Inspection on 21/07/05 for Westgate House

This inspection was carried out on 21st July 2005.

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

The inspector 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

Westgate House 04/01/07

Westgate House 09/12/05

Westgate House 17/03/05

Westgate House 22/06/04

Westgate House 20/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Westgate House Millington Road Wallingford Oxon OX10 8FF Lead Inspector Jane Handscombe Unannounced 21 July 2005 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. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Westgate House Address MIllington Road Wallingford Oxon OX10 8FF 01491 836332 01491 827851 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) The Orders of Saint John Care Trust Care Home (CRH) 60 Category(ies) of Care Home with Nursing (N) registration, with number of places Dementia - over 65 years of age (DE(E)) 25 Learning Disability over 65 years of age (LD(E)) 3 Physical Disability over 65 years of age (PD(E)) 30 Terminally Ill over 65 years of age (TI(E)) 5 Old age, not falling within any other category (OP) 60 Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The total number of service users that may be accommodated at any one time must not exceed 60. Up to a maximum of 20 places may be used for nursing needs. Date of last inspection 17 March 2005 Brief Description of the Service: Westgate House is a care home providing personal care and accommodation for 60 older people. It is able to offer nursing care for up to 20 service users. Westgate House is managed by The Orders of St John Care Trust who are responsible for 19 other care homes in Oxfordshire. Westgate House has been purpose built and became operational in June 2003. It is located on a new housing development close to the centre of Wallingford and all the amenities of the town. Each room has been designed with en-suite facilities, and new furnishings and fittings are of a high standard. The two storey building is arranged in three wings providing unit living, and the communal lounge area creates a central heart of the home. The home has pleasant grounds with seating and a small water feature. Westgate House also provides day centre accommodation for 35 older people from the local community. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on the 21st July 2005. The purpose of the visit was to see how the home is meeting the National Minimum Standards. The visit involved speaking to residents in order to ascertain their views on the care and the services they receive at the home, the staff members and the newly appointed manager, and viewing care plans and assessments whilst observing the general day-to-day operation of the home. At the time of inspection the service users were busy going about their daily activities and there was a calm relaxed atmosphere. The inspectors were warmly welcomed, by both the staff and service users, on arrival. Much of the inspection focused on life from the service users’ point of view. Overall, the general picture of the home gained by the inspectors was of being a well organised and caring home with a dedicated team of staff who offer a client focused approach to the care provided. Comments received from residents and relatives during the day included: • • • • ‘It is excellent here’ ‘The food is very good and nourishing’ ‘You can go to bed when you like’ ‘Very good personal care – can’t fault it’ The inspectors would like to thank the residents and their families, and all the staff members and visitors to the home for their time and co-operation during this inspection. What the service does well: The home is a ‘happy home’ according to the GP, relatives and staff. All visitors are made very welcome. All areas of the home are clean and the décor and furnishings are of a high standard. There is a good feeling of teamwork amongst all the staff and this was evident during the inspection. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: There are a number of things that Westgate House could do better which have been addressed within this report. A lot of information gathered at the pre-admission assessment is not always transferred to the care plans, which could lead to missing a vital part of an individual’s care. The pre-admission assessments, along with risk assessments and monthly reviews of care, should be used to form the basis for developing care plans and setting out in detail the action that needs to be taken by care staff. Using the information in this way would ensure that all aspects of the health, personal and social care needs of the residents are met. The home should undertake risk assessments on all residents and review the residents’ care plans on a more regular basis to ensure the health, safety and welfare of those residents in their care more appropriately. The provision of more activities on a regular basis and staff being enabled to spend more quality time with residents on a one to-one-basis would allow for the residents’ recreational and social needs being met more appropriately. Whilst there is a complaints procedure in place, the home must ensure that all residents have access to it and are aware of its content, which did not appear to be the case during the inspection. Whilst, on the whole, the home presented as clean and tidy, the issue of spillages and odorous smells needs to be looked into and decided how these should be dealt with and by whom, since it is apparent that presently cleaning is only carried out by the maintenance person and has to wait until it can be fitted into his schedule. Staff on the nursing unit spoke of how they would like to be able to offer more quality time to individual residents and how, presently, this was not possible due to staffing levels. A recommendation has been made within the report to look at the staffing levels in relation to the dependency needs of the residents, to address this matter. Some practices in relation to infection control were not in accordance with recent research and guidelines. It is recommended that the community infection control nurse be contacted to gain advice into how best to implement good practice throughout the home. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 7 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. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All residents have their care needs assessed before moving into the home. EVIDENCE: The manager or her deputy carry out pre-admission assessments on all prospective residents in order to ensure that their needs will be met. A sample of care plans were examined and very thorough assessments had been made of each of the resident’s care needs. Westgate House H57_h08_S47098_Westgate House_239843_210705_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 and 10 Every resident has a care plan in which their needs are identified and the action required to meet those needs, although care must be taken to ensure that these are comprehensive and that the pre-admission assessment forms the basis for the care plan. Risk assessments are undertaken when a resident wishes to administer and store their own medication. EVIDENCE: A lot of information gathered at the pre admission assessment is not always transferred to the care plans, and this could lead to missing a vital part of an individual’s care. A good practice recommendation is listed in the appropriate section of this report. A person recently admitted to the home was assessed as being at risk of falls at home and no risk assessment had been documented following admission. There was no baseline weight recorded, and no record of wound/pain management or dressing protocol for the wound. There were other omissions and it is recommended that, on admission, the pre-admission assessment should be used as the basis for developing care plans. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 11 The home’s monthly reviews of care were not seen to be adhered to; three residents’ care plans evidenced that their care plans had not been reviewed since May 2005 and a further care plan since April 2005. Furthermore, two of these failed to contain the signature of either the assessor or that of the resident, to show that they had been involved in the process. Residents who wish to maintain responsibility for their own medication are protected by the home’s policies and procedures for dealing with medication. A relative spoken to said, ‘The personal care is very good, I can’t fault it’. The inspector observed staff speaking to residents in an appropriate and kindly manner, and noted that they always knocked on doors before entering a person’s room. On most occasions the staff treated the residents with dignity and respect. However, during the inspection the inspector observed a notice that was stuck on the wall in one of the resident’s private rooms that was inappropriately worded and was a breach of the individual’s privacy and dignity. The manager acknowledged this issue and informed the inspectors that she would remove the notice during the course of the inspection. A requirement with regard to this matter is listed in the appropriate section of this report to address this matter. Westgate House H57_h08_S47098_Westgate House_239843_210705_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 and 15 There is little opportunity for residents to take part in social or recreational activities, due to lack of staff hours available to this part of the care provision. A good practice recommendation is listed in the relevant section of this report. The meals offered to residents in this home are very good, offering choice and variety and catering for special dietary needs. EVIDENCE: A relative spoken to said she would like to see more activities available on a regular basis. Staff spoken with were very frustrated that the workload was such that they did not have the time to give any personal support and encouragement to the residents in pursuit of their special interests. It is recommended that the registered manager should look at the staffing levels, and the amount of time each of the residents are able to engage in any activities. Residents were enjoying a chicken casserole during lunchtime, with cabbage, mixed vegetables and creamed potatoes with an alternative of lamb burgers for those who preferred. Dessert could be chosen from fruit crumble with custard or ice cream, yoghurts or fresh fruit. All residents spoken to were very complimentary of the quality of food offered at Westgate House. Comments included, ‘The food is good and nourishing’, ‘The food is very good, I couldn’t wish for better’. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 There is a clear complaints procedure which is on view in the home for residents and visitors to access if the need arises. EVIDENCE: Residents and visitors spoken with informed the inspector that they were aware of the complaints procedure, and would be confident to raise any issues with the manager, should the need arise. However, it was noted through discussions during the inspection that this was not the case with all residents and a recommendation has been made to ensure that residents who have visual impairments are also made aware of the procedure. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 Overall, the home is clean and orderly, although the system for immediate cleaning of spillages needs to be addressed. EVIDENCE: Generally the home presented as clean and tidy. However, the carpet in one of the resident’s rooms was badly soiled and stained and had not been cleaned for a couple of days. The inspectors were informed that cleaning is only carried out by the maintenance person and has to wait for him to fit it into his schedule of work. The carpet was cleaned during the inspection. It is recommended that the manager looks into the whole area of spillages and how these should be dealt with and by whom. The home provides accommodation for each resident which is furnished and equipped to assure comfort and privacy and meets the residents’ needs. Residents are encouraged to bring small items of furniture, memorabilia and ornaments in order that they can personalise their own rooms to their liking. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The present staffing levels on the nursing unit meet the minimum requirement but should be reviewed to ensure that all care needs can be met and quality time spent with the residents. EVIDENCE: Staff spoken to felt that they were just able to carry out the care needs of the residents but that they would like to be able to offer more quality time to individuals. Sometimes they are very pushed to manage the basic care requirements. Sometimes there is insufficient staff available to assist those residents who require assistance with eating and drinking, as they are carrying out other care duties. Provision of a hostess is excellent and helps in this respect, but it is sometimes still not sufficient. A recommendation with regard to staffing levels has been made within this report. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 and 38 The home is well managed and the deputy manager has done an excellent job in maintaining the status quo during the period since the previous manager left and the new manager taking up her post. The manager has only been in post for a few days, and is beginning to settle into her new position. She has had previous experience of running a care home with nursing and is looking forward to taking on a new challenge. The health, safety and welfare of service users and staff is generally promoted, although risk assessments and care plans, as discussed in the section Health and Personal Care in this report, need to be addressed. EVIDENCE: There is a good feeling of teamwork amongst all the staff and those spoken with are very happy to be working at the home, and appreciate their colleagues and the support they give each other. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 17 Generally the home was cleaned to a high standard and issues of infection control have been addressed with the staff. However, the inspector observed some practices in relation to infection control that were not in accordance with recent research and guidelines. Talking to staff highlighted that they did not have the up to date knowledge regarding infection control procedures and practices. This was discussed with the manager and it is recommended that the community infection control nurse should be contacted to advise how best to implement good practice throughout the home. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x x 2 Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 19 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 14(1)c Requirement The manager must gain the residents/representatives signatures to evidence that an appropriate consultation regarding the assessment took place. Timescale for action Immediate and henceforth 2. 8 13(4)c The manager must ensure to identify any risks to the health and safety of the residents and how the risks are to be managed. Immediate and henceforth 3. 10 12(4)a The manager must raise the issue of notices on display with regard to the residents dignity and respect with all staff. Immediate and henceforth Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 7 26 27 38 16 Good Practice Recommendations It is recommended that on admission the pre-admission assessment should be used as the basis for developing care plans. It is recommended that the manager looks into the whole area of spillages and how these should be dealt with and by whom. It is reccommended that the staffing levels and deployment of staff on the nursing unit be looked at in relation to the dependency needs of the residents. It is recommended that the community infection control nurse should be contacted for advice into how best to implement good practice throughout the home. It is reccemmended that residents with visual impairments are made aware of the complaints procedure. Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Burgner House 4630 Kingsgate Oxford Business Park Cowley, Oxford, OX4 2SU 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 Westgate House H57_h08_S47098_Westgate House_239843_210705_Stage 4.doc Version 1.40 Page 22 - 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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