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Inspection on 30/06/05 for Westgate House Nursing Home

Also see our care home review for Westgate House Nursing Home for more information

This inspection was carried out on 30th June 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents were well groomed and appeared well cared for. Relatives comment cards stated that they were happy with the care and attention provided. Staff were observed to be friendly and respectful to the residents in their care, and dealt with potentially difficult situations in a professional way with respect for resident`s dignity. The home provides staff with ongoing training to make sure that residents differing needs may be met, and employs an internal auditor to monitor standards in the home on a regular basis.

What has improved since the last inspection?

An ongoing process of decoration and refurbishment is in place to provide residents with improved facilities in which to live.

What the care home could do better:

Resident care plans are not personalised or in sufficient detail to allow carers to meet their needs. Some care plans contain conflicting information and need to be updated to ensure current needs are recorded. The home was required to update these documents. Two residents had unsuitable locks on their doors, which had the potential for them to be locked in. Advice was given that these must be changed for more suitable locks. Privacy locks were not provided on communal bathroom doors. A discussion took place in which the registered provider stated that this was for reasons of staff safety, with unstable residents. The home was required to find alternative ways of maintaining resident privacy.

CARE HOMES FOR OLDER PEOPLE Westgate Eastcote Road Gayton Northants NN73HQ Lead Inspector Linda Preen Unannounced Thurday, 30th June 2005 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 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 C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Westgate Address Eastcote Road Gayton Northants NN7 3HQ 01604 859 355 01604 858 674 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr James Byrom Mr James Byrom Care Home 41 Category(ies) of DE(E) Dementia - Over 65 (41) registration, with number MD (E) Mental Disorder - Over 65 (41) of places TI (E) Terminally Ill - 41 Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Age range for service users in the category MD is 40 years and above Date of last inspection 1/11/04 Brief Description of the Service: Westgate House is a large nursing home situated in the outskirts of the village of Gayton near to Northampton.The home provides nursing and personal care for up to fortyone Service Users within the categories of Dementia, Mental Disorder and Terminal Illness. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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, and comments from relatives. The inspection took place over a period of two and a half 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 and talking to the staff concerning the care received. It was not possible to talk to the residents owing to their mental conditions. In addition to this staff training records and fire records were seen. 3 comment cards had been received from relatives. Relative comment cards all recorded satisfaction with the care provided, but two out of the three were unaware of the complaints procedure in the home. This was brought to the attention of the Registered Provider, who was asked to ensure that this information was easily accessed. Requirements and recommendations made at the previous inspection were monitored. What the service does well: What has improved since the last inspection? Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 6 An ongoing process of decoration and refurbishment is in place to provide residents with improved facilities in which to live. 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 C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 standard(s) 3 and 4 Residents may be assured that their needs may be met in the home. EVIDENCE: Case notes seen demonstrated that comprehensive assessments are undertaken prior to admission in order to ensure that resident’s needs may be met in the home. These assessments involve other health professionals as well as informal carers. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 standard(s) 7, 8, and 10 Resident care plans are not in sufficient detail to guide staff in the care required. Residents are treated with respect and with due regard to their privacy. EVIDENCE: Resident plans are formulated following assessment, but these plans are pre-printed and are not personalised to the individual. For example “Promote regular habits” “participate with patient in social and rehabilitative activities “ with no explanation as to what these terms mean or what activities the resident enjoys. One resident who was reported as having behaviour problems at night and who was being nursed on a specialist mattress had no record of this in her care plan. In fact the care plan stated that she slept for 7-8 hours and only needed checking every two hours. This resident also had conflicting evidence of her risk of developing pressure ulcers, with her Waterlow being recorded as 13 in one document and as 19 in another. Staff spoken to confirmed they had received training on caring for Service Users with dementia and mental illness. They were observed to interact well with Service Users and they demonstrated a good level of understanding of the needs of individuals when questioned. One resident said that she had tooth ache and this had been dealt with appropriately. She was seen by the dentist two days before and prescribed antibiotics prior Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 10 to extraction. Staff were dealing with her in a sympathetic manner and offering her pain relief in the interim. A potential conflict between two residents was observed to be dealt with in a sensitive manner and was resolved in a way that preserved the dignity of the residents concerned. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 standard(s) 12, and 13 Social activities provide daily interest for the people living in the home. Residents are involved in the community. EVIDENCE: Several of the more able residents attend “Mind” day centres on Thursday and Friday, and another resident case tracked attends a day centre in Brackley as she enjoyed going there before admission. A Group of residents go out to lunch at a local public house once a week. An Occupational therapist attends three times a week to provide activities and stimulation for those unable to go out. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 Relatives are unaware of the complaints procedure. Residents are protected from abuse in the home. EVIDENCE: Two of the three relative comment cards received stated that they were unaware of the complaints procedure. A complaints procedure is available in the home, but this does not have the address of the Commission for Social Care Inspection included. This was recommended at the last inspection. No complaints have been received since the last inspection. The member of staff interviewed was aware of the types of abuse, which may occur, and of her responsibility to report any actual or suspicions of abuse. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 24 and 25 Residents live in a safe, well-maintained environment, with communal and individual rooms to meet their needs. EVIDENCE: A limited tour of the environment was undertaken. Communal areas were bright and airy with comfortable furnishings. Some rooms have had new carpets fitted since the last inspection and others were planned in the near future. The Registered Provider stated that new hard flooring had been ordered for the smoking lounge to improve safety and to prevent the carpet becoming spoilt by small burn marks. In addition to the communal rooms, a large garden Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 14 is available for residents use. Individual rooms were pleasantly furnished with evidence of personalisation in the form of pictures and ornaments. Two of the residents had unsuitable locks on their doors, which had the potential for residents to be locked in. The registered provider stated that these had been requested by the residents concerned. These were required to be removed and advice was given concerning suitable alternatives. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 The home has a commitment to staff training. EVIDENCE: A training officer is employed three days a week and provides weekly training sessions on a rolling programme to ensure all staff are able to attend. A training matrix was available to demonstrate provision and outstanding training required. This is recorded on a monthly basis. Six care staff currently hold a National Vocational Qualification in care and another six are currently working towards this award. In addition to this, fourteen registered nurses are employed. The staff member interviewed confirmed that she held National Vocation Qualification level 2 and that she had undergone training in the core subjects as well as additional training for the care of residents with a diagnosis of dementia. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 38 The home is managed in a way that protects resident’s health and safety. EVIDENCE: The registered manager has many years experience of working in this field and is a registered nurse in mental health care, holds a social work qualification (CQSW) and has completed an open university managers course. Staff spoken to confirmed that six weekly supervision is provided by the Registered Nurse employed for internal audit. Records of testing of fire alarms and emergency lighting were seen and found to be satisfactory. The Environmental Health Officer had visited in March 2005 and made no requirements. COSSH and Health and Safety information is on display in the home. Resident’s files seen showed evidence of manual handling assessments being undertaken and staff had received training in the correct manual handling techniques. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 17 Staff confirmed that new staff are supernumerary during their induction process. The home provides induction that conforms to Training Organisation for Personal Social Service guidelines. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 x x x 3 3 x STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 x x x x 3 x 3 Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 19 Yes Are there any outstanding requirements from the last inspection? 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 24 Regulation 16(2)c and 13(4) Requirement The registered person must review the provision of door locks to bedrooms, to ensure the provision is stated within the Statement of Purpose and risk assessments carried out to assess individuals capabilities to use a key to their room and put in measures to minimize the risk to Service Users from other Service Users entering their rooms. (Previous timescales of 30/6/04 and 30/12/04 not met The provision of locks on communal bathrooms must be reviewed to ensure the privacy and dignity of the Service Users is maintained.(Previous timescale of 30/12/04 not met ) Care plans must be reviewed to ensure that information is up to date, accurate and personalised to the individual concerned. Timescale for action 1/8/05 2. 10 12(4)(a) 1/8/05 3. 7 15(2)b 1/8/05 4. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 20 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. Refer to Standard 16 Good Practice Recommendations The complaints procedure should be updated to ensure that it contains the address of the Commission for Social Care Inspection and that it is freely available to visitors in the home. Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Westgate C51 C08 S12656 Westgate V234149 300605 Stage 4.doc Version 1.40 Page 22 - 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. 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