Inspection on 30/06/08 for Westgate House

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE Westgate House Westgate House 178 Romford Road Forest Gate London E7 9HY Lead Inspector Nurcan Culleton Unannounced Inspection 09:45 30th June and 1st July 2008 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 Westgate House DS0000069391.V366718.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. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westgate House Address Westgate House 178 Romford Road Forest Gate London E7 9HY 020 8534 2281 020 8534 9567 brinah.nyamugure@barchester.net www.barchester.com Barchester Healthcare Homes Ltd 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) Mrs Brinah Nyamugure Care Home 80 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (49) of places Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minimum Staffing Notice Date of last inspection 08th and 10th August 2006 Brief Description of the Service: Westgate House is a care home for older people, which provides general nursing care for up to forty-nine people and nursing care for up to thirty-one people with dementia. The home is situated in a purpose built three story building, located on the Romford Road in Newham. The home is pleasantly furnished to a homely style, all rooms have en-suite facilities and there are large attractive landscaped gardens to the rear. The home is served by local bus routes and has car-parking facilities in the front for visitors. Barchester Healthcare Limited owns Westgate House, which is a private provider of care services. At the time of this inspection, there is a flat fee of £669 per week for dementia care and £655 per week for nursing care. The home is currently negotiating block contract beds with the London Borough of Newham. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place over two days and was jointly conducted with a second inspector on the first day of inspection. We gathered information through speaking with people living in the home, their relatives or representatives, staff and the registered manager. In addition we examined individual files including assessments and care plans, staff files, policies and procedures and health and safety practises. We toured the premises and made observations of the standard of care in the home. What the service does well: What has improved since the last inspection? All previous requirements and recommendations have been met. Medication records have improved, all staff have received the whistle-blowing policy and staff on the dementia unit have received dementia care training and other additional training. Occupational references were seen in staff files, assessments were seen together with care plans and meal times were being observed. The environment is very pleasant and continues to see improvements. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Westgate House DS0000069391.V366718.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 Westgate House DS0000069391.V366718.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides good information to prospective residents and their representatives about the home to assist in their decision making about moving in. The home provides comprehensive and person-centred assessments prior to individuals moving in. EVIDENCE: There is a satisfactory Statement of Purpose and Service Users Guide available in the home. The Service Users Guide is provided in a Welcome Pack to individuals with additional information about the home and of Barchester Healthcare Homes Ltd. A visiting relative informed that she had been provided with all this information prior to her mothers’ admission. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 9 The Statement of Purpose and Service Users Guide outlines that prospective residents are able to visit and have trial stays at the home. These documents will need to be updated to include the new contact details for CSCI. Pre-admission assessments alongside local authority assessments were seen in individual files. The homes’ assessment comprehensively covers a range of needs: communication, personal hygiene, continence, mobility, moving and handling, tissue viability, nutrition, breathing, pain, sleeping, mental state and cognition, gender , sexuality, hopes and concerns, social interests, hobbies, spiritual/cultural/ needs and contact with family/friends/carer. The relative of one individual confirmed that persons from the home had visited her mother in hospital to complete the assessment. Assessments were detailed, identifying religious or cultural needs where relevant to the individual, their social background and personal interests. One person for example was noted to be a practising Roman Catholic and enjoyed listening to classical music. Assessments demonstrated that the home does not concentrate solely on the functional needs of the individual but rather focuses on the whole needs of the individual. Contracts are completed and signed by all individuals or their representatives, also showing the Local Authority contribution. One privately funded persons’ contract was also seen and was satisfactory. One visitor who was not a relative but whom visited weekly had a lot of information about the individual and her family and we thought that staff could speak to visitors more to gain more information about individuals, their background history and needs. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are generally of good quality and individuals have appropriate access to health care services. However the service needs to ensure that care plans and risk assessments are adequately completed for all users of the service. Whilst care practises are generally good, the home must ensure consistency in the quality of service provision. EVIDENCE: We examined eight randomly chosen individual files from across all the units. In-house, local authority and PCT care plans were available in files. Care plans and risk assessments were generally in good order, with the exception seen in one file where the care plan for one individual failed to adequately identify their needs. This individual was observed to be asleep in Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 11 bed during the inspection and we were informed that they had to be cared for lying down in order to prevent their vulnerable skin from breaking down. Neither the individuals’ pre-admission assessment nor care plan gave any indication of the need for them to spend large amounts of time in bed and neither was there evidence in any associated risk assessments. The tissue viability section of the care plan stated that the long term objective was to maintain their healthy intact skin. The Waterlow Risk Assessment did not reflect the verbal feedback given by the manager and had not been updated monthly in accordance with internal procedures. All relevant risk assessments, including the Waterlow chart, must be updated monthly as is good practice and in accordance with internal policies and procedures. Furthermore the individuals’ pre-admission assessment had identified a risk of falls, however the falls risk assessment form in the file was blank. The manager was able to provide evidence in the file that the issue related to the quality of recording in the care plan and associated risk assessments in this case rather than the quality of care being delivered. Daily records showed that the care being delivered was as according to the advice given by the previous care worker of the individual’s NHS funded service provision. Another file examined showed there was one mistake with the Waterlow Assessment as it failed to give a higher scoring for an underweight individual otherwise their care plan was satisfactory and their blood sugar levels were being checked weekly as required. Two other care plans we received were detailed and of good quality with no concerns identified. We questioned whether the change in the senior staffing structure of the home may have be having an impact on the work of the Registered Nurses who have responsibility to complete and update the care plans and associated risk assessments on the dementia unit. The manager however informed that care plans and assessments are divided up between the nurses who have responsibility for six care plans each. The home must make sure that robust systems are in place to ensure that care plans and assessments are completed for each individual so that the care received by those individuals is not compromised by inadequate recording of their needs. There is some anecdotal evidence from residents in the home and from visitors we spoke with that there have been occasions when people have had to wait longer to have their needs attended to as staff were not always available when needed, though the care and support was reported to be satisfactory when Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 12 received. People living in the home and some relatives we spoke with also stated that there were less staff available to them at weekends. Other people we spoke with including residents, a relative and friend informed that they experienced or observed positive outcomes received by individuals in the home. The relative and visitor made highly complimentary comments about the service and care received by the individuals they regularly visit in the home, citing specific examples about how the quality of life they experienced had significantly improved compared with their past experiences. The quality of support offered by staff; their knowledge about individuals’ needs on a daily basis as well as on an ongoing basis; the manner in which people’s needs were met with dignity and respect; staff engagement with people and excellent communication with family and friends were particular strengths which were highlighted. This mirrored the quality assurance results in the latest survey to residents, relatives, friends and visiting professionals in the home, reflecting that the overall experience of the service received by people in the home was positive. We also read letters from relatives expressing their gratitude for the excellent care services in the home and an array of thank you letters displayed in the office. One resident informed that the nurses are busy but this did not impact on her care at all and she had no complaints. Medications were checked on the first floor general nursing unit. The current British National Formulary medication book was found, the controlled drugs cabinet was checked, controlled drugs manually counted and checked against the controlled drugs book. The contents of the medication fridge were checked, and daily temperature records also checked. The Medication Administration records were in order with no gaps in signing for medicines. One issue was raised when the front page for a medication chart was observed to be missing from the file, then later found (with the residents’ photograph and label identifying whether the person has allergies or not) however the allergy status was also recorded at top of each MARS sheet. An additional observation was made when touring the premises when we found a food thickener prescribed to an individual. This was left out in a persons’ room and had no label. We advised that this needed to have been stored and treated in the same way as other prescribed medicines. Medication administration practises were good, however there were no medication risk assessments in files and records did not indicate whether individuals were able to self-administer their medication or whether they required assistance or the level of support they needed. This information was particularly lacking in care plans. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 13 It is also recommended that the medication policy is further developed in line with professional guidance regarding the administration of medicines in nursing homes such as from the Royal Pharmaceutical Society and the CSCI professional website. It was noted, for example, that there was a lack of sufficient guidance as regards the use of homely remedies, the storage life of liquid medicines when opened. Files seen evidenced that peoples’ death and dying wishes are discussed with individuals and appropriately considered in their care planning. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides opportunities for individuals to engage in a range of appropriate and stimulating activities. The home enables individuals to meet people from different generations in the local community. EVIDENCE: We spoke with the full time Activities Co-ordinator who provided photographic evidence of an array of activities enjoyed by people living in the home. The Coordinator and her assistant have just finishing a relevant activities course accredited by the Alzheimers Society. They are also members of NAPA who provide day courses and magazines and enable them to swap information with other homes. The Co-ordinator completes an activities assessment form after people have settled in after their admission. At the end of each month she then completes an activities monthly review and evaluation sheet for each individual. These were seen in individual files. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 15 Daily activities on Memory Lane (the dementia unit) include for example, reminiscence, sensory experiences such as touching objects and massage, arts and crafts such as flower arranging, making collages, movement to and listening to music. Objects of interest were seen around the unit, including an attractive cupboard with drawers filled with sensory objects for people to explore. Additionally there are monthly themed events and entertainers. We were informed about entertainment at St Georges’ Day and Veterans day with a visit from a Chelsea pensioner who led a ceremony presenting eight veterans with badges and certificates in acknowledgement of their contributions during the war. There is a tea party held every afternoon and every second month the home holds a tea dance. We spoke with people attending the tea party at the time of the inspection. People are invited from other homes to visit, for example a choir which visits homes within Newham. The home also liaises with local schools. School children come to the home and residents have visited schools to attend school assemblies. The domestic team also get involved, for example, helping residents with seed planting and garden ornament painting and evidence of their work was seen in the well maintained gardens around the building. People have the opportunity to day centres in the community if they choose, for example, one individual who continues to attend a Caribbean day centre as she did before she came to the home. There are two religious services in the home per month, attended by religious ministers. One individual chooses to have their existing minister to visit them in the home. The home identifies peoples’ religious and cultural needs and takes suitable action to have these met. One individual of a particular religious background does not practise their religion but appreciates their room being appropriately decorated by the Activities Co-ordinator during religious and cultural celebration days. Peoples’ rooms are also decorated on their birthdays. We were presented with pictures showing evidence of good engagement and interaction of residents in a wide variety of social activities in an album called ‘Memories of Westgate House.’ Due to practical reasons the Coordinator informed that there is a rota to bring individuals out into the community, for example, for pub lunches, to the park, flower gardens, playgrounds, shopping centres or for a walk around the block. The home used to go Southend however we were informed that this proved difficult due to the residents’ needs and comfort whist travelling. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 16 The Coordinator informed that residents meetings have been held, evidence of which was seen in minutes of meetings, however we were informed that recently residents meetings had not taken place as people have not shown interest in attending. We saw records of recent meetings which showed that meetings had been postponed as only two people had turned up. Some relatives informed that the days and times when relatives meetings were held were not convenient for them. This needs to be addressed by the management of the service. Whilst activities are generally well provided, the home may need to think further about ensuring that all individuals have equal access to engage in activities, as comments received from relatives and an individuals indicated that some individuals may not have the same opportunities as others, for example, to go out of the home, despite their being no apparent reason for this. The family of one individual also commented that people are too often left in the building and they would like staff to support residents to come out more and make greater use of the garden spaces outside the home. It is recommended that all individuals have equal access to social activities and leisure opportunities of their choice and for staff to actively support people to access and sit out in the garden. The main kitchen was clean and well organised. There was a good choice of cereals, biscuits and snacks. The home uses fresh vegetables and there is daily fresh baking (either for afternoon tea, or the puddings served at lunchtime or supper). The service will buy in any favoured requests, such as additional cereals, even if this is for one resident only. Fresh fruit platters are sent to each unit at afternoon tea- time, a choice of milky drinks is offered for bedtime, cooked breakfast is offered daily and ‘offmenu’ alternatives are available if residents do not want the choices featured on the menu. This includes meals to suit individual cultural preferences or special dietary needs. Sandwiches are made for residents that want a more substantial snack with their bedtime drink and biscuits; extra sandwiches are made so that residents can have a snack if they are hungry during the night. Barchester is looking at expanding this ‘night-time’ menu, particularly for residents with dementia that might not eat well in the day but are awake and hungry in the night. We sampled the food on the first day of inspection and noted that the presentation of the food could improve with more texture, more distinctive flavour and more variety of colour. Some individuals were observed to eat and enjoy their meals and comments were received that the food was good. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals are provided with information about how to complain. However individuals and staff who have complaints need to be encouraged to make more use of the home’s complaints procedure in order that any complaints are properly investigated and addressed. Individuals are protected from abuse with appropriate policies and procedures in place. EVIDENCE: The complaints folder was examined. It contained ten recorded complaints and their outcomes since the last key inspection of June 2006. These were appropriately investigated using the homes’ complaints procedure. The complaints procedure needs to be updated with the new contact details for CSCI. The complaints folder also contained monthly Fast Response Feedback forms from residents, relatives and visitors, the majority indicating that they felt welcomed in the home; staff were friendly and courteous; that they were satisfied with the care; there was sufficient communication between staff and themselves and they were aware of the complaints procedure. Only one Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 18 individual expressed dissatisfaction about some environmental issues in their room and a record was noted about an agreed programme of refurbishment with the family. The whistle-blowing policy and procedure is now contained in the staff handbook and provided to each employee. Two complaints received by the Commission from staff members about the impact of staffing on their caring responsibilities have been considered throughout this inspection and also investigated by the provider. We examined these complaints during the course of the inspection. Randomly selected individual files and records demonstrated that care plans, risk assessments, records of care provision, individual health monitoring and daily evaluations are generally in good order, with some exceptions highlighted in the section above in Health and Personal Care. It is not possible to identify exactly the reason for the shortfalls identified in the individual cases highlighted above, though there are implications as regards possible overloading of work in the areas where nurses are responsible, or individual staff competency issues, possible implications regarding the staff members’ supervision and or support or management audits. This is for the organisation to carefully examine and to adequately address. However there is some anecdotal evidence in interviews with some staff and residents that people may need to wait longer for their care needs to be attended to due to staff being busy with other people who may have higher needs. Mixed views were provided by staff and residents, however some staff informed that they were feeling under pressure to carry out their support tasks with people, particularly when needing to assist people with their personal care needs, due to the level of need and the time needed to undertake this task. The evenings and weekends were particularly highlighted by some residents, who stated that they sometimes waited longer if they required assistance. We examined the staff rota to see if there were any changes in staff numbers during these times however the rota did not reflect any changes in staffing levels. The manager and Regional Operations Director who was present during feedback were advised that they must explore these issues carefully with residents and staff to ensure that staffing issues concerning staff numbers or the deployment of staff are adequately addressed so that individual residents’ needs are adequately met at all times. Similarly, it is important to ensure that the needs of staff are met and that they feel adequately supported to carry out their responsibilities. The complaints policy and procedure is available to individuals and provided to them individually or given to their family or representatives. Individuals and their families know how to complain. Some individuals who expressed dissatisfaction with their service during the inspection had not used the Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 19 complaints procedure to express their complaints. We informed the individuals and the manager that people in the home need to be encouraged to make formal complaints in order that their complaints are transparent, adequately investigated and openly addressed. The manager was advised that residents and their families need to have more opportunities to engage in dialogue with the home and to ensure that people are actively encouraged to attend residents’ and relatives’ meetings or to find alternative and creative ways of engaging and consulting people for their views on the service. The financial records of four randomly chosen residents were examined and deemed to be satisfactory. There were no issues of concern as regards receipts and balance sheets present and there was evidence of residents spending their personal allowances for hairdressing, toiletries, entertainments and clothes. Barchester is assisting one individual with their allowances to ensure they are not disadvantaged pending their application for assistance with their financial entitlements. The home has an adult protection policy and instigates the procedures in appropriate situations. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People in the home benefit from living in a very pleasant, comfortable and homely environment that is safe, well maintained and suitable to meet their needs. EVIDENCE: The environment at Westgate is very pleasant, comfortable, furnished to a good standard and has large landscaped rear gardens. The home has changed the curtains in all bedrooms. The lounge and corridors in the dementia unit have been carpeted. The home was clean, spacious, bright and well maintained on the day of inspection. Glenparke Unit (for individuals with dementia, also Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 21 known as ‘Memory Lane’) was decorated in a reminiscence style. A variety of large colour and black and white pictures adorn the corridor walls to help evoke memories of landmarks, historical events such as aircraft in the war, famous old music and movie stars. The day rooms and dining rooms contained pleasant and suitable images, furniture, sensory objects and items reminiscent of the past, creating a relaxed and homely ambience. Residents have a choice of communal lounges. Bathrooms were decorated with homely effects such as wall mosaics and colourful tiles. Inspectors were invited to view some bedrooms which were observed to be comfortably maintained, bright and personalised with photographs and ornaments. The home was clean and free from offensive odours. The home has implemented a non-smoking policy following consultation with residents and their representatives. A small wooden building for smokers has been created in the rear garden. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals’ needs in the home are presently being met, however the home needs to ensure that any staffing issues do not impact on the quality of service provision. Recruitment practises are good to ensure only suitable people are employed by the service. Staff receive supervision and training to support them to work effectively. EVIDENCE: Issues regarding staffing were examined during the inspection following the recent staff complaints and comments received during the inspection from individuals, relatives and staff. The complaints have been investigated by the Regional Operations Director and dealt with under their disciplinary procedures. There are presently six nurses on the rota to work on the Glenpark (dementia) unit, though there is one nurse per shift plus the Head of Care. There are currently 28 residents on the Glenpark unit and five care workers. The nurses have responsibility over individuals on their unit thought the care assistants Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 23 are key workers to the individuals. Care workers and nurses meet to discuss care plans and risk assessments on monthly basis. The unit with 29 residents has two nurses and six carers and another unit with 12 residents has one nurse and two carers. Overnight, there is one nurse and two carers on the units with the exception of the 12 bedded unit which has one nurse and one carer. The nurses receive their handovers from the night shift nurses, then prepare and administer medication to all individuals on their unit. This we were told can take up to an hour. The nurses then undertake their general nursing duties and check on work that care assistants are doing. Nurses have responsibility for all care plans and risk assessments on their units. Care staff have responsibility for giving personal care, serving and assisting people with their meals and engaging in various activities with people. At the time of the last inspection there were two Heads of Care who were appointed as senior nurses to the general nursing units and the dementia unit respectively. Since the last inspection there is now one Head of Care who spends 18 hours per week on the Glenpark Unit and additional supernumerary hours. We were informed that there is another Head of Care however they have different responsibilities. Information obtained about the impact of having one head of care instead of two and staffing levels was mixed during this inspection with opposing views expressed by individuals living in the home, their relatives and staff alike. Some staff members expressed that they considered themselves to be under pressure particularly when carrying out activities requiring more time and such as personal care in the mornings. Similarly some individuals and their relatives complained about waiting too long at times for staff to attend to them when they needed, particularly at night time and at weekends. See also issues addressed in the Complaints and Protection section. Conversely, feedback was received from individuals and their relatives who were very complimentary about the service and the support they received. Some staff informed that in their view staffing levels were sufficient and they felt adequately supported on their unit. These staff worked on the same unit where other staff complained about the staffing pressures on their unit and how individuals’ service provision is affected. It was recommended that the service further explores the underlying reasons why discontent is being expressed by some individuals living in the home, their relatives about the care service they recieve and from some staff about their staffing experiences and the quality of service provision. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 24 Four randomly selected staff files were examined to assess the home’s recruitment practises. All files evidenced that staff had two references, an enhanced Criminal Record Bureau check, identification and health checks. However two files did not contain recorded evidence of induction training. All staff on the Memory Lane dementia unit have received YTT dementia care training run by Barchester undertaken over an eight day period. More than 50 of staff possess an NVQ Level 2 or higher grade in Care or a recognised equivalent. All staff are continuously refreshing their mandatory training using a computer located on the first floor unit. Staff have received training on falls awareness, they have also used the skills bus from City University to receive information about, for example, catheter care, challenging behaviour, and dementia awareness. The Head of care has had training on End of Life who will cascade this down to other staff. 3 nurses have had a half day awareness course in End of Life care. Staff in addition receive clinical support from the Newham Liaison Nurses and St Josephs Hospice who come visit individuals funded by the Local Authority and will train nurses regarding counselling individuals who receive End of Life care. Staff were observed to have positive engagement with individuals in the home. Staff spoken to confirmed they received regular training in a range of relevant areas and received regular supervision, as seen in supervision records available. Staff are also receiving annual appraisals. Staff were observed to encourage individuals in their daily activities and to interact positively with them. Staff demonstrated that they had empathy and understanding of the needs of people living in the home. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is competently managed. Policies and procedures are in place to ensure that operations run smoothly and in the best interests of people using the service. Health and safety procedures are well observed in the home. EVIDENCE: The manager is a registered nurse and possesses the Registered Managers’ Award. The manager has previous experience as a deputy manager, has Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 26 worked in the care industry for eight years and has been the manager of this home for over three years. She also has a background as a trainer. Staff interviewed informed that the manager was supportive to them and efficient in carrying out her duties and responsibilities. They generally thought the manager had good insight into the needs of staff and residents and acted appropriately when needed. The service has shown areas of improvement such as satisfactorily meeting previous requirements including medication records, information to staff about the whistle-blowing policy and staff training. Fast Response Feedback forms for residents, relatives and visitors are available to view in the home. Positive comments were seen throughout these forms, typically such as , “I have always found everyone to be so helpful. Everyone looking after my mum was wonderful.” Letter of thanks were seen in the office including comments like, “to all the staff for their kind contributions to the care and wellbeing of my husband. We were sure that he was in safe hands.” Despite such positive comments however, as highlighted in earlier sections of this report, the home needs to find more suitable ways of engaging residents and their representatives who may see shortfalls in care practises to seek their views on how to improve the service. A complaint received in the fast response feedback form regarding the carpet and other issues in one individuals’ room had a dated response recorded on the top of the form stating that the home had agreed a programme of refurbishment with the family. The home operates an on-going audit system which focuses on different aspects of the service. A clinical and quality audit form was completed on 8/10/07. These are completed on an annual basis. The latest satisfaction survey in 2007 aimed at residents, relatives and visiting professionals (produced in laminate) showed a high level of satisfactory in responses to questions asked about the quality of service. Internal monthly audits were seen to be completed. Regulation 26 visits are completed on a monthly. An array of relevant policies and procedures are available in the home and were reviewed in September 2007. Records and certificates were available to demonstrate good health and safety practises. Testing on the following were deemed to be satisfactory: portable Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 27 appliances, electrical and gas safety, legionella, fire alarms, fire drills and water temperatures. The Newham Environmental Health inspector in December 2007 gave a 4 star ‘very good’ rating for food safety. Good maintenance and repair logs are as are regular service checks for the equipment used in the home. There is regular monitoring of wheelchairs, mattresses and beds. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 17 18 3 4 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 3 x 3 Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 15 Requirement Timescale for action 31/10/08 2 YA8 The home must make sure that robust systems are in place to ensure that care plans are adequately completed for each individual so that the care received by those individuals is not compromised by inadequate recording of their needs. 15, Appropriate risk assessments 13(4)(b)c) must be completed in all cases where increased risks are identified to residents’ individuals’ health and care needs. Risk assessments to be updated monthly, where appropriate, in accordance with internal policies and procedures. Ensure that all supplements prescribed to individuals are stored safely and handled in the same way as other prescribed medicines. 31/10/08 3 OP9 13(2) 14/08/08 Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 30 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 YA9 Good Practice Recommendations Ensure medication risk assessments are available for all individuals as to whether they require support and assistance or whether they are able to self-administer their medication. Update the medication policy in line with professional guidance, including advice available on the CSCI professional website. Ensure all individuals have equal access to social activities and leisure opportunities of their choice. Staff to actively support individuals who may wish to access the garden or support individuals who would benefit from sitting out in the garden. Ensure residents and relatives are further consulted about attendance at residents and relatives meetings. Consider how best to engage and seek the views of residents and their representatives about the quality of service provision. Meals to be served with more of a variety of texture, more distinctive flavour and more variety of colour. Ensure the complaints procedure is updated with the new contact details for CSCI. Ensure that more effort is made to encourage residents, their representatives and staff to make more use of the complaints procedure to ensure that all complaints are transparent and can be adequately addressed. The home to ensure that issues concerning staff numbers or the deployment of staff are adequately addressed so that individual residents’ needs are adequately met at all times. Ensure that the needs of staff are met and that they feel adequately supported to carry out their responsibilities. 2. YA12 3. OP14 3. 4. OP15 OP16 5. OP27 Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 31 6. OP30 Record evidence for all staff to confirm that they have completed induction training. Westgate House DS0000069391.V366718.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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