Inspection on 29/10/08 for Westgate House Care Centre

This inspection was carried out on 29th October 2008.

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

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 21/11/07

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Westgate House Care Centre Tower Road Ware Hertfordshire SG12 7LP Lead Inspector Claire Farrier Unannounced Inspection 29th October 2008 10:30 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.V373253.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.V373253.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 Manager post vacant Care Home 109 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (39), Old age, not falling within any other of places category (109), Physical disability (75) Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2007 Brief Description of the Service: Westgate House is owned and operated by Westgate healthcare Limited, which is a private organisation. It is registered to provide nursing care and accommodation for 109 older people, of whom 39 may also have dementia. Westgate House is a purpose built three storey building situated in a residential area of Ware. 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 en-suite facilities. There is a lift to all the floors and the home is accessible for wheelchair use. The home has a large enclosed garden with raised flowerbeds. There is a CCTV camera at the front entrance to the building. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current accommodation charges ranged from £580 to £850 per week in November 2007. Current fees are available from the home. A copy of the most recent CSCI inspection report should be made available on request to the home. Westgate House Care Centre DS0000066188.V373253.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 0 star. This means the people who use this service experience poor quality outcomes. Three inspectors carried out this unannounced inspection 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 spent two hours sitting with people in the areas of the home where the most vulnerable people are looked after. This is called a SOFI – Short Observation For Inspectors. The aim of this was to get an impression of what life is like for the people who live there. We spoke to several people who were visiting the home. We also talked to some of the staff. 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 manager about what we had seen during the day. 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. The AQAA is a self-assessment document that focuses on outcomes for service users. It also provides us with some statistical information. What the service does well: There is a noticeable difference between the quality of care provided on the first and second floors and what is provided on the ground floor. The quality of nursing care and personal care on the first and second floors is good, and everyone that we spoke to there is happy in the home. The staff understand what each person needs and how to assist them, and they treat them with courtesy and kindness. The care plans on the first and second floors have been updated. They are generally well written, with good details of each person’s physical personal care needs and healthcare needs. Most of the staff who we spoke to were positive about their work in the home, and said that morale has improved among the staff team. The company provides a good training and development programme to give staff the skills and information that they need to meet the needs of the people who use the Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 6 services in the home. Two thirds of the care staff have completed NVQ level 2 in care or are working towards it. What has improved since the last inspection? What they could do better: In the last inspection report we made two requirements that have been repeated following this inspection. One was that care plans must provide good information on all of each person’s needs, and record what is being done properly; the other that medication must be audited effectively, so that there is no risk of people being given medication that is not correct for them. Although recording of pressure care has improved, and there has been some improvement in monitoring people’s nutrition, we saw some examples where poor nutrition was not monitored and recorded properly. Poor nutrition is an indicator of poor health, and promotion of good nutrition encourages improved health. We found continued errors in the recording of medication. This means that the people who live in the home cannot be sure that they are receiving the correct doses of their prescribed medicines. This is the second time that the AQAA has reported that regular medication audits take place, but from our observations these appear not be effective. The home fails to meet the needs of people with dementia. Some of the nurses and care staff who we spoke to showed little understanding of how to meet the needs of people with dementia. Some staff have had training in dementia care. However the poor practice that we observed means either that many of the staff had not had this training, or that the training is not effective in providing them with the information that they need to fully understand how to meet the needs of people with dementia. There is insufficient information available for the staff on the needs of people with dementia care and other specific conditions. The environment of the dementia unit provides minimal comfort or stimulation for the people who live there. The home has commissioned an independent audit of their dementia care services. We have not seen the report of this audit, but the manager said that the findings were similar to our observations during the inspection. However at the time of the inspection there was no plan of actions to address these areas of concern. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 7 There has been no registered manager at Westgate House for eighteen months. The current manager took up her post in November 2007. She left in April 2008, and returned in September 2008, a month before this inspection. The deputy manager, who was also manager of the dementia unit, has left and a new manager has been appointed to the dementia unit. Two new unit managers have also been appointed for the first and second floors. This new management structure should provide a stable and competent team to manage the different aspects of the home, and improve the management practice in the home. The situation when we visited the home was that there was some improvement in practices on the first and second floors, but we observed some very poor practice and lack of good management on the ground floor dementia unit. Some members of staff work excessive amounts of overtime on a regular basis. This means that staff may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. 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.V373253.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff have the skills and experience to meet the needs of people who receive intermediate care and nursing care. However, the home does not provide sufficient facilities and expertise to provide a good service for residents with dementia. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated that each prospective service user has a person centred and individualised pre-admission assessment to make sure that Westgate House can meet their needs. 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. The assessments for people who are admitted for intermediate care have improved, and the home now receives appropriate information from the hospital before they are admitted. There have been fewer inappropriate admissions than before, when some people had medical needs that could not Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 10 be met in a residential 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 PCT (Primary Care Trust) has a contract with the home for 20 intermediate care beds for 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 staff have the experience, training and support to meet the needs of the people who are admitted to the home for intermediate care and nursing care. The people who we spoke to on the first and second floors were very happy with the care they receive. The AQAA stated that in February 2008 there was a review by the Hertfordshire Council Health Scrutiny Committee. An example of the feedback received was, I was very impressed with Westgate House and the range of facilities that they were able to offer to their service users. Although the owners have to approach this as a business enterprise it is run with such empathy and professionalism for their clients that it has to be a excellent example of what good joint working between ACS (Adult Care Services), NHS (National Health Service) and HCC (Hertfordshire County Council) can achieve. In April 2008 the number of beds registered for dementia care increased from 35 to 39. In the last inspection report we said, “The staff had a very good relationship with the people that we observed (in the dementia unit), and showed a good understanding of each person’s needs and how to communicate with them.” On this occasion we observed some poor practice and understanding of dementia care by several of the staff, including senior staff on the dementia unit. (See Health and Personal Care.) The home has commissioned an independent audit of their dementia care services. We have not seen the report of this audit, but the manager said that the findings were similar to our observations during the inspection. The AQAA (which was completed in July 2008) stated, “Following the dementia care audit, new care plans will be introduced which will emphasize service users strengths rather than weaknesses. Documentation will be available to help staff assess at what stage service users are on their journey with dementia and guidance will be offered as to how to stimulate and occupy them. Discussion is taking place with staff about the wearing of uniforms and these may be dispensed with, in accordance with best practice for those living with dementia.” During this inspection we saw no evidence of a plan to improve the dementia care service following the audit, and no evidence of the improvements that were detailed in the AQAA. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. People who live on the first and second floors of the home know that the staff will care for them with courtesy and kindness. On the ground floor many of the staff do not have the skills and expertise to meet the needs of people with dementia. EVIDENCE: 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.” The AQAA reported that in the last year clinical audit tools of pressure ulcers and falls have been implemented. The acting manager 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. The Occupational Therapist has run a breakfast club to enable service users to improve their level of independence, and the Physiotherapist has held weekly one hour exercise classes for service users who are grouped according to their ability. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 12 In the last inspection report we made two requirements, one that care plans must provide good information on all of each person’s needs, and record what is being done properly; the other that medication must be audited effectively, so that there is no risk of people being given medication that is not correct for them. Both of these requirements have been repeated following this inspection. The care plans that we saw on the first and second floors have improved. We saw good monitoring and recording of pressure care. But in two of the care plans we looked at the monitoring of food and drink for people who had lost weight was not recorded properly. One person had lost 6kg in one month, but the nutrition assessment (MUST) did not take this into account, and there was no care plan for monitoring their nutrition. In the other care plan, the daily records showed that over a two week period the person was refusing meals and eating very little. But there was no further MUST assessment. On the ground floor, in the dementia unit, the records for people at risk of poor nutrition did not show the amount they ate at each meal, just a list of the foods. For example, “porridge 1 bowl, 1 beaker tea, lunch puree”. This is the second time that the AQAA has reported that regular medication audits take place. We saw no evidence of this. In May 2008 the home notified the Commission that due to an error on the prescription, staff had not noticed a change in the amount of a controlled drug that was prescribed for one person. The notification stated that the two staff involved were interviewed and had further training. However when we mad a spot check of medication during the inspection we found further errors that had not been noticed. One person had a prescription for 2 tablets of one medicine to be given at night. The number of tablets remaining did not tally with what was recorded as administered as there were four more tablets than there should have been. This indicates that either only one tablet was administered on four occasions, instead of two, or that on two occasions no medication was administered, although it was signed for. We saw similar discrepancies in three other spot checks. One person has paracetamol prescribed when required (PRN), but there is no record of the reason why it was required when it has been given, and no record of whether 1 or 2 tablets were given. The people who we spoke to on the first and second floors were very pleased with the nursing care and personal care they receive. One person said that the care is very good, and the staff do everything they can when they ask for help. This person did not want a cup of tea during the afternoon, and one of the care staff happily made them some Horlicks instead. A visiting relative said that the staff are always available when they are needed, and they are always cheerful and willing to help. The home has a physiotherapy gym, and an occupational therapy kitchen, so that people who stay for intermediate care can have good therapy treatment to prepare them to return home. The home employs a physiotherapist, occupational therapist, and two therapy assistants. We saw evidence that people who are admitted with pressure sores have improved due to good nursing and wound care. There are appropriate procedures for treating and preventing the spread of infections. However there Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 13 is one resident who does not speak English. One member of staff speaks their language, but there is no guidance in their care plan for other staff on how to communicate with them. A relative visits every day, and the staff rely on the relative to assist the person with their particular needs. The relative said that on some occasions the resident will phone them to say that they want to go to the toilet because they cannot communicate effectively with the staff. Guidelines are needed to enable this resident to communicate more effectively with the staff. This could include better timetabling of their personal care, or the use of simple sign language or pictures so that staff can ask them about their needs. We spent some time sitting with people on the ground floor 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. In one lounge the staff engaged with the people who were sitting there, and for most of the time people appeared to be alert and interested. We observed some good practice, when staff spoke to people and assisted them sensitively. One person seemed distressed, and a member of staff spent time comforting them. One person was encouraged to fold napkins at lunchtime. However we also observed some very poor practice. One person observed seemed to be asleep, and a member of staff adjusted the chair so that the person was in a sitting position, they did not speak to them, and poured tea into their mouth while they seemed still to be asleep. The person gave no indication that they were aware of what was going on. Another person asked for a banana, the member of staff gave this to them then walked away while the person was still talking to them. Staff came into the lounge while we were there, and ignored most of residents there. One member of staff put slippers on one person’s feet with no communication, and the person ‘jumped’ as they did not know what was happening. We saw another person who tried to speak to a member of staff, and was ignored. This person said, “It’s a long morning.” Later this person appeared distressed, and said that they wanted to go home. A member of staff appeared to want to give comfort, but did not know what to do. All the people who we observed were either distressed or withdrawn during the time we observed them. We heard continual sounds of distress from someone who was not in the room. When we walked around the unit we saw one person crying in their room, saying, “It’s a terrible day.” We heard a call bell ring for eight minutes before it was answered, and we saw staff watching TV in one of the lounges during this time. Several people walked around the corridors. The staff brought one back to the lounge, who then said that they wanted to go again. Staff did not talk to another person who was walking in the corridors. There is nothing in the lounge or in the corridors for people to connect with and to give them purpose when they walk around (see Environment). The table napkins (see above) were the only occupation available for people in one lounge, and colouring books and crayons in the other (see Daily Life and Social Activity). The television was on throughout the morning in one lounge, but no-one appeared to be watching it. The tables were prepared for lunch, and protective aprons were put on several people, half an hour before the food trolley arrived. One Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 14 person was given a lunch of mashed potatoes and custard. They were not asked what they wanted, and the food was not described or explained to them. Another person said that they didn’t want potatoes, and the member of staff told them that they weren’t potatoes. This person also asked for salt and was ignored. There was no salt available on the table. There is a separate dementia unit with four beds on the first floor. The care in the small unit is better than on the ground floor. One visitor said that it is quieter there, and their relative is well cared for. “I cannot fault them. I would come here if I needed care.” It was reported that the staff on the dementia unit have a three day training in dementia care. One pf the staff has been completing this, and said that it comprises of workbooks that they complete and then discuss. However the poor practice that we observed means either that many of the staff had not had this training, or that the training is not effective in providing them with the information that they need to fully understand how to meet the needs of people with dementia. The 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.” We looked at a sample of care plans on each floor. The recording in care plans on the first and second floors has improved (see above), but the care plans that we saw on the ground floor dementia unit were very poor. They do not contain appropriate information on how to care for people or how to recognise their needs. The care plan for personal care is a tick list of tasks. The care plan for dementia contains no clear guidelines on how to recognise and meet each person’s individual needs. None of the care plans that we saw in the home are written in a person centred way, which puts each person at the centre of their care and involves them in decisions about the care that they receive. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 15 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a range of activities to suit the needs of most of the residents, but the quality of life is limited for people with dementia due to the shortage of time spent on providing each person’s choice of activities. EVIDENCE: The home employs two activities co-ordinators. We did not meet them on this occasion, but when we visited the home last year we found that, “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.” The Annual Quality Assurance Assessment (AQAA) stated, “Our two activity co-ordinators provide a wide range of entertainment both in-house and locally, including cooking/baking sessions, gardening, bingo, quizzes, days out, weekly sing songs with an external keyboard player, garden parties and our exceptionally popular fish and chips club. We maintain close links with the local community, regularly taking our service users to attend concerts at the local Church, and at Christmas, local school children visit the centre to sing carols and have drinks and biscuits with our service users. We also take service users to various theatres and pantomimes within the local community.” Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 16 The care plans on the first and second floors include a record of the activities that each person took part in. Of those that we saw, one stated that the person chooses to stay in their room, and another showed no activities, although the care plan stated that this person likes bingo. A third had a full record, including activities such as the seated exercise group that they attended but did not take part in. this person’s care plan stated that they like bingo and quizzes, and in their review meeting they said that they were bored. A visiting relative told us that this person had done some flower arranging and attended a barbeque in the garden during the summer, and had been on an outing in the mini bus. We saw a notice in one lounge of celebrations for Halloween and Divali, and a visiting musician. It is clear that activities take place on the first and second floors, but we suggest that more could be done to address each person’s individual interests. We saw very little appropriate interaction and stimulation on the ground floor dementia unit (see Health and Personal Care). In one lounge colouring books were available, but in another there was no stimulus apart from the television. There were no interesting objects available in the unit for people to pick up and make use of as they wished. We were informed that a third activities coordinator has been employed who has a diploma in dementia care, and she will start when her pre-employment checks have been completed. We anticipate that this will improve the quality of life for people in the dementia unit. However all the staff should be involved in one to one activities and interactions with people, not just the activity co-ordinator. The nursing and care staff who currently work in the dementia unit either do not have the training to understand how to interact with people in a positive way, or the facilities are not available to enable them to do so. We observed lunch in two lounges on the dementia unit. In one we saw the staff assisting people with sensitivity and talking to them about the food. In the other, some people were given food they did not want, with no communication (see Health and Personal Care). There were no drinks available during lunch in this lounge. On the other floors the people who we spoke to said that the food is good. A complaint was made to the home following a review by Social Services, that one person’s cultural dietary needs were not being met, and their family provided appropriate food. This person’s care plan states, “Likes ethnic food, home and family supply.” We spoke to this person and their relative during the inspection. The relative feels that the situation has improved, and some meals, such as beans on toast, are provided that the person likes to eat. Westgate House Care Centre DS0000066188.V373253.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 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: The home has a satisfactory complaints procedure in place, which is given to everyone in the Residents’ Guide. The Annual Quality Assurance Assessment (AQAA) stated that five complaints have been made to the home in the last twelve months, of which none have been upheld. Several visiting relatives said that they are able to raise any concerns that they have and they are addressed immediately. The home has comprehensive procedures for prevention of abuse. Training in safeguarding vulnerable adults has been provided for all the staff, and the staff who we spoke to were aware of their responsibilities for whistle blowing. There have been two safeguarding investigations since the last inspection. Appropriate actions were taken as a result, including disciplinary actions. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained and provides a safe and comfortable environment for the people who live there. 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 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 Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 19 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. On this occasion we saw people walking around in the dementia unit who appeared to be disoriented and to have no purpose. There is nothing in the lounge or in the corridors for people to connect with and to give them purpose when they walk around (see Daily Life and Social Activities). 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. There is a full time maintenance man, who is also responsible for health and safety and fire precautions in the home. More housekeeping staff have been employed, and the home appeared to be generally clean. There are appropriate procedures for the control of hygiene and for effective management of laundry. The carpets in the corridors have been that were stained and worn have been replaced. New bed linen and towels have been provided in the home, and on this occasion we did not see any that were excessively worn. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 20 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. The people who live in the home are supported by a stable staff team. However some people work excessive hours, and this may affect the quality of their work and leave the people who live in the home at risk. 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. The care staff and nursing staff work either 6 hour or 12 hour shifts. No agency staff have worked in the home in the last three months. This means that there is a stable staff team. However some people work excessive amounts of overtime on a regular basis. One nurse had worked 60 hours the previous week and was scheduled on the rota to work 60 hours every week. One care assistant had worked 66 hours the previous week, and was scheduled to work 66 hours during the current week and the next two weeks. These long hours are contrary to the Working Time Directive, which safeguards staff from the risk of losing concentration by working too long. The exceptionally long hours worked in Westgate House means that staff may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 21 More housekeeping staff have been employed, and it was reported that this has improved the standards of cleanliness in the home. Most of the staff who we spoke to were positive about their work in the home, and said that morale has improved among the staff team. 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. It was reported that the staff on the dementia unit have a three day training in dementia care. One of the staff who has been completing this told us that it comprises of workbooks that they complete and then discuss. However the poor practice that we observed means either that many of the staff had not had this training, or that the training is not effective in providing them with the information that they need to fully understand how to meet the needs of people with dementia. (See health and Personal Care.) Two thirds of the care staff have completed NVQ level 2 in care or are working towards it. Three 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.V373253.R01.S.doc Version 5.2 Page 22 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. The current 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: Westgate House has not had a registered manager for eighteen months. Since the last registered manager left, three managers have been appointed, but have left before they were registered with CSCI. The current manager took up her post in November 2007. She left in April 2008, and we were informed that a new manager was starting in August 2008. When we arrived at the home for this inspection, we found that the previous manager had returned, and we were informed that the appointed manager had not taken up the post. The Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 23 current manager returned to the home in September 2008, a month before this inspection. Although she was away from the home for six months, we were surprised that she was not fully aware of the problems that we found in the dementia unit. We asked for information, including current policies and procedures, which she was not able to find. However all the staff who we spoke to were pleased that she has returned to the home, and said that she manages the home well and is always available for them and supportive to them. We saw records that showed that everyone has regular one to one supervision, where they discuss their work and any training and development needs. The deputy manager, who was also manager of the dementia unit, has left and a new manager has been appointed to the dementia unit. Two new unit managers have also been appointed for the first and second floors. This new management structure should provide a stable and competent team to manage the different aspects of the home, and improve the management practice in the home. The situation when we visited the home was that there was some improvement in practices on the first and second floors, but we observed some very poor practice and lack of good management on the ground floor dementia unit. The Annual Quality Assurance Assessment (AQAA) stated that the home has a good system for quality assurance that includes questionnaires and relatives’ forums. 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. There has been no change in the arrangements for management of residents’ money. 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 follow the home’s policies and procedures. Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 24 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 X X 3 1 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 2 X 3 X 3 X X 3 Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 25 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 OP4 Regulation 12(1) Requirement The registered person must ensure that the home provides specific facilities for dementia care. This includes training for the staff in understanding dementia, provision of a sympathetic environment, and interactions and activities specific for people with dementia. This will ensure that people with dementia have their needs met and have a positive and fulfilling experience in the home. There is little indication of the involvement of each person in setting up and reviewing their care plan in accordance with the principles and practice of person centred planning. Measures must be put in place to ensure that residents are involved in decisions about their care, and that these are recorded appropriately. Timescale for action 28/02/09 2. OP7 12(2) & (3) 28/02/09 Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 26 3. OP7 15 4. OP8 12(1)(a) 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. The previous timescale of 31/05/08 was met in part. Appropriate actions must be taken following a recording of abnormal weight change, and the actions and results must be recorded in the care plan. Food and fluid intake for people at risk of poor nutrition must be recorded accurately. Poor nutrition is an indicator of poor health, and promotion of good nutrition encourages improved health. 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. An effective audit safeguards the people in the home from the risks of being given the wrong dosage of medication. The previous timescale of 31/05/08 was not met. The registered person must ensure that the care staff understand the need to treat residents with respect at all times. This includes responding to their needs and communicating with them effectively. 28/12/08 28/02/09 5. OP9 13(2) 28/12/08 6. OP10 12 28/12/08 Westgate House Care Centre DS0000066188.V373253.R01.S.doc Version 5.2 Page 27 7. OP12 16(2)(n) Meaningful activities need to be developed for people with dementia that meet each person’s individual needs. 28/02/09 8. OP27 18(1)(a) This will ensure that people have a positive experience and stimulation and social interactions throughout the day. The staffing rotas show that 28/02/09 some staff work very long hours. People who work excessively long hours may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. The management structure in the home must be 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. 9. OP31 9(2)(b) 28/02/09 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.V373253.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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.V373253.R01.S.doc Version 5.2 Page 29 - 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!