Inspection on 28/11/05 for Westgate House Nursing Home

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Westgate House Nursing Home 09/05/08

Westgate House Nursing Home 12/09/06

Westgate House Nursing Home 30/06/05

Westgate House Nursing Home 01/11/04

Westgate House Nursing Home 05/04/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOMES FOR OLDER PEOPLE Westgate House Nursing Home Eastcote Road Gayton Northants NN7 3HQ Lead Inspector Mrs Linda Preen Unannounced Inspection 28th November 2005 10:00 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 Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 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 Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Westgate House Nursing Home Address Eastcote Road Gayton Northants NN7 3HQ 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) (01604) 859355 (01604) 858074 Mr James Byrom Mrs Patricia Byrom Mr James Byrom Care Home 40 Category(ies) of Dementia (40), Dementia - over 65 years of age registration, with number (40), Mental disorder, excluding learning of places disability or dementia (40), Mental Disorder, excluding learning disability or dementia - over 65 years of age (40), Terminally ill over 65 years of age (40) Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range for service users in the category MD is 40 years and above. Date of last inspection 30th June 2005 Brief Description of the Service: Westgate House is a large nursing home situated on the outskirts of the village of Gayton near Northampton. The home provides nursing and personal care for up to forty-one residents within the categories of Dementia, Mental disorder and Terminal Illness. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two hours were spent prior to the inspection reviewing previous requirements and recommendations, comments from relatives and collating notifications provided by the service. The inspection took place over a period of three hours as part of the statutory inspection programme. Two residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them and their relatives and also to the staff concerning the care received. In addition to this staff rotas and medication records were seen. 2 comment cards had been received from relatives. One of these commented on the inability of residents to reach their call bells from their beds in shared rooms. This was checked and found to be the case but staff spoken to assured the inspector that these call bells were used by staff only and that residents in these rooms were unable to use a call bell unaided owing to their mental condition and physical frailty. Two relatives spoken to during the inspection stated that they were satisfied with the care on the whole, but one of them stated that he is offered a meal at the home every day and the standard of food is good particularly at the weekend. What the service does well: What has improved since the last inspection? Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 6 The complaints procedure has been updated to include the address of the Commission for Social Care Inspection and is on display at the entrance to the home. Some bedrooms have been refurbished and redecorated. 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 Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 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 Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 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 and 3 Thorough assessments and Terms and Conditions ensure that residents are confident that their needs may be met in the home. EVIDENCE: Comprehensive assessments to include physical, mental and social aspects were available for the residents chosen to monitor. Copies of Terms and Conditions of residence were seen on these files. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 9 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 and 9 Staff do not always have the information required to ensure that all resident needs are met. Residents are treated with dignity and respect, but their right to privacy is not maintained. Systems in place for the control of medication do not meet with current good practice guidelines. EVIDENCE: Care plans do not contain up to date information to guide staff concerning resident’s needs in some cases. For example, one lady tracked had very good plans in place for her night care and dementia but although she was reported as having a pressure sore and was being rested in bed to relieve this, there was no up to date care plan in place for this need. Her assessment records that she is nursed on a pressure relieving mattress and the care plan that she had a pressure ulcer with the size and grade of this on the 25th June 2005. There is no further entry or guidance for staff on the care of this ulcer or its progress or dressing type used. An entry in her daily record for the 26th November records that the wound on her bottom is getting bigger and on the 27th November that it is getting bigger and looking bad. There is no evidence that advice has been sought from the General Practitioner or Tissue viability nurse concerning this Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 10 wound or adequate record of its size, grade or treatment plan. Care staff spoken to confirmed that she is being nursed in her bed between meals in order to reduce the pressure on the affected area. In discussion, it was ascertained that the current pressure ulcer was a new ulcer and that the old one had been healed. There was no evidence of this in the care plan to inform the reader, giving the impression that this was the same wound. Her care plan for skin care states that she is at high risk of pressure ulcers and that her Waterlow risk assessment had increased from 23-27. It states that “intervention 1-6 continues” but intervention 5 says that “Waterlow should be reviewed every week” Despite this entry having been made on the 27th June, and her development of a new ulcer, there is no further assessment of Waterlow score recorded. Staff were observed to be treating the residents in a respectful manner with due regard to their dignity, but toilet facility still do not have a privacy lock fitted. The Providers have stated that this is for reasons of staff safety who may have to summon aid in an emergency. Advice was given that some indication that the room is in use, for example an engaged sign, should be provided in order that the resident’s privacy is maintained. Systems for the ordering, recording, administration and disposal of medication were found to be satisfactory with the exception of the recording of controlled dugs. These records demonstrated that administration of these was not being witnessed by a second person as required. The Registered Provider/manager arranged for staff to have training in this aspect at the time of the inspection. Requirements have been made concerning these areas. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 11 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): 13 Residents are encouraged to maintain contact with the Community and family and friends are encouraged to visit. EVIDENCE: A group of residents visit the local public house once a week. The Occupational Therapist employed by the home took one of the residents out to buy craft materials during the inspection. Several visitors were in the home and two spoken to confirmed that they visited most days and one stated that he is able to share a meal with his wife if he wishes. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 12 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): These standards were not assessed on this occasion. EVIDENCE: Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 13 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, 22, 24 and 26 The environment is not maintained in a way in which to promote a homely place in which to live, although all areas seen were clean and tidy. Resident safety is not always promoted in the home. EVIDENCE: A limited tour of the environment was undertaken. All areas of the home seen were clean and tidy, and communal areas were decorated and furnished in a homely manner. However some resident’s rooms were in need of redecorating with missing tiles, uncovered light bulbs and furniture in a bad state of repair. One room had a hole in the wall above the bed where a TV socket had been broken. The Registered Provider stated that there are plans to refurbish some rooms in the new year. Requirements have been made concerning this. A chain type lock was found high up on the outside of one residents room door. This has the potential for the resident concerned to become locked in his room either accidentally or intentionally which is a breach of his rights and a danger in case of fire. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 14 An immediate requirement was made in this respect. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 15 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, 29 and 30 Staff are provided with training and are in sufficient numbers to meet the needs of the residents. The homes recruitment policies do not protect residents from possible abuse. EVIDENCE: The home has a commitment to staff training and employs a training manager to organise this. Four staff members are currently working towards the Registered Manager’s Award. The National Vocational Qualification assessor was in the home during the inspection. Three Registered nurses and seven carers were on duty at the time of the inspection to care for 40 residents. Residents seen appeared clean and well groomed and those still in bed looked comfortable. In addition to carers, cleaning and laundry staff as well as kitchen staff are employed. A selection of staff files was seen. These demonstrated that Criminal Records Bureau checks have been carried out on British staff but not on overseas staff. In discussion, the Registered Provider stated that as the police in their own country cleared these staff members, he had not thought it necessary to obtain clearance here. This is necessary, as the member of staff may have visited the country on a previous occasion and gained a Criminal Record at that time. A Requirement was made in this respect. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 16 Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 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): 38 The safety and welfare of residents is not always protected in the home. EVIDENCE: As stated under standard 24 above, one resident had a lock on the outside of his door and the poorly maintained furniture and walls with broken tiles and the exposed TV socket could present a danger to the residents. Some radiators were not covered, nor were they of the low surface temperature type, potentially putting residents at risk of burning if they have prolonged contact with them. Some of these radiators were close to resident’s beds. In discussion, the Registered Provider confirmed that risk assessments were not available for these radiators, but that they were currently in the process of being covered. A Requirement was made concerning this. Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X 2 2 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Westgate House Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 19 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 OP7 Regulation 15(2) b Requirement Care Plans must be reviewed to ensure that information is up to date, accurate and personalised to the individual concerned. (Previous timescale of 1/8/05 not met) Residents identified as at risk of developing pressure ulcers, must have care plans in place to instruct staff how to minimise that risk. Evidence must be available of the size and grade of any pressure ulcer, which may develop in order that progress may be monitored. Timescale for action 01/01/06 2 OP7 15(1) 01/01/06 3 OP8 15(1) 01/01/06 4 OP8 13(1) b 5 OP9 13(2) Evidence must be sent to the Commission for Social Care Inspection that any resident who has developed a pressure ulcer has been referred to the appropriate professional for advice. Signed evidence must be available that two members of staff witness all administration of Controlled Medication. DS0000012656.V264856.R04.S.doc 01/01/06 01/01/06 Westgate House Nursing Home Version 5.0 Page 20 6 OP10 12(4) a 7 OP19 16(2) c 8 OP38OP24 13(6)&(7) 9 OP29 19(1) b 10 OP38 13(4) a The provision of locks on communal bathrooms must be reviewed to ensure the privacy and dignity of the residents is maintained. A programme of refurbishment and maintenance of resident’s rooms must be submitted to the Commission for Social Care Inspection. The chain type lock at the top of the identified residents room door must be removed to prevent him becoming locked in his room. (An immediate requirement was left in this respect) Evidence must be available that all staff including overseas staff have been checked with the Criminal Records Bureau. Risk assessments for uncovered radiators must be available until the covering of these is completed, in order to minimise the risk to residents. 01/01/06 01/01/06 28/11/05 01/01/06 01/01/06 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 Nursing Home DS0000012656.V264856.R04.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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. 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