Inspection on 12/03/07 for Westgate House Care Centre

This inspection was carried out on 12th March 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Westgate House Care Centre 29/10/08

Westgate House Care Centre 21/11/07

Westgate House Care Centre 04/05/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Westgate House Care Centre Tower Road Ware Hertfordshire SG12 7LP Lead Inspector Claire Farrier Unannounced Inspection 12th March 2007 6:30 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 Care Centre DS0000066188.V334999.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 Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westgate House Care Centre Address Tower Road Ware Hertfordshire SG12 7LP 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) 01920 468079 01920 469340 kathy@westgatehc.co.uk www.westgatehealthcare.co.uk Westgate Healthcare Limited Care Home 109 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (109), Physical disability (75) Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2006 Brief Description of the Service: This purpose built home is situated in a residential area of Ware. The home was purpose built and was opened in January 2006. It provides accommodation and nursing care for 109 older people. The home is a newly built three storey building. 35 people with dementia are accommodated on the ground floor, and the first floor has 20 beds for people who require intermediate care. All the bedrooms are single and all have ensuite facilities The home has a large enclosed garden with raised flowerbeds. Closed Circuit Television is in situ and is discreetly positioned over the main entrances to the home. The Statement of Purpose and Service Users Guide provide information about the home for referring agencies and prospective clients. The current charges range from £580 to £850 per week. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors visited the home to carry out this inspection. It was unannounced, and took place over one day. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We talked to as many of the people who live in the home as we were able to. We also talked to some of the staff. 13 people completed Have Your Say surveys following our visit to the home, and we have used some of their comments in this report. When we were in the home we looked at the home’s records, care plans and staff files, and we made a tour of the premises. We talked to the proprietor about what we had seen during the day. The proprietor sent some information about the home to CSCI following the inspection. What the service does well: What has improved since the last inspection? What they could do better: The manager who was appointed when the home opened left the home six weeks before this inspection. There is no unit manager in the intermediate care unit. The absence of consistent management has already shown some effects. Some staff are working excessively long hours and long shifts, which has an impact on staff morale and may affect the wellbeing of the residents. The staff are not supervised regularly. We saw some poor practice in moving and handling, which could cause a risk to the health and safety of both the Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 6 staff and the residents. The home does not have an effective system of quality assurance that focuses on the consultation with the service users. 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 Care Centre DS0000066188.V334999.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 Care Centre DS0000066188.V334999.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, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient information on the needs of the people who live in the home, and access to appropriate services to enable them to meet their needs. EVIDENCE: A sample of files were inspected on each floor, and each one contained a full assessment that was completed before the resident was admitted to the home. Care plans are written from the information in the assessments, and the assessments and care plans generally provide appropriate information so that the staff can meet each person’s needs. The assessments include risk assessments for moving and handling and the risk of falls, and other assessments are also carried out when appropriate, for example for pressure area care and for nutritional needs. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 9 The staff have the experience and training to meet most of the residents’ needs. Each floor has it’s own team of staff, and there is a separate Residents’ Guide for each floor. The Residents’ Guides are clearly written, and contain all the information that is needed before anyone moves to the home. The second floor provides care and accommodation for 20 people who need intermediate care between leaving hospital and going home, and for people who are assessed to need continuing nursing care. Physiotherapy and occupational therapy is available for people who need it as part of their therapy care plan. Everyone who completed a Have Your say survey said that they had received enough information about the home before they moved in so they could decide if it was the right place for them. One person said, “It was a short stay, and I love it here” Westgate House Care Centre DS0000066188.V334999.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, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides appropriate care for identified health concerns, but it is not proactive in addressing concerns such as weight loss and prevention of pressure sores. EVIDENCE: When we arrived at the home at 6.30 in the morning, the night staff were assisting some people to wash and dress, or to wash and go back to bed. They said that these were people who were awake and wished to get up at that time, and several people that we spoke to confirmed this. Everyone who completed a Have Your Say survey said that they receive the care and support that they need. One person said, “The staff in this home are fantastic…. I know my father is safe. He is very ill and he is very happy. His quality of life has improved although his disabilities have increased.” Another person commented, “ Medical care is excellent in the home.” But one person said that there is not sufficient attention given to the needs of continuing care patients Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 11 who are unable to communicate. We spoke to several visiting relatives, who were all appreciative of the care that the staff provide. We looked at a sample of care plans on each floor. They contain appropriate information and procedures to enable the staff to provide the care that each person needs. The monitoring of each person’s health includes assessments for the risks of falls and for pressure area care. Each person’s weight is recorded. However when there has been a loss of weight, it is not always noted and appropriate action taken. Treatment of pressure sores is satisfactory, but there is insufficient monitoring of skin care and bruising to prevent pressure sores from occurring. The PCT (Primary care Trust) employs a physiotherapist who provides treatment for the intermediate care unit. A speech and language therapist, occupational therapist and dietician also visit the home. The home has good procedures for administering and recording medication. We watched the way that the staff behave with the people in the home. In most cases the staff treated people with respect. In the dementia unit on the ground floor we saw staff talking to people and assisting them with courtesy and kindness. However we also saw two care staff assisting a person to move from a wheelchair to a chair in a manner that could cause a risk to their health and safety. A hoist was available, and the care workers used the hoist when assisting several people to move close to where we were sitting. But in another lounge we saw them lift a person without using the hoist. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents maintain their independence by making choices about the food and how they spend their days. EVIDENCE: Two activities co-ordinators are employed and a timetable of activities is on display throughout various points in the home. The activities co-ordinators are enthusiastic and imaginative, and they constantly look for new activities and interests that suit the people in the home, particularly in the dementia unit. Most people who completed Have Your Say surveys for this inspection said that they do not take part in the organised activities, either because they don’t want to or because they are unable to. However one person said that their father enjoyed the activities, and the summer barbecue was fantastic. Relatives and friends are welcomed into the home when they visit. We spoke to several visiting relatives during the inspection. They said that they are very happy with everything about the home. They are kept informed about their relative, and consulted about the care provided. The people who were spoken Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 13 to during the inspection said that they are able to make decisions about their lives in the home. Everyone that we spoke said that they enjoy their meals in the home. We observed breakfast and lunch on the dementia unit. Mealtimes are very relaxed and unhurried time, and the staff support and assist people who need encouragement to eat. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to safeguard the residents from abuse. Residents and relatives are confident that any complaints will be properly investigated. EVIDENCE: We received two complaints about the quality of care provided in the home. As a result of these complaints we started this inspection at 6.30 am, so that we could check whether people were woken early for the convenience of the staff. As reported above (see Health and Personal Care), we found that the people who were assisted to get ready for the day at that time were people who were awake and wished to get up early. Two allegations of abuse by care staff have been investigated since the last inspection. Both were properly reported to Hertfordshire Social Services and investigated by their procedures. One of these incidents resulted in disciplinary action, and the other in further training for the staff who were involved. The home has a satisfactory complaints procedure in place, which is given to everyone in the Residents’ Guide. Everyone who completed Have Your Say surveys for this inspection said that they know how to make a complaint, and they were confident that they could talk to the manager or other members of staff about any concerns. One person said, “Complaints are acted on quickly. They are viewed as positive feedback. I am very happy regarding the Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 15 complaint I made.” Training in protection of vulnerable adults is available for all the staff, and the staff spoken to were aware of their responsibilities for whistle blowing. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and gardens provide a comfortable, attractive and safe environment for the people who live there. EVIDENCE: Westgate House care Centre is a new purpose built three storey building. It was opened in January 2006, and appears to be well maintained. The home appeared to be generally clean, and appropriate procedures are in place for the control of hygiene and for effective management of laundry. Almost everyone who completed Have Your Say surveys for this inspection said the home is always clean and fresh. The dementia unit is no different in appearance from the other units in the home. It is arranged so that people can walk around it securely, and there is Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 17 access to the garden in the centre of the unit. But there is no environmental differentiation, such as colour coding or pictorial cues to assist orientation. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 18 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, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers in the home are sufficient to ensure that all the residents’ needs are met, and staff receive appropriate training. Good recruitment procedures and staff training make sure that, as far as possible, the residents are supported and protected in the home. EVIDENCE: We received a complaint that staff numbers have been reduced and morale is very low. Some of the staff that we spoke to said that several staff have left since the manager resigned. However the staffing levels in the home have been maintained, and it was reported that there is one member of staff for four or five residents, according to their need. The staff we spoke to said that they generally enjoy their work in the home, and they take part in regular training. There is a measure of uncertainty due to the lack of a manager. The proprietor is currently managing the home, and some changes have been made that some staff are not happy with, including a reduction in their rate of pay. The unit managers on the ground floor and second floor provide good support for the staff on their units, but there is no unit manager on the first floor. The unit managers are not involved in the recruitment and selection the staff in their teams, and this means that there is a risk that staff may be appointed who re not suitable for that unit. The staff rotas show that some staff work long shifts Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 19 of 12 hours, and one person worked five 12 hour shifts, a total of 60 hours, during the week of the inspection. These excessively long hours and long shifts could cause a risk to the welfare of the residents. All the staff spoken to said that they take part in regular training. The company provides a rolling training programme that covers all the statutory training, and other training as required for the specific needs of the service users. Everyone who works on the dementia unit does at least two days training in dementia care. Almost a third of the care staff have completed NVQ level 2 in care. Two staff files were inspected for recently recruited members of staff. They both contained all the required information, including good references and a satisfactory CRB (Criminal Record Bureau) disclosure. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 20 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, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management structure in the home is insufficient to carry out the aims and objectives of the home’s Statement of Purpose, and to ensure that systems are in place to meet the needs of the residents. EVIDENCE: The manager who was appointed when the home opened left the home six weeks before this inspection. The proprietor is currently managing the home. It was reported that a new manager has been appointed, but at the time of writing this report there was no confirmation of this. Each unit is managed by a unit manager, but there has been no manager of the intermediate care unit on the first floor for some time. The absence of consistent management has Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 21 already shown some effects. The staff are not supervised regularly. The supervision record shows that only four members of staff have had formal supervision in the last three months. Some staff are uncertain about the changes that are happening in the home, and several experienced staff have left following the departure of the manager. The arrangements for management of residents’ money were inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. The home does not an effective system of quality assurance. It was reported that each unit manager sends out questionnaires to the residents and their families and professionals. These are then analysed, and the unit manager tells the manager what needs to be improved as a result. However no evidence was seen of this process, and there is no quality assurance report or development plan for the home. An independent consultant carries out regular monitoring visits to the home. The reports of these visits show that the consultant audits the home’s records and procedures. But he does not talk to the people who live in the home and the staff, to ask their views about the quality of care provision. Appropriate records are maintained for the health and safety of the residents and staff in the home, and the staff generally follow the home’s policies and procedures. However we observed two care staff assisting a person to move from a wheelchair to a chair in a manner that could cause a risk to their health and safety. A hoist was available, and the care workers used the hoist when assisting several people to move close to where we were sitting. But in another lounge we saw them lift a person without using the hoist. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 22 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 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12(1)(a) Requirement All health care needs must be monitored appropriately in order to prevent any avoidable risks to the health of the people in the home. Appropriate actions must be taken following a recording of abnormal weight change, and the actions and results must be recorded in the care plan. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. The need for excessively long hours and long shifts could cause a risk to the welfare of the residents. The registered person must ensure that the management structure in the home is sufficient to carry out the aims and objectives of the home’s Statement of Purpose, and to ensure that systems are in place to meet the needs of the residents. Timescale for action 31/08/07 2. OP27 18(1)(a) 31/08/07 3. OP31 18(1)(a) 31/08/07 Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 24 4. OP33 24 5. OP33 26(4)(a) 6. OP36 18(2)(a) 4. OP38 13(5) A system for monitoring the quality of care must be established, that focuses on the consultation with the service users and other involved people, and provides feedback on the process and the results of the consultation. The monitoring visits of the home must include the views of the people who live in the home and the staff. The registered person must ensure that each member of staff has formal supervision at least six times a year. The registered person must ensure that the health and safety of the residents and staff is not put at risk by poor practices in moving and handling. 31/08/07 31/08/07 31/08/07 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 11. Refer to Standard OP29 Good Practice Recommendations Unit managers should be involved in the process of recruitment and selection of the staff who work in their unit. This would ensure that the people in the home are cared for by staff who are best suited to meet their needs. Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Westgate House Care Centre DS0000066188.V334999.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!