Inspection on 21/11/07 for Westgate House Care Centre

This inspection was carried out on 21st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Care Centre 29/10/08

Westgate House Care Centre 12/03/07

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 21st November 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westgate House Care Centre DS0000066188.V359774.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.V359774.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.V359774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th March 2007 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.V359774.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We spent three days at Westgate House, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. An Expert by Experience (EBE) took part in the inspection. The EBE is a person who has experience of care services for older people. The EBE met and talked to many of the people who live in the home. We also talked to some visiting relatives, some of the staff, and to the proprietor. We also spent two hours sitting with people in the area of the home where the most vulnerable people are looked after. The aim of this was to get an impression of what life is like for the people who live there. The proprietor sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and her assessment of what the service does in each area. Evidence from the AQAA has been included in this report. On September 4th 2007 we visited the home to review the requirements made following the last key inspection, for which the compliance date has past. We have included some of the findings from that visit in this inspection report. What the service does well: What has improved since the last inspection? A new manager has been appointed, and there are additional staff in the home during the early morning. Westgate House Care Centre DS0000066188.V359774.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 Care Centre DS0000066188.V359774.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.V359774.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 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who are planning to move into Westgate House know that the home has sufficient information on their needs so that the staff can support them and assist them appropriately. However in some cases the assessments for people having a short stay for intermediate care do not ensure that the home is able to meet their needs. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated, “We have a comprehensive website which provides relevant information on the care centre and photos to view, as well as a contact us link which provides a forum for service users and their relatives to explore the centre and ask any questions they may have in their own time pre-admission. The site also provides a direct link to the latest CSCI report on the centre ensuring prospective service users can make a fully informed decision. Additionally, the site provides a request brochure option which links directly to the centre.” There is a Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 9 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. We saw a sample of files 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. 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 are available for people who need it as part of their therapy care plan. The Expert by Experience (EBE) spoke to three people who were staying in the home for intermediate care. They were all very pleased with the home, which met their expectations. “very nice…staff understanding ..helpful”. There was a “happy feeling…not pressurised …couldn’t think of anything better”. The PCT (Primary Care Trust) has a contract with the home for the intermediate care beds. There have been some cases when people were admitted to the home with insufficient information for the hospital, and the home was unable to meet their needs. This is being addressed with the PCT. The registered person, who is currently the proprietor as the new manager is not yet registered, is responsible for ensuring that full assessments are carried out for everyone who is admitted to the home, and that the home is able to meet each person’s assessed needs, before they are accepted for admission. Westgate House Care Centre DS0000066188.V359774.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, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. However the recording of pressure care and monitoring of weight loss does not support this good practice. The system for auditing medication audit is not robust enough to ensure that any errors in recording are seen and corrected with out delay. EVIDENCE: The Expert by Experience (EBE) reported that the universal view from the residents was that they were treated with respect and dignity. A sample of views included: “ Very well; looked after well; kept clean; happy enough; it’s our room; the staff don’t interfere; they always knock.” “Alright; can’t grumble; comfortable; staff alright; some very nice. Tried another home, didn’t like it.“ “ Very good; nice; all friendly; do what you like, stay in bed.” One person said that they had been in another home before that was “ horrible”. The EBE spoke to a visiting relative, who said that they had looked Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 11 at a several potential nursing homes and chose this one because “ X needed nursing. I like the nursing here. There are people around, and the key worker feeds X”. Another relative, of a person who only communicates in Punjabi, said, “Overall it is very good. Z is well taken care of and the nurses quite helpful. Z has vegetarian food”. This relative said that initially there was a problem with communication, but now three or four of the staff can communicate with Z. We spent some time sitting with people in the area of the home where the most vulnerable people are looked after. The aim of this was to get an impression of what life is like for the people who live there. The staff spoke to people in the lounge each time they came in, and explained to each person what they were doing. Several people constantly walk around in the unit. We spoke to all of these, and they were able to respond, and showed a sense of purpose in what they were doing. The staff had a very good relationship with the people that we observed, and showed a good understanding of each person’s needs and how to communicate with them. The Annual Quality Assurance Assessment (AQAA) stated, “Each service user is supported to make their own decisions, the centre uses a person centred care planning approach, which is evaluated at regular intervals. There is ongoing and comprehensive staff training to ensure best standards of care for our service users. Within service users documentation formal decisions regarding end of life care, such as advance directives and wishes and feelings, are recorded. We plan to ensure that all staff are aware of the implications of the Mental Capacity Act on the care we provide by implementing a relevant training plan” We looked at a sample of care plans on each floor. Most of those that we saw contain appropriate information and procedures to enable the staff to provide the care that each person needs. However in some cases the care plans did not reflect the person’s wishes and individual needs. For example, the care plan for one person stated that their hearing is good, but this person is deaf in one ear and partially hearing in the other. The care plan also states that this person eats Shreddies for breakfast, but we were told that they don’t like Shreddies. 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. In two cases there was no record that the skin care and regular turning that were part of the care plan have been carried out. The care plan for one person who we were told has a pressure sore had no description of the wound, and there was no mention in the daily record of wound care. Some information in the care plans is confusing. For example, there is no clear distinction between the assessments, including pressure area and dependency Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 12 assessments, that ere made before or at the time of admission to the home, and those that are current. The home has employed a new permanent physiotherapist and occupational therapist who are available to provide treatment for everyone in the home. A speech and language therapist and dietician also visit the home. The GP from the local medical centre visits daily. People who are staying in the home for intermediate care and rehabilitation have an individual therapy programme. We made a spot check of the medication and medication records on each floor. The recording was unclear in some cases. For example, when the prescription states that 1 or 2 tablets can be given, the number given each time is not recorded. One person has a prescription for Adcal D3, for two to be taken once a day. The medication check did not tally with the record, and it is possible that only one was administered on several occasions. Similar errors were seen for other people. We saw some gaps on the MAR (medication administration record) charts, with no explanation of why the medication had not been administered. The details of one medication had been handwritten onto the MAR chart, but the details w=were not the same as on the label on the packet. The AQAA stated that the acting home manager has organised for the Intercare Pharmacist to carry out regular spot checks, audits and training on medications to ensure all staff are following correct policies and procedures. However the errors that we saw on this occasion show that the audits are not sufficiently robust to prevent and correct errors when they occur. The home provides a good service for palliative care. The nursing staff have sufficient expertise to meet people’s individual needs, and relatives are treated with appropriate care and concern. The AQAA stated, “Following a discussion with the GP, we have acted upon his suggestion of identifying a quiet room in the home, which is available to any service user with a specific request or need during their final days, eg: if they wish for peace and quiet or certain religious surroundings. Additionally we offer a dedicated and qualified member of staff to the service user in this situation.” Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 13 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. The people who live in the home are supported to live full and active lifestyles. EVIDENCE: The home employs two activities co-ordinators and a timetable of activities is on display throughout various points in the home, with activities morning and afternoon from Monday to Friday, including sedentary exercises, art, bingo, quiz, music, reminiscence, cookery, board games. 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. During this inspection they involved people in decorating the lounges for Christmas. We also observed an exercise group on one floor. The Expert by Experience (EBE) reported that overall the activities were impressive in their range and appreciated “ … like quizzes, bingo, exercises in chair … musical evenings sometimes”. However, the EBE said that on the question of exercise and being taken out, apart from the planned activities, he had the impression that beyond a very basic level a lot depended on visitors. The wife of a resident said “..I take him out … staff very busy”. Her husband has dementia Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 14 and needs more than 1 person to help with walking. Another resident “.. daughter takes outside… [staff] haven’t got time but are very good”. The EBE had lunch with 5 residents. There was a choice the night before of two main courses and supper. The food was served from a hot trolley with the staff either knowing the vegetable preferences or asking people, and in one case accommodating a last minute meal change of mind. There were plenty of staff to help and two residents who needed some help were dealt with sympathetically and with humour. One of these said “ good waitress service … staff wonderful.” The cook appeared to ask people their views on the meal and future preferences. “I talked to the cook, who I think was relatively new. I very much liked her book record of alternatives to the menu choices. This was gleaned by her floor walking. Her request book was full of individual requests, including several salads - for salad provision not just going through the motions. We discussed the provision of fruit, which seemed to rely on the provision of families. She was receptive to the concept of it being provided regularly to all residents; one option being plated variety fruit as finger food.” In order to encourage people to eat enough and maintain good health, especially in the dementia units, finger foods should be available for people to pick up and eat at all times throughout the day. 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 to during the inspection said that they are able to make decisions about their lives in the home. Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 15 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. The people who live in the home are confident that their concerns are listened to, and that they are safeguarded from the risks of abuse. EVIDENCE: Following the last inspection concerns were raised by the relative of a person who had a short stay at the home. These were investigated by Social Services, and the investigation included two strategy meetings, a monitoring visit to the home and an inspection by environmental health officers. No evidence was found to substantiate the allegations of poor food hygiene. Some necessary actions were identified concerning medication and personal care. At both meetings Social Services were concerned that the proprietor and senior managers have poor understanding of HCC procedures for safeguarding vulnerable adults, and in particular for the process of strategy meetings. Since then there has been further training in the home on safeguarding procedures, and the revised Hertfordshire safeguarding procedures are in the home. 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. The home has a satisfactory complaints procedure in place, which is given to everyone in the Residents’ Guide. The Expert by Experience (EBE) reported that there was to be an informal system for people to make their views Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 16 known, which seemed to work because of the active interchange between staff and residents at various levels. People said that they tell individual members of staff if they have any concerns. One said, “I tell the nurse…no complaints with the place”. The home has a satisfactory complaints procedure in place, which is given to everyone in the Residents’ Guide. The EBE said that there was an informal system for people to make their views known, which seemed to work because of the active interchange between staff and residents at various levels. People said that they tell individual members of staff if they have any concerns. One said, “i tell the nurse…no complaints with the place”. The Annual Quality Assurance Assessment (AQAA) stated, “The centre has a policy which recognises that each service user has the capacity to make all decisions unless proved otherwise. Workers are also aware that service users capacity may change daily and assess this at each individual decision.” Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 17 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, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a safe and comfortable environment for the people who live there. The appearance of the home is spoiled by stained carpets and poor quality bedding. EVIDENCE: Westgate House care Centre is a purpose built three storey building that was opened in January 2006. It is designed on three floors around an enclosed central courtyard. The Annual Quality Assurance Assessment (AQAA) stated that this is a particular highlight of the centre as on each floor there are lounges at each corner with large glass windows that over-look the courtyard. This is particularly enjoyable when there are concerts and parties in the courtyard so that everyone can enjoy the festivities from inside or outside. The O shape of the centre also provides a wander route for people with Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 18 dementia to enjoy without getting lost or disorientated. 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 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. Since the last inspection most of the bedroom doors have photographs of family and friends of the person who lives there, to help them to recognise their room. The AQAA stated that there are plans to investigate colour coding in the dementia unit. There are a variety of assisted baths and showers for people to use, and appropriate equipment, such as hoists, for people with disabilities. The home has a large modern rehabilitation gym that is used primarily for people in the intermediate care unit, but which is available to anyone who wishes to make use of it. A new call bell system has recently been installed, following complaints that staff on all floors were ignoring the buzzers and visitors were left waiting. The bells are now specific for each floor. There is a full time maintenance man, who is also responsible for health and safety and fire precautions in the home. The home appeared to be clean in all areas while we were there, but some visitors commented that the staff do not have time to clean the bedrooms thoroughly. There is one housekeeper on each floor every day, and one extra to assist where needed. The housekeeper has to clean all 35 rooms on their floor every day. The additional person is responsible for shampooing carpets to control smells and prevent infection. (See also Staffing.) The carpets in the corridors on all three floors are very stained in many areas. The AQAA stated that there are plans to replace the carpets in the dementia unit with laminate flooring. Alternative flooring could be considered throughout the home. We heard from both visitors and staff that the quality of bedding in the home is very poor. Some visitors provide their own bedding for their relatives because of this. We saw sheets on the beds in several rooms that were so thin that they had the appearance of muslin, and it was possible to see through them. The proprietor said that new sheets have been provided, but the staff who we spoke to were not aware of this. Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 19 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 adequate. 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. However there is a risk that the high use of agency and bank staff may affect the quality of care they can provide for the people in the home. The low number of housekeeping staff means that hygiene standards may be compromised. EVIDENCE: The staffing rotas show that there are sufficient staff in the home every day. The Annual Quality Assurance Assessment (AQAA) stated that there are extra staff on duty early in the morning as many residents like to get up very early as requested during their care plan reviews However staff and senior staff who we spoke to told us that due to short notice for staff sickness and high sickness levels the shifts often include bank and agency staff, and frequently staff move around the home. This means that the staff teams are not stable. Together with the concerns over poor recording of some aspects of healthcare (see Health and Personal Care), there is a risk that the staff may not be fully aware of all the needs of the people that they care for. Some of the relatives in the relatives meeting said that there are not enough staff in the home at weekends. The lack of a stable staff team may be the reason for this perception. The need for a stable staff team with knowledge of each person’s Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 20 particular needs and how to communicate with them is particularly important in the dementia care unit. On this occasion and during our visit to the home in September, the staff who we spoke to said that there has been no change in their shift patterns, and they are expected to work 12 hour shifts. One person said that they like this, as it enables them to have more time off. However these excessively long hours and long shifts could cause a risk to the welfare of the residents. Most of the staff said that they are happy working in the home. They said that everyone is very friendly and it is a nice place to work. The concerns that some of them expressed are due to the possible effect that this has on the quality of care they are able to provide. Some visitors commented that the staff do not have time to clean the bedrooms thoroughly. There is one housekeeper on each floor every day, and one extra to assist where needed. The housekeeper has to clean all 35 rooms on their floor every day during a 6 hour shift. We were told that the rooms only get a thorough clean when they are vacant. (See also Environment.) 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. The AQAA stated that at least 50 of staff delivering personal care hold an NVQ level 2 or above. NVQ training is offered to all staff - the Chef is about to start NVQ level 2, and the home has offered the same opportunity to the cleaning staff. 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.V359774.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A new manager has been appointed, which should lead to an improvement in the structure and practice of management in the home. EVIDENCE: When we visited the home in September the proprietor was managing the home, but she has not registered as manager. A new manager was appointed in March, but did not take up the post. One of the deputy managers was appointed as manager in July, but then left the home. A new manager has now been appointed, and this inspection took place on her third day in the home. two deputy managers mange the units on the ground floor and the first floor. There is no deputy manager on the second floor. The manager and Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 22 deputy managers work Monday to Friday. This means that there is no management presence in the home at weekends, and this may be another reason why some relatives feel that there are not enough staff in the home at weekends (See Staffing). The proprietor has a lack of trust of the staff in the home, and an accusatory attitude. All the issues that were raised during the inspection, for example recording in care plans and the poor quality of bed linen, she blamed on the staff not doing what she had instructed them. However, as the acting manager of the home, and the registered provide, it is her responsibility to ensure that the home complies with the regulations and National Minimum Standards of the CSCI. The instability of the staff team may be a cause of the poor recording (see Staffing), and the staff who we spoke to said that they did not have new bed linen (see Environment). The new manager is qualified and experienced, and may improve the management structure and practice in the home. The Annual Quality Assurance Assessment (AQAA) stated that the home has a good system for quality assurance that includes questionnaires and relatives’ forums. “We distribute questionnaires to service users, relatives and stakeholders in order to gain feedback on our services.” The proprietor said that questionnaires were sent out six weeks ago, and at the time of our visit they were being evaluated. The outcomes from these questionnaires will lead to a development plan for the home. No development plan, or evidence of these consultations, has yet been provided to CSCI. However changes that have been made following previous consultations led to changes in the way that laundry is done, and the detergents used for laundry. An independent consultant makes regular monitoring visits to the home on behalf of the proprietors, and provides a report of his visits. These reports have not been sent to CSCI, but were seen during the inspection. The report of the residents’ and relatives’ questionnaires should be sent to CSCI. We inspected the arrangements for management of residents’ money during the last inspection, and they appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. 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. On the first day of this inspection we saw a container of bleach in an unlocked cupboard in the kitchen on the second floor. The cleaning cupboard was unlocked and accessible for over five minutes, with cleaning items on show that included toilet cleaner and wasp and fly killer. The bleach had been removed and the cleaning cupboard was locked on the last day of the inspection. Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 23 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 2 X X 3 X X X 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 X 3 X 3 X X 2 Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 Requirement A comprehensive assessment must be completed before any resident is admitted to the home, that provides appropriate and adequate information to enable the staff to meet all the person’s assessed needs. The registered person must ensure that all care plans provide adequate and appropriate information on all the resident’s needs, and that recording in care plans is relevant and informative. Measures must be put in place to ensure that medication is audited effectively, and that any errors in medication are noted and rectified without delay. The registered person must provide bedding that is of a suitable quality to provide comfort and lessen the risk of pressure sores. Timescale for action 31/05/08 2. OP7 15 31/05/08 3. OP9 13(2) 31/05/08 4. OP19 16(2)(c) 31/05/08 Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 25 5. OP19 23(2)(d) 4. OP27 18(1)(a) 5. OP38 13(4)(a) The carpets in the corridors on all floors must be thoroughly cleaned or replaced with an alternative flooring that can be maintained in a clean and hygienic manner. The registered person must ensure that sufficient staff are available at all times to meet the needs of the residents and to maintain a clean and hygienic environment. All substances that may be hazardous to health must be stored securely at all times. 31/05/08 31/05/08 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westgate House Care Centre DS0000066188.V359774.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Inspection 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.V359774.R01.S.doc Version 5.2 Page 27 - 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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