlled drugs were administered correctly. Stock balances take place on a monthly basis and staff are aware of how to dispose of medication. Staff use the monitored dosage system and liaise with the pharmacist and GP when service users medication needs to be reviewed. Staff discussed their homely remedies and are now aware that a stock balance of these would be beneficial. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. Service users have a good choice of meals, though the setting could be improved. There are only a limited range of activities for service users to participate in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users discussed the activities available in the home. There are dominoes, cards and exercise sessions available. There is no specific activities organiser and this was an area that service users felt could be improved on. This was apparent in the surveys completed at the site visit. Church services take place the 3rd Sunday of each month, however many service users spoken with said they would like more ‘fresh air’. During the site visit observations showed service users sat in the lounge areas with the television on very loud. Only a few service users were watching this. Staff felt they did not have time to offer one to one sessions because there are no domestic staff so they have to help out with those duties(see Standard 26). Consideration should be given to employing an activities organiser. One service user who paints and enjoys reading was keen to continue with these hobbies. One relative felt his relation would like to go outside more, this was confirmed by the service user. The home does have a gardened area to the side of the conservatory, and the village of Killinghall where the home is situated is very picturesque and service Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 12 users would benefit from trips outside the home. Many visitors enter the home, this was confirmed through observation and checking entries in the visitors book. Staff welcome visitors throughout the day at a range of times. The meals provided in the home were good. Breakfast commences at 8.15 and supper is served at 7.30pm. Lunch and evening meal start at 12.45 and 4.45 respectively. The meals can be served in either the dining room, one of the lounge areas or in service users own rooms. Service users were observed at lunchtime enjoying their meal. The stew and dumplings served looked very appetising with a good sized portion. Juice was available and material napkins and table cloths were in place. Service users can have either a cooked or continental style breakfast. Service users spoken with said the food was good. The chef had recently had a visit from environmental health. (see Standard 38). The food was stored correctly and temperature of food was taken and correctly recorded. The chef was knowledgeable in meeting individual needs. Diabetics could be catered for and those on a fortifying diet, many of the service users in the home enjoyed home cooked traditional food, this was reflected in the menu. An alternative menu is always available which includes jacket potatoes, ham or cheese salad and omelette. Ice cream, yoghurt and fresh fruit is always available. The chef uses a mix of fresh and frozen vegetables and bakes cakes and buns on a regular basis. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 Quality in this outcome area is good. Service users feel their concerns will be listened to by the home, and the risk of harm is minimised through adult protection procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users spoken with felt their concerns were always listened to. Relatives confirmed they would speak to either the manager or person in charge if they had any issues causing concern. The surveys completed stated that service users were aware of how to make a complaint. No formal complaints had been received, this was confirmed in the pre-inspection questionnaire. The complaints procedure was available which had appropriate timescales. Staff were spoken with regarding the adult protection procedure. Training has taken place in this area and when questioned staff were clearly aware of the different types of abuse and the action to take if an allegation is made. The Four Seasons adult protection procedure encompasses the ‘no secret’ document and whistle blowing. Service users were observed during the day been handled in a gentle manner with a pleasant manner and attitude from staff. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 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 the following standard(s): Quality in this outcome area is poor. Service users live in a poor environment which is not maintained effectively, this puts service users at risk as infection control procedures are not maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is set in the picturesque village of Killinghall. The atmosphere is homely which service users commented positively on. However, many areas of the home need to be refurbished. The manager is aware that a complete refurbishment is planned, however no timescale has been made available for this to take place. On touring the premises one room had wallpaper hanging from the ceiling. This was discussed at the previous inspection over six months ago and still has not been addressed. This room was occupied by two service users. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 15 Whilst the communal areas were large in size, it was evident that no domestic staff were employed in the home and many areas were dirty. All rooms inspected needed a thorough clean. This was evident in the dining room where service users were eating. Cobwebs were on the ceiling, paint was flaking on the sills and dust was evident on the floor and skirting board areas. Staff spoken with confirmed that they have to help with domestic duties as there are no other staff available. The laundry was inspected which was located in the cellar down some steep steps. The cement floor was unsuitable and there were health and safety risks for staff. Whilst in the laundry one member of staff came down the stairs which a bundle of dirty clothes in her arms. This was not acceptable practice, as staff must follow the infection control procedures in the home. Care staff spoken with said they try not to spend much time in the laundry because it is very dingy and dangerous taking laundry up and down the stairs. This has been highlighted at previous inspections. The manager could not confirm which staff had received infection control training, some staff said they had received this training whilst others spoken with were unsure. Staff were aware of hand washing techniques and the use of aprons and gloves. Service users hygiene needs need to be met in a safe way through appropriate procedures being in place to reduce cross infection. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. Service users needs are met through adequate staffing levels in the home. Recruitment practices are robust which service users benefit from. Staff generally receive mandatory training on a regular basis. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels regarding care staff are good. There are usually two registered nurses (including the supernumerary manager) and four carers for up to 31 service users. Currently there are 24 service users. Observations showed that call bells were answered and service users needs were being met in an appropriate way. Staff are encouraged to undertake NVQ Level 2 training. One member of staff spoken with had worked in the home over 10 years, she has recently attended adult protection training and confirmed that induction training takes place for new staff. One carer spoken with had completed her NVQ Level 2 and has worked in the home for over 5 years. The home encourage this training and are keen to get at least 50 of care staff completing an NVQ qualification. The staff team have a good rapport with the service users and staff morale appeared to be good. Surveys returned highlighted that staff were usually available when needed and that staff listen and act on what service users say. The manager confirmed the recruitment procedure. Three staff files were checked, two written references had been obtained, CRB and POVA checks Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 17 were in place and application forms were routinely completed. One member of staff who was from South Africa confirmed she had attended an interview and had gone through a series of checks. She said she had been through an induction programme which looked at a range of care practices. Individual training files are in the process of being completed. The induction programme is in line with Skills for Care guidance which covers all aspects of practice, three days paid training per year is also in place. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. The home is run in the best interests of service users through the manager having a good understanding of the service users needs in the home, though the quality assurance system needs improving and training in infection control and food hygiene need to take place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has completed her NVQ Level 4 and is waiting for her certificate of completion. The manager is a registered nurse and midwife and has many years experience at Westfield, though in a management capacity for three years. The staff in the home made positive comments regarding the style of management and felt their concerns would always be listened to. Clearly the home is run in the best interests of the service users. However, at the present time no formal supervision takes place and staff are unclear as to the training they have received. This includes infection control and food hygiene. The home Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 19 must ensure that following their recent visit from environmental health that the requirements and recommendations are actioned. It was evident at the site visit that the freezers and Fridges in the kitchen need a thorough clean and the linoleum floor in the rear store room of the kitchen needed replacing. The maintenance person is responsible for taking water temperatures, these were checked and were within normal parameters. Certificates for legionella and the use of gas appliances were available. Electrical wiring and contracts for lifts, and equipment were in place. Fire safety is adhered to and weekly fire alarm testing takes place. Service users spoken with said they felt safe in their environment. Quality assurance was discussed, the manager is aware that Four Seasons are developing their quality assurance procedure. Currently care plan and medication audits take place. Questionnaires have recently been sent to all service users, positive comments regarding the care in the home were received. Residents meetings have previously taken place (in the past 3 months) and staff meetings take place on an infrequent basis. This should be addressed. Service users finances are dealt with through a personal allowance system. Individual statements are available and these tallied with the amounts available. Service users confirmed this system is in place, and invoices can be sent to service users for items outside the fees. For example hairdressing and chiropody. A policy is available regarding service users finances which the manager was aware of. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 20 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 3 x 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 1 x x x x x x 1 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 1 Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 21 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 OP19 Regulation 23 Timescale for action The home must provide the CSCI 22/08/06 with evidence of the refurbishment due to take place, this should include estimated timescales for completion. This is pertinent to the location of the current laundry. The linoleum flooring in the rear 22/08/06 store room kitchen must be replaced. The ceiling in room 5 must be repaired. (Previous timescale of 31/01/06 not met). 22/07/06 Requirement 2. OP19 23 2. OP19 23 3. OP26 OP27 OP31 16 4. 24a 5. OP38 13 The home must maintain the 22/08/06 cleanliness of the home through employing a sufficient number of domestic staff. An improvement plan must be 22/08/06 submitted to the CSCI within one month detailing the actions to be taken to improve the service. The home must provide evidence 22/08/06 to the CSCI that infection control training has taken place. Staff who have not attended this training must do so. DS0000028046.V298985.R01.S.doc Version 5.2 Page 22 Westfield Nursing Home 6. OP38 16 The fridge and freezers in the kitchen must be cleaned thoroughly 22/07/06 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. Refer to Standard OP28 OP12 OP33 Good Practice Recommendations 50 of care staff are trained to NVQ level 2 or equivalent . Consideration should be given to having a designated activities organiser. The manager should be familiar with the Quality Assurance system in Four Seasons. Westfield Nursing Home DS0000028046.V298985.R01.S.doc Version 5.2 Page 23 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 DS0000028046.V298985.R01.S.doc Version 5.2 Page 24 - 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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