CARE HOMES FOR OLDER PEOPLE
Westfield Residential Home Limited 16 Carr Lane Willerby East Yorkshire HU10 6JW Lead Inspector
Sarah Urding Unannounced 31 August 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Westfield Residential Home Address 16 Carr Lane Willerby East Yorkshire HU10 6JW 01482 651760 01482 659355 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Westfield Residential Home Limited Mrs Suzanne Barbara Cross Care home 22 Category(ies) of OP Old age 22 registration, with number DE(E) Dementia - over 65 22 of places Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 10th February 2005 Brief Description of the Service: Westfield house is a privately owned care home that is part of a growing local organisation. Westfield House is situated in a residential area of Willerby close to local amenities, i.e. shops, hairdressers, public houses, a chemist and a post office. The home is close to a bus route. The home is a large traditional house that has been converted and extended to provide accommodation for 22 older people. There are 18 single bedrooms and 1 shared room. Communal accommodation is provided in a lounge, conservatory and dining room. Access to all areas of the building is facilitated by the use of ramps and stair lifts. There is a pleasant, easily accessible garden to the rear and car parking facilities are available at the front of the building. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over six hours. The inspector looked around the building and at records and policies. Seventeen of the twenty-one residents and five staff were spoken to. A physiotherapist engaged by the home was also spoken to. What the service does well: What has improved since the last inspection? What they could do better:
Minor additions to the care plans of service users are required so that staff fully understand how to meet the oral health care needs of service users. The home does not meet the needs of all service users in the activities it Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 6 offers. One service user described the activities on offer as “so-so”, another service user felt that the home “could do better” in this area. Not all staff are aware of the local authority guidelines for the protection of vulnerable adults. This could compromise the safety of service users if correct procedures are not followed. Some environmental factors need to be addressed by the home so that environment is a safe place for service users. A risk assessment needs to be carried out on the building works at the front of the home and the under stairs cupboard should be inaccessible to service users at all times. This currently presents as a risk as the key is left in the door and the cupboard houses the fuse box to the home. The floor covering is also uneven and a trip hazard. 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 Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 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 standard(s) 1, 3, 6 Service users are well informed by the home’s statement of purpose and service user guide. The home is able to meet the needs of service users owing to a thorough assessment on admission. EVIDENCE: On admission the home provides comprehensive information to service users and their families about the facilities on offer so that they can make an informed choice about where to live. Recommendations made at the last inspection regarding obtaining service users views about the home for inclusion in the guide had not yet been carried out. The manager said that this is currently being addressed. Some service users who had been in the home for a long time did not recall having seen the brochure about the home. When working with people with dementia and memory loss this is to be expected so it would be good practice if staff revisit this with them on a regular basis. A copy of the service user guide should be available to all service users in the home. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 9 Service users undergo a thorough assessment of needs prior to admission, which demonstrates that the home works in partnership with service users, their families and health professionals to glean full information about service users lives. The assessment covers all aspects of standard 3.3 and is completed in detail. The assessment linked clearly to the care plan. The home is not providing intermediate care at the present time. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Service users health care needs are well met by the home. Service users are respected and treated with dignity by the staff. EVIDENCE: All service users have a detailed plan of care that provides staff with the information they need to ensure needs are met. This links in to the home’s assessment on admission and is reviewed on a regular basis and when needs change. A minor addition to the care plan is required so that all needs identified in the assessment are addressed. Reference to how staff should meet oral health care needs should be made. Service users health care needs are being clearly identified and met by the home. There was evidence in service users records that all health care needs were being consistently met. The home employs a physiotherapist who works with service users on a weekly basis. This is good practice. The home has a comprehensive medication policy and trained staff administer medication to service users. Records kept were clear and concise. All service users spoken to spoke warmly about the staff in the home. They consistently stated that their privacy was respected and dignity upheld during personal care tasks. Staff were observed to knock on service users doors prior
Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 11 to entering and were aware of the sensitivities involved while carrying out personal care. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The home does not offer all service users the opportunity to experience activities suited to their needs. The lives of service users are enriched by family and friends being able to visit the home. Meals are nutritious and balanced and offer a healthy diet for service users. EVIDENCE: The home offers weekly activities of bingo and board games but an activities plan is not available for service users to refer to. Staff spoken to said that external activities have been booked in the past but at the last minute service users did not wish to be involved. Some service users spoken to said that they did not get out much and would like to be taken out more by staff. Activities on offer in the home were referred to as “so-so”. It was clear from speaking to staff and service users that the existing range of activities on offer in the home is not sufficient to meet needs and interests of all the service users. The home must address this by providing activities for all. A regular plan of varying activities would enable service users to have more choice in this area. Contact with service users friends and family is promoted well by the home. Service users said that they are able to see friends and family when they wish. Positive examples of this were seen during the inspection. Relationships between staff and service users were positive and mutually beneficial, with staff speaking positively about the service users they care for.
Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 13 One service user said “staff will do anything for you, they are very nice”. Independence is promoted by the way in which staff work with service users on a daily basis and a range of advocacy services are made available to service users in the home’s brochure. Service users are given choice around where to have their meals although they are encouraged by staff to eat in the dining area so that social contact is maintained. Staff ask service users daily what they would like to eat at lunch and teatime. The home provides healthy and well-balanced meals for service users who said that meals are “nicely presented”. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Arrangements for complaints and the protection of vulnerable adults are handled well and ensure that service users feel listened to and protected. EVIDENCE: The home has a clear complaints procedure in place. Service users spoken to said that they had no complaints about the home but felt confident to raise issues of concern if they arose. Complaints are recorded in the diary and addressed by the manager who then records them appropriately in a complaints log. There had been one complaint since the last inspection, which evidenced how the complaint was dealt with and the outcome. The home has an appropriate policy in place for the protection of vulnerable adults. Staff spoken to were clear about reporting procedures should a service user make an allegation and around the indicators of abuse. Service users spoken to said that they felt safe when being looked after by staff. The local authority guidelines for the protection of vulnerable adults are in place but many of the staff spoken to were not aware of these. Arrangements must be made to familiarise staff with these guidelines. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25, 26 Service users live in a safe and homely environment, which is well maintained. EVIDENCE: The home is clean, well presented and homely. A planned programme of maintenance is in place and work is ongoing to further improve standards in the home. Currently, the work identified at the last inspection regarding the need for radiator covers is being carried out. Water temperatures are monitored on a regular basis and are kept at an appropriate level by pre-set valves on service users hand basins. Policies for the control of infection are in place and followed in practice. Service users spoken to were positive about standards of cleanliness in the home. Laundry facilities in the home are appropriate and meet the needs of the service users. Service users commented on the cleanliness of their clothes on the return from the laundry. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Service users needs are met by the good level of staffing and training provided in the home. Service users are protected by the home’s recruitment procedures. EVIDENCE: The home is well staffed at all times. Three staff are on duty throughout the morning and two staff are on duty in the afternoon, supported by a housekeeper and a cook. Two staff are on duty at night. A senior member of staff is on duty at all times supported by a member of the management team. Recruitment practice in the home is adequate to ensure that service users are protected. Application forms are fully completed and gaps in employment explored. Two written references are in place prior to staff starting work. Where CRB checks are not in place when staff are employed by the home, POVA First checks are always in place and staff are supervised until CRB checks are received. Staff are trained appropriately and receive a thorough induction. Staff spoken to feel supported well by colleagues and senior members of staff. As identified earlier in this report staff must be made aware of the local authority guidelines for the Protection Of Vulnerable Adults. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 37, 38 High levels of consultation and regular reviews by the manager ensure that service users are looked after in an environment that is both safe and inclusive. Some minor areas require attention in order to ensure that service users are safeguarded in all aspects of care. EVIDENCE: The home operates an effective quality assurance system that seeks the views of service users and staff on a regular basis. There is a monthly audit system in place that looks at key areas aimed at improving standards. This is good practice. Service users are protected by the financial procedures of the home. The home does not act as appointee for any service users and looks after money appropriately. Written records of all transactions are accurately maintained. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 18 The home has detailed policies and procedures in place. Most records are kept appropriately. Some elements of service users records are not in place. Photographs of service users were not kept by the home in every case and must be as specified in schedule 3. Generally the home operates in the best interests of the health and safety of service users and staff. All safety checks are carried out within the specified time frame and policies are in place for safe working practice. Two areas require attention so that service users continue to be safeguarded. A risk assessment must be carried out in respect of the building work at the front of the home and the cupboard under the stairs should be inaccessible to service users at all times as this stores the fuse box to the home and the floor covering is uneven. All staff receive health and safety training. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x 3 x 2 2 Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 12 & 15 Requirement The registered manager must ensure that care plans identify how oral health care needs are to be met by staff. The registered manager must ensure that photographs of all service users are held by the home. A risk assessment must be carried out in respect to the building work. The understairs cupboard must not be accessible to service users. Timescale for action Sept 30th 2005 Sept 30th 2005 Sept 30th 2005 2. 37 17 3. 38 13 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 1 Good Practice Recommendations The registered person should ensure that the views of service users are included in the service user guide. Staff should ensure that service users are familiar with the guide to the home. A reference copy should be available to service users at all times. Activities available in the home should be reviewed and meet the interests of all service users. An activities plan should be available for their reference.
I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 21 2. 12 Westfield Residential Home Limited 3. 18 The registered manager should ensure that staff are familiar with the local authority POVA guidelines. Westfield Residential Home Limited I 20050831 Westfield Residential Home IR J53 V246480 S46005 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection First Floor Unit 3 Hesslewood Country Office Park Ferriby Road Hessle East Yorkshire HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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