CARE HOMES FOR OLDER PEOPLE
Westfield Nursing Home Ripon Road Killinghall Harrogate North Yorkshire HG3 2AY Lead Inspector
Mrs Rosalind Sanderson Unannounced Inspection 8th December 2005 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.V266293.R01.S.doc Version 5.0 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.V266293.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Westfield Nursing Home Address Ripon Road Killinghall Harrogate North Yorkshire HG3 2AY 01423 506344 01423 506344 westfield.house@fshc.co.uk 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) 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), Physical disability (31) of places Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users in category (PD) must: i) be over 50 years and ii) require nursing care 10th May 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. 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.V266293.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 8/12/05 and lasted for six hours including preparation time. The focus of the inspection was a on a number of key standards that remained to be inspected for this year and also the shortfalls in the standards that had been subject to requirements and recommendations at the last inspection. A look around the premises was undertaken and records relating to service users care and health and safety and maintenance within the home were looked at. A number of service users and staff were spoken with and the registered manager and her matron were also spoken with. Their comments are included in the summary and body of this report. What the service does well: What has improved since the last inspection?
Since the last inspection progress has been made with the development of service users care plans and this ensures that plans address health and social care needs of service users. Service users are given the opportunity to take part in activities if they wish, one commented, ‘There are plenty of activities on if you wish to join in’ Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 6 The systems in place for administration and recording of controlled drugs have improved and all records looked at were correct and up to date. Trained staff have undergone training in the safe handling and administration of medicines. Sufficient staff are employed to meet the needs of the current service users and keep the home clean and tidy. Staff receive regular supervision that is based on the homes aims and objectives and ensures that training needs are identified. 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.V266293.R01.S.doc Version 5.0 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.V266293.R01.S.doc Version 5.0 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): These standards were not looked at at this inspection. Standard 6 is not applicable. EVIDENCE: Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 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 An inconsistent approach to reviewing of care plans could potentially lead to shortfalls in the care provided. 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 liked living at the home. Comments received included, ‘The staff are absolutely marvellous’ ‘I like it here, the staff are very good.’ ‘I have no complaints, living here provides me with friendship and companionship from other residents and the staff’ Service users and staff were observed to interact well with each other and had a good rapport. Individual care plans of three service users who were looked at. The quality of the care plans from the previous inspection had greatly improved and as well as health needs being identified the social and psychological needs were
Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 10 addressed also. Each individual service user file contained a range of risk assessments to promote independence and safety. It was clearly recorded when health professionals such as the GP or District Nurse had visited the service users. Service users have access to dental and chiropody services when required. Care plans had not been reviewed and updated on a regular basis and this could lead to some health care or social needs been missed. The medication records were examined. The Medication Administration Records and controlled drugs register were accurate and up to date. Medications were stored appropriately. Trained staff have undergone training in the safe handling and administration of medicines. Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 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): 12,14,15 Service users are able to exercise choice and control over their day-to-day lives. Meals provided at the home are varied and nutritious and meet service users taste and choice. EVIDENCE: Service users said that they like living at this home. They expressed their satisfaction with the food and the activities on offer. Comments included: ‘Living here is convenient, and affords me friendship and companionship’ ‘There are plenty of activities on if you wish to join in’ ‘I attend a church service in the home once a month and this is lovely’ ‘The food is marvellous and the staff and accommodation are excellent’ ‘The food is good and there is always a choice’ The menus were based on a four week cycle and offered good choice and variety. Records are kept of food provided. Service users were offered plenty of cold and warm drinks during the day. Details of advocacy services were displayed on the notice board so that service users or their families are able to access these if they wish. A regular newsletter informs service users and families about recent and forthcoming events in the home.
Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 12 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): 18 The lack of understanding of some staff with regard to the reporting of disclosures of abuse could result in referral of such matters to the correct authority being delayed. This could potentially place service users at risk. EVIDENCE: The adult abuse policy and procedure does not properly support the local authority in their responsibilities to investigate matters of abuse. It requires amendment in line with the local authority multi agency policy for the protection of vulnerable adults. It should clearly state that all matters of abuse would be referred to the local authority for investigation in the first instance. Staff understood what constituted abuse, but were unclear about how they would report such matters and in some cases suggested that they would investigate the matters themselves. Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 &26 Further investment in the home is required in order that service users live in a safe and comfortable environment. EVIDENCE: The home was clean and tidy at the time of the inspection. Laundry facilities are located in the basement. Washers have a sluice programme and are able to wash at appropriate temperatures. The flooring is not impermeable and walls cannot be washed. This should be addressed at the forthcoming planned works for the home. The access to bedrooms 1 and 2 is via a series of low steps making it difficult for some service users. Consideration is given to this during the period of pre admission assessment of service users wishing to reside in these rooms. The decoration work to the ceiling of bedroom 5 remains outstanding. The wallpaper on the ceiling is not glued on sufficiently and this is not acceptable for the service users in this room. This has been outstanding for the last two
Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 14 inspections. 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. No further beds had been provided following the recommendation made at the last inspection. The organisation is in the process of looking at re-development planning for the home to improve environmental standards that should improve the environmental standards. Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 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 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 &30 Service users are supported by sufficient numbers of staff that are trained to do so. EVIDENCE: The duty rota shows that there are sufficient numbers of staff on each shift to meet the needs of the current service users and keep the home clean and tidy. Staff observed did not seem unusually rushed when going about their duties. Service users made the following comments, If I need help it is quick in coming’ ‘Staff are very attentive’ ‘If I ring my bell it is always answered promptly’ The manager ensures that all new starters have an induction to the home and documentary evidence was seen of this. The induction meets the ‘Skills for Care’ standards. She continues to encourage staff to undertake the NVQ award to further inform them and currently the home has 28.5 of care staff with this award with additional staff working towards it. Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 16 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): 33,35,36 &38 Service users benefit from the systems that are in place to assist in the effective management of the home. 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. Service users said that they would feel confident that the manager would be able to address any of their concerns. She has further developed her skills in relation to staff supervision and there is now regular supervision available for all staff. There is a questionnaire that is given out to service users and their relatives to seek their views but no formal quality assurance system is in place whereby results of surveys are audited and published.
Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 17 Records that relate to service users personal monies showed that all monies held on behalf of service users are subject to rigorous checks and accounting procedures. Monies are held individually and receipts kept for all transactions. The home has a maintenance man who undertakes regular tasks, such as monthly hot water checks and a fire warden who carries out the weekly fire alarm checks and ensures that fire training for staff is up to date. Records showed that this was the case. The manager employs a moving and handling trainer who works at the home, and who provides training to staff. All care staff have received this training. The following issues need addressing in order that the home remains a safe environment for those service users living here: • • • • • There was widespread use around the home of door wedges to hold fire doors open. This could prevent the safe containment of any fire that may occur. The gas safety certificate showed that a visual check only had been carried out and a check of the gas appliances was still required. The visual check had failed in one area. A visit by the environmental health officer in January 2005 had generated requirements relating to the cleanliness and disrepair in the kitchen. These issues had still not been attended to. There remain gaps in the provision of first aid, health and safety and infection control training. There is unguarded pipe work in a room identified at the inspection. Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 1 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 1 Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2(b)) Requirement Timescale for action 31/12/05 2 OP18 13(6) 3 OP19 23(2(b)) The registered manager must ensure that service users care plans are reviewed on a regular basis to ensure that all health and social needs identified are current and addressed. The registered manager must 31/01/06 ensure that all staff have training in the Protection of Vulnerable Adults in order that they understand their reporting responsibilities in the case of alleged or actual abuse. The ceiling in room 5 must be 31/01/06 repaired. (Previous timescale of 30/11/05 not met).. The registered manager must: 08/12/05 • Carry out a risk assessment for the unguarded pipe work identified at the time of the inspection. The registered manger must: 31/01/06 • Provide documentary evidence that the gas appliances that are in use in the home are safe.
DS0000028046.V266293.R01.S.doc Version 5.0 4 OP38 13(4(a)) 5 OP38 13(4(a)) Westfield Nursing Home Page 20 6 OP38 13 7 8 OP38 OP38 23(4(c(i)) 23(5) The registered manager must 28/02/06 make arrangements for staff that have yet to undergo training to receive training in first aid, infection control and health and safety. The unauthorised use of door 08/12/05 wedges to keep open fire doors must stop. The registered manager must 31/01/06 provide an action plan to show how they will meet the requirements made in the report from the Environmental Health Officer dated January 2005. 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 OP24 OP26 OP28 OP31 OP33 Good Practice Recommendations Additional adjustable beds should be provided. Consideration should be given to the relocation of the laundry in the building works planned for the home. 50 of care staff are trained to NVQ level 2 or equivalent by 2005. The registered manager should continue to work towards the registered managers award. The quality assurance sytems in the home should be developed to ensure that the views of all stakeholders are sought. Westfield Nursing Home DS0000028046.V266293.R01.S.doc Version 5.0 Page 21 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
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