Inspection on 04/05/06 for Westgate House Care Centre

This inspection was carried out on 4th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 21/11/07

Westgate House Care Centre 12/03/07

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 Angela Dalton Unannounced Inspection 4th May 2006 10:25 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.V293708.R01.S.doc Version 5.1 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.V293708.R01.S.doc Version 5.1 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 Westgate Healthcare Limited Janet Susan Arberry Care Home 109 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (109), of places Physical disability (75) Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection First Site Visit Brief Description of the Service: Westgate House was registered in January 2006 and is situated near Ware town centre. It caters for the needs of 109 older people – 35 beds are dedicated to dementia care, 20 beds accommodate service users who require intermediate care and 54 beds are for service users who require nursing care. Each floor is equipped with an activities room as well as small lounge areas. The laundry and kitchen are sited away from service users’ bedrooms. Staff accommodation is situated on the second floor and is not accessible to service users. Throughout the home there are kitchen diners where there are facilities for service users and visitors to prepare refreshments. The home has a large enclosed garden with raised flowerbeds to provide the opportunity for wheelchair users to participate in gardening. A large quadrant area is in the centre of the home which is used as a patio area. Closed Circuit Television is in situ and is discreetly positioned over the main entrances to the home. A number of rooms have a patio area outside and it is hoped that service users will personalize this area. The home is registered with a local G.P. Surgery and has identified other professionals who are able to visit the home e.g. chiropodist, dentist, optician etc. Where possible local service users will be encouraged to maintain links with existing surgeries. Specialist equipment is in place and more can be accessed via the district nurse or purchased where necessary. The home has assisted baths and showers with floor level shower trays to facilitate shower chairs where required. They are on all floors. A loop system for those with hearing impairments is in place in communal areas. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Six Inspectors conducted this unannounced site visit on 4th May 2006. This is the home’s first inspection and the high number of Inspectors was in recognition of the diversity and size of the home. A high number of beds are funded by Social Services and the Primary Care Trust but a number of privately funded beds are available. The weekly fees for (private) nursing beds range between £700 and £800 and for (private) dementia care range between £750 and £850. This was a positive first inspection and although some requirements have been made it is in recognition that they will assist the home in progressing. The atmosphere in the home was calm and friendly. The environment was clean, bright and odour free. As the building is new staff are endeavouring to make the environment homely and some service users have achieved this by personalising their rooms. Service users appeared well groomed and spoke highly of the care they received. What the service does well: What has improved since the last inspection? As this was the home’s first inspection this area is not applicable. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 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. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 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.V293708.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Service users are provided with adequate information about the home and service that they will receive. The format of documentation should be tailor to the needs of older people. Quality outcome in this are is good to adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose is available in the reception area of the home and the manager welcomed the suggestion to display it more prominently. This will occur on the completion of brochures being printed, which will include information about the home, and a copy of the service users’ guide. This is being developed to avoid jargon and unnecessary information. Each service user has a contract in place and is invited by letter to visit the home. Following the end of the assessment period a review is held and the service user or their family member will be written to informing them of a permanent place. It is recommended that the assessments fully explain the reasons why any service users’ needs cannot be met by the home to furnish the referral body with this information. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 9 Although the standard relating to Intermediate Care has been met the Inspector visiting this provision made some suggestions. The care plans could be streamlined to ensure that they were more efficient and appropriate for the length of time service users spend in the home (8 weeks). Staff should be encouraged to focus upon supporting people to return back home rather than ensuring they are able to complete a task without help (e.g. making a cup of tea) and then providing assistance. The manager recognised that further training and development is required and will ensure this occurs. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Privacy could be better observed in relation to telephone use. A safe medication system was in use but the lack of risk assessments may compromise service user’ wellbeing. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are in place for each service user and detail their individual requirements. Some further work is required to ensure that risks are fully assessed e.g. use of bedrails, recliner chairs and risk of choking. More expansive recording of nutritional and fluid intake is suggested to support the positive progress that has taken place regarding weight gain and an improvement in service users’ health. Staff are adjusting to the new medication system (most are used to a hospital system) and although no concerns were identified staff may benefit from some practical training to increase their confidence. Bedrooms have blinds fitted to ensure that personal care occurs in private (if blinds are open rooms are overlooked by those opposite). Service users Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 11 confirmed that privacy is observed. A requirement has been made to ensure all service users can access a telephone easily and talk in private. A charge is made for telephone provision and not all service users have chosen to access this facility but no suitable alternative is available. Care plans contain personal preferences and choices regarding funeral wishes. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Mealtimes should be focussed upon the needs of the service users rather than the requirements of the home. Some service users’ choice and freedom is restricted. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Two activities co-ordinators are employed and a timetable of activities is on display throughout various points in the home. The manager is currently exploring how to ensure service users are aware of activities within the local community and how to facilitate participation. Staff were observed to ensure service users were provided with choice. Items that service users requested were provided and a service user who sat outside and requested to sit inside and then return outside was assisted to do so with the minimum of fuss and without any negative remark. Staff were unaware of the Inspector’s observation. Concerns were raised regarding the ground floor. Service users with dementia do not have access away from this floor and staff have key fobs to activate the doors. The manager agreed to explore a more appropriate option and a requirement has been made regarding restraint. Lunch was hot and tasty but gravy was poured over lunch (including quiche) without choice first being offered to service users. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 13 The proprietor will ensure that small jugs are purchased to enable gravy and sauces to be served at the table. Service users commented that they were asked to make meal choices a day before and felt that this could be improved. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Procedures are in place to protect service users and facilitate concerns being raised. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff have attended training regarding the Adult Protection procedure and had an awareness of the Whistleblowing procedure. The home does not deal with service users’ finances. A complaints policy is in place and incorporated into the Statement of Purpose. Relatives whom the Inspectors spoke with did not have an awareness of the policy but felt comfortable in reporting any concerns they may have to staff. The manager plans to ensure that service users and their family or friends have an understanding of the complaints policy. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The home is well maintained but the shower provision is to be reviewed. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is newly built and as such is in good condition. All required furniture and furnishings are in place. Garden furniture is on order and will be well received with the arrival of the warmer weather. The first floor is shared by service users who are receiving intermediate and nursing care. The shower provision is away from those service users in receipt of intermediate care and they have to walk along the corridor to another bathroom. Although the required ratio of bathrooms is in place the facility should be reviewed and rails fitted in the existing shower. The proprietor agreed to review the situation and liaise with the manager. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The home has a thorough recruitment procedure and a training programme is in place. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels were reflective of the needs of the service users and as the capacity of the home increases the staffing will rise accordingly. Personnel files were inspected and all required documentation was in place. All staff are subject to a Criminal Bureau check and this was in place. A training programme is in place and mandatory training is taking place in a ‘rolling programme’ to ensure all staff attend. It was identified by a service user that because of the similarity in colour between carer and nurse uniforms it was difficult to identify who the most appropriate person to speak to was. This often resulted in a carer being given information and then the service user having to repeat it to a nurse other carer not passing the information on. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 The home benefits from a strong management team. Poor health and safety is currently observed. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users, staff and visitors spoke highly of the manager. She was reported to be straight talking and approachable. As stated earlier some work needs to occur to ensure the shift in focus from health care to social care. Views from service users and relatives have been sought in a recent forum and an audit to assess quality will take place once the home has settled. Supervision of staff occurs informally and the manager has an action plan to introduce formal supervision. A requirement has been made to ensure the health and safety of service users and staff. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 18 Door wedges must not be used and a safe and suitable alternative approved by the Fire & Rescue Service used. Window restrictors must not be detached (as is currently occurring). Clinical waste must be appropriately stored as bags are currently open and hanging on laundry trollies. Closed pedal bins must be in place for clinical waste. Poor moving and handling was observe in one area of the home and this must be addressed. The home was excessively hot (with a temperature of 24ºC outside forecast) in areas where air conditioning is not provided. At 11.30am it was 27ºC in one communal lounge. The heat rose and became more uncomfortable. Remedial measures must be taken to ensure comfortable living and working conditions. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 19 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 2 3 2 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 1 Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? N/A 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 2 Standard OP8 OP10 Regulation 12 & 13 12(4)(a) Requirement Timescale for action 31/05/06 3 4 OP14 OP38 13(8) 13 Risk assessments must ensure that identified risks are monitored and managed. Service users must be able to 31/05/06 make and receive telephone calls in a private and easily accessible manner. Environmental restraint must not 31/05/06 occur in respect of service users with dementia. The health and safety of service 05/05/06 users and staff must be ensured. Door wedges must not be used and a safe and suitable alternative approved by the fire department used. Window restrictors must not be removed. Clinical waste must be appropriately stored and closed pedal bins must be in place. Poor moving and handling must be addressed. Remedial measures must be taken to control the air temperature to ensure comfortable living and working conditions. Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 OP3 Refer to Standard OP1 Good Practice Recommendations The Service Users’ Guide should be in a format that can be easily understood. It is recommended that the assessments fully explain the reasons why any service users’ needs cannot be met by the home to furnish the referral body with this information. Sauces to accompany meals should be served at the table in small jugs. Napkins should be used to replace aprons worn by service users to ensure dignity is observed. Menus should be available to reflect choices available and individual requests recorded on the same day meals are served. Convenient shower provision should be available to service users. 3 OP15 4 OP21 Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westgate House Care Centre DS0000066188.V293708.R01.S.doc Version 5.1 Page 23 - 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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