Inspection on 09/05/08 for Westgate House Nursing Home

This inspection was carried out on 9th May 2008.

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

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 Nursing Home 12/09/06

Westgate House Nursing Home 28/11/05

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Westgate House Nursing Home Eastcote Road Gayton Northampton Northamptonshire NN7 3HQ Lead Inspector Louise Trainor Unannounced Inspection 9th May 2008 07:20 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.V364169.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 Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westgate House Nursing Home Address Eastcote Road Gayton Northampton Northamptonshire NN7 3HQ (01604) 859355 01604 858074 westgatehouse@aol.com 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) Mr James Byrom Mrs Patricia Byrom Mr James Byrom Care Home 41 Category(ies) of Dementia (41), Dementia - over 65 years of age registration, with number (41), Mental disorder, excluding learning of places disability or dementia (41), Terminally ill over 65 years of age (41) Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No one falling within the category MD (E) may be admitted into the home where there are 40 Service Users of this category already accommodated within the home. No one falling within the category DE(E) may be admitted into the home where there are 40 Service Users of this category already accommodated within the home. No one falling within the category DE may be admitted into the home where there are 41 Service Users of this category already accommodated within the home. No one falling within the category MD may be admitted into the home where there are 41 Service Users of this category already accommodated within the home No one falling within the category TI may be admitted into the home where there are 40 Service Users of this category already accommodated within the home. The age range for the Service Users in the category MD is 40 years and above Bedrooms numbered A50 and C6 may only be used to accommodate Service Users who are fully ambulant. 12th September 2006 2. 3. 4. 5. 6. 7. Date of last inspection 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 forty-one Service Users within the categories of Dementia, Mental Disorder and Terminal Illness. At the time of this inspection, the fees ranged from £546 to £700 according to resident’s assessed needs. Westgate House Nursing Home DS0000012656.V364169.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which require review of the key standards for the provision of a care home for both older people and younger adults, that takes account of service users’ views and information received about the service since the last inspection. Evidence used and judgements made within the main body of the report include information from this visit. This was a Key Inspection, and Regulatory Inspectors Mrs Louise Trainor and Mrs Sally Snelson carried it out on The 9th of May 2008, between the hours of 07:20 and 15:30 hours. The homes’ Registered Provider and Registered Manager was present throughout this visit to assist with any required information. Verbal feedback was given periodically throughout the inspection and at the end of the visit. During the inspection the care of three people who use the service were case tracked. This involved reading their records and comparing what was documented to the care that was provided. Documentation relating to: staff recruitment, training and supervision, complaints and medication administration were also examined. One of the inspectors spent the majority of the visit in the communal areas of the home, talking to staff and residents and observing the care practices that were carried out during this eight-hour inspection. As the inspection coincided with CSCI arranging a thematic probe around safeguarding we asked specific questions to the staff and the manager during the inspection. We would like to thank everyone involved for their support and assistance during this visit to the home. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The service does what is required to satisfy the regulators, and has the right policies and procedures in place, however there is evidence that the pre admission practices are not always consistent or well applied. Care plans had not been written in sufficient detail to ensure that a consistent quality of care would always be delivered. On the whole good medication practices were evident. The home tries to be flexible and attempts to provide a service that is as individual as possible, however, although some residents are given choices, this process could be improved to include those with more severe disabilities. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 7 The Registered Provider told us that not many of the resident were able to speak and could therefore not make choices. This indicated that other methods of offering choices, such as visual choices, were not being considered or addressed. We were concerned that at 13:20 hours, meals that had been plated at 12:15 and put in the hot plate, were still being served. Although this in itself was not a problem, when we probed two of these meals for temperature checks, one was 39 degrees and the other was 43 degrees. These were both below acceptable serving temperatures. The physical environment generally meets the specific needs of the people who live here. There home has a programme for decoration and maintenance however maintenance is reactive rather than proactive. This service recognises the importance of training and delivers a programme that meets the National Minimum Standards. However there are gaps in the recruitment process so that residents and staff may not always be protected. There appeared to be a limited uniform dress code. Care staff were wearing blue polo shirts and could wear any trousers they wished, some had chosen to wear jeans, some of which look rather unprofessional. The staff duty rota, in some cases, had staff member’s first names only. This is a legal document and as such, should be formally completed. The manager is appropriately qualified and experienced to run this home, but lacks knowledge on research based current best practice for people with dementia. 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 Nursing Home DS0000012656.V364169.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 Nursing Home DS0000012656.V364169.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): 1, 3, 4, 5, 6 Quality in this outcome area is adequate. The service does what is required to satisfy the regulators, and has the right policies and procedures in place, however there is evidence that the pre admission practices are not always consistent or well applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home does not display its’ Statement of Purpose, we accept this to be appropriate given the client group that live here. There is however a detailed document for this service, which is held electronically, and is under constant review. This document is issued to anyone who calls or visits the home to make enquiries about placements. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 10 Of the three people whose records we case tracked, only one had a preadmission assessment. The first resident had been admitted as an emergency, and although it was not practicable for the home to carry out a pre admission assessment, this person came with documentation from the local authority. A second person had been at the home for number of years and although the third had an assessment filed, it this was not signed or dated, therefore making it meaningless, however staff that we spoke to did know who had completed this documentation. The home had a registration that allowed them to admit people with diverse and complex needs. The recorded training, qualifications and experience of many of the staff team generally supported these needs. The staffing complement was good (see staffing section of this report) and a Mental Health trained nurse is rostered on duty at all times. The home offers limited day care and respite places to people, and found this particularly useful in supporting the families of those people awaiting a permanent care home vacancy. Westgate House Nursing Home DS0000012656.V364169.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, 10, 11 Quality in this outcome area is adequate. Care plans had not been written in sufficient detail to ensure that a consistent quality of care would always be delivered. On the whole good medication practices were evident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection we looked, in detail, at the care and documentation of three particular people who used the service. We chose one person who had been a fairly recent admission, one who had high care needs, and another at random. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 12 There were care plans in place for all, but they did not cover, in sufficient detail, all the areas of care provided. It was apparent that the staff team provided care that was not documented and passed on instructions ensuring that people received the correct care, but we were unsure that care would be delivered in a consistent way if for any reason the regular staff team were unavailable. For example, personal hygiene plans did not describe in detail how this care was to be delivered. A diabetic plan did not provide enough detail about normal blood sugar ranges, and what staff should do if there was a deviance. Staff told us that they routinely reviewed the care plans every six months and made changes as necessary. However one person who had had an accident and was slightly incapacitated had not had their care plans changed to reflect this. It is set out in standard 7.4 of the National Minimum Standards that care plans and risk assessments must be reviewed at least monthly by staff. The manager told us that they differentiated long-term and short-term care plans, and that most of the people using the service had long –term plans. The standards do not make this differentiation. Since this inspection, the manager has worked hard reviewing different care plan documentation, and is now in the process of introducing a new system to the home. One person had commenced on the Liverpool Care Pathway, which is a care plan to support the care provided in the final days of life. The staff were vigilant in recording in this plan and following its instructions. It was clear that the GP was also involved and would support the care package. Staff kept very detailed daily records about the care delivered. These were all signed, dated and numbered and stored appropriately. The home had a variety of different equipment available including moving and handling equipment and pressure mattresses. During the inspection we observed that equipment was generally being used correctly. However, we were concerned that service users were moved around in wheelchairs that did not have footplates. The manager told us that the physiotherapist had agreed to this, as they believed that the plates could be more of a risk and cause injuries to some residents. We were told by staff that there was documentation to support this in individual’s care files. This was seen in some files, however we believe that staff were moving all people in this way, this was risking injury to themselves, as they were pushing the chair on the back wheels only, even when an individual would not be at risk of injury from the footplates. The morning medication round started at the same time as breakfast. The nurse bought the medication trolley into the dining areas and waited until people had a drink and their breakfast before dispensing medications. However we had to point out to the manager that the trolley was left Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 13 unattended and open when the nurse went to administer the medications. After making this observation a member of staff watched the trolley throughout. The medication round was not hurried, and examination of the medication procedures confirmed that safe processes for administering and storing medications were in place. However we were concerned that medicines that were ‘bulky’, such as lactulose, or ‘thick and easy’, that were prescribed for a number of people, were used in rotation. This meant that all the service users were given doses from Mrs** bottle until that was empty, and then Mr ** bottle was started. This compromised the nurses administering the medication, as they have a duty to give the correct medication to the correct person etc, and this process deviates from the policy. The manager explained that all the residents in this home are registered with the same GP who has agreed this practise. It is planned that in the future the GP will be supplying ‘stock’ bottles that are labelled for all those people it is intended for. However we did not see any documentation to support this during this inspection. This will be followed up at the next inspection. The manager remains in discussion with the GP and local Primary Care Trust (PCT) regarding this matter. Controlled drugs were checked. A controlled drug book was in use and staff were ensuring that two staff documented when a controlled drug was given. Staff would benefit from recording in the front of the controlled drug book, to identify on which page, records of each medication for each individual could be found on, at a glance. We were able to reconcile the medications for the people whose care was tracked. Throughout the inspection we observed staff addressing people living in the home in an appropriate manner and in the way they had chosen, some more formally than others. However it was revealed through one relative’s survey that they felt that these residents are often treated like small children. During the breakfast period, blood sugars were tested, and an insulin injection was given to a diabetic in the dining area. We did not believe that this persons’ privacy and dignity was being fully considered at this time. This matter was addressed immediately, and this process will now take place in private. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 14 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. The home tries to be flexible and attempts to provide a service that is as individual as possible, however, although some residents are given choices, this process could be improved to include those with more severe disabilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the morning of the inspection, three service users went to day centre and two vicars visited the home, one was an individuals’ visitor and the other had come to serve Holy Communion. Staff told us, that is a regular event. Both residents and staff that wished to participate did so. One resident told us. “We go to the pub for lunch on a Tuesday”. They looked forward to this. However many of the people living in the home have a dementia type illness and we saw very limited activities being provided that were suitable or stimulating for them. We were told that an occupational therapist visited four Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 15 times a week to encourage mental and physical activity, unfortunately on the day of this inspection, she was not in attendance, and we did not see any care plans that reflected this social aspect of care. Two complaints that had been received by the home and were viewed during this inspection, both related partially to lack of activities. We received nine completed relatives surveys prior to this inspection, and this was also reflected in some of their comments. One said. “Outside mealtimes and toileting times, inertia reigns.” Another comment was. “The patients are fed and watered – little else is on offer”. Alternatively comments on surveys indicated that people felt that because their loved ones had Dementia, they were unable to make any individual choices or be involved in social activities. This is not the case, as research has progressed, there are many ways in which the ‘state of well being’ can be improved for people with Dementia. During this inspection we saw visitors were welcomed into the home and staff spent time reassuring visitors. The manager told us that he would not expect to admit a person whose relatives had not visited the home in the first instance. Breakfast was served from 8am as people came into the lounge/ diner and were ready for their meal. There were eight care staff in attendance at lunch time, and they supported those that needed help, by sitting with them on a one to one basis, talking to them and making the experience social and unhurried. We noted that independence was encouraged and people were allowed to eat as they wished. For example one person we observed did not use his cutlery but certainly still enjoyed his meal. Another was eating fruit and finger foods while they wandered, rather than sitting at the table. Although the menus are varied, they are not planned on a weekly / monthly basis. The registered provider informed us that the meals were planned around individuals’ choices, and were also sometimes dependant on what was available from their suppliers. One resident told us. “The foods nice here, my favourite is the Chicken Korma that we sometimes have”. On the day of the inspection residents were served a white fish in sauce, with potatoes and vegetables. There was no main meal alternative seen being offered to anyone. The chef told us that if someone did not like what was on the menu they could ask and would be served an alternative. One resident told us. “You only have to ask and you can have what you like”. This was very positive, however the Registered Provider told us that not many of the resident were able to speak and could therefore not make choices. This indicated that other methods of offering choices, such as visual choices, were not being considered or addressed. We were concerned that at 13:20 hours, meals that had been plated at 12:15 and put in the hot plate were still being served. Although this in itself was not Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 16 a problem, when we probed two of these meals for temperature checks, one was 39 degrees and the other was 43 degrees. These were both below acceptable serving temperatures. The manager had mentioned that the fish dish served for lunch “was not a hit”. We wander if this is because it was cold by the time some people were served and ate it? We discussed this matter with the registered provider and the manager, who were going to address this issue immediately. It transpired that the hot holding oven had been switched off at the mains in error. Westgate House Nursing Home DS0000012656.V364169.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, 18 Quality in this outcome area is adequate. This service has a complaints policy on display and easily accessible to residents, however records of complaints, investigations and responses are not always recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the entrance hall to the home. We inspected the complaints file, which this home prefers to call the ‘feedback file’. Since January 2008 there had been two complaints logged in this file. One had been received by e-mail, and the other by letter. Both addressed numerous issues of concern. Lack of activities was common to both complaints. We were able to view one letter of response, which was sent five days after the complaint was received and clearly addressed each issue raised, individually. Unfortunately the other had been responded to by e-mail, and no copy had been filed or kept on record. Regulations dictate that these documents should be kept on record. There was no evidence to suggest any investigation was done relating to any of the matters raised. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 18 As this inspection coincided with CSCI arranging a thematic probe around safeguarding, we asked specific questions to the staff and the manager during the inspection. New staff in this home attend a two-day induction before working with the residents. Safeguarding training is included in this induction programme, and regular refresher and up date sessions are held to ensure that staff are knowledgeable on this subject. In general staff that we spoke to, were able to demonstrate their understanding of what would constitute ‘abuse’ and therefore need to be reported. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 19 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, 20, 21 22, 23, 24, 25, 26 Quality in this outcome area is adequate. The physical environment generally meets the specific needs of the people who live here. There home has a programme for decoration and maintenance however maintenance is reactive rather than proactive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home comprises of eight shared bedrooms and twenty four singles. There are thirteen rooms with en suite facilities. During this inspection we visited many of the bedrooms, and most were decorated and furnished with personal assets and photographs that clearly reflected the life history of the people who lived in them. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 20 One person had an organ in her room, music had been a great part of her life, and she still enjoyed it. Another person’s bedroom boasted a gallery of photographs, and newspaper cuttings, which had been taken and saved over the years, of various celebrities that they had worked with during their career. Someone else had numerous family photographs, and also one of the cottage that they used to live in, this was an ideal way to keep this persons memory active. Generally the home was clean and tidy, with the exception of one particular area, where there was a rather unpleasant odour. We believe this was mainly caused by the carpets in this area, which were badly stained and in need of replacing. The provider told us that these were on the ‘to do list.’ We suggest this happens sooner rather than later to eliminate this smell. We also noted that some of the fixtures and fittings, such as bedroom flooring and headboards on beds were in need of attention or replacement. The communal areas in this home were light and spacious with plenty of room for the residents to wander. However there was little evidence of dementia friendly signage, which may enhance the independence of some residents. There was ample seating of various heights, shapes and sizes to meet with everyone’s taste and needs. However some seating was so low, it is unlikely that many of the residents would be able to get up again once seated in them. We also noted that some of the armchairs and footstools had seen better days, they were observed to be rather old and loosing their stuffing. There are large secure gardens surrounding this home. These are mainly laid to lawn making it a safe for residents to wander without tripping hazards. There was also an arrangement of garden furniture providing seating areas so that residents could sit and enjoy the fresh air. One resident had been a keen golfer, and the home had set up ‘The Wentworth’, which is a small putting green on the lawn. This provides an enjoyable activity for some residents weather permitting. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 21 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, 30 Quality in this outcome area is adequate. This service recognises the importance of training and delivers a programme that meets the National Minimum Standards. However there are gaps in the recruitment process so that residents and staff may not always be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home employs approximately fifty staff in total, and it was impressive to see ten care staff, three of which were qualified nurses, on duty on the day of the inspection. Laundry, housekeeping and kitchen staff were additional. The home retains their staff well, and some have been employed here for many years. We inspected the personal staff files of three recently recruited staff. Two of the three contained application forms, which were not fully completed, and only one reference could be located for one person. Whilst we appreciate that these recruits may be friends or relatives of current staff members, or may have been recruited through an agency, it is important that all appropriate Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 22 information and documentation is formally collected and available for inspection in the home. The three members of staff spoken to all spoke highly about the training and the training opportunities they were given. This home employs a full time training officer, who is an experienced ex nursing sister. She provides a detailed training programme that incorporates a wide range of subjects both mandatory and specialist, ranging from Moving and Handling and Food Hygiene, to Palliative Care, Dementia, Diabetes and Wound Care. Staff are also offered training provided by external trainers in subjects such as Phlebotomy, Speech Therapy and Swallowing and PEG Feeds. We spoke to an overseas student, who was a qualified nurse in her own country and was working and studying to gain a qualification recognised by the Nurses and Midwifery Council (NMC). She advised us that her work permit did not allow for her to be paid, but that she is given board and lodgings. There appeared to be a limited uniform dress code. Care staff were wearing blue polo shirts and could wear any trousers they wished, some had chosen to wear jeans, some of which look rather unprofessional. We were concerned that a number of staff providing care were wearing open-toed shoes. This could present health and safety issues. We were told that the decision was theirs, as the policy stated they should wear ‘sensible shoes’. One new carer, had started work when only the POVA first part of her Criminal Record Bureau check had been returned. We did advise the Registered Provider, that staff commencing work prior to a full Enhanced CRB check should be the exception rather than the rule, as both staff and residents are very vulnerable in this environment. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 37, 38 Quality in this outcome area is adequate. The manager is appropriately qualified and experienced to run this home, but lacks knowledge on research based current best practice for people with dementia, however the senior nurses coordinate the day-to-day running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home has a clearly defined management structure and hierarchy of staff, many of whom have a designated role such as wound care or phlebotomy. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 24 One of the senior nurses told us that the home adopts a ‘laid back and relaxed’ approach to care, which promotes an unhurried and individual style of care. However we noted that it was accepted by everyone, that because many of these people with dementia were unable to speak, they were also unable to make choices about the own lives. So although people were allowed to wander as they wished, the consideration of using pictures and visuals to offer choices at mealtimes for instance, and encouraging participation in meaningful activities, such as ‘sensory work’ was limited. This indicates that current best practice for nursing this client group is not fully understood and is not being fully embraced in care delivery. The staff duty rota, in some cases, had staff member’s first names only. This is a legal document and as such, should be formally completed. The home employs an Auditor/ Assessor /Verifier, who amongst other things is responsible for the staff supervision. Records were seen that indicated that generally supervision of staff is carried out on a regular basis, however there were some gaps in the records that identified that some staff had not received supervision since August 2008. The Auditor is also responsible for the homes routine fire safety checks. Records identified that the last fire drill had been undertaken on 13.02.08. Emergency lighting was tested monthly, but there was no documentation to support that water temperatures were checked regularly. The home manages ‘personal expenditure funds’ for a few of the residents. Since last year when there was some money stolen from the office, the Registered Provider no longer keeps individual’s money on site at the home. She is the only person who has access to this money and completes the financial records. We were therefore on this occasion unable to balance individual records with individual’s funds. We explained that although the home is not appointee for any of the people who live here, it is important that clear account records are kept for each individual for every transaction that takes place. This is to safeguard the residents and the home. We will review this in more depth at out next visit The Registered Provider explained that when she is on holiday, she leaves ‘a float’, sufficient to cover all the residents’ accounts, with the senior nurse, so that residents always have access to funds should they need it. . Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 X 2 X 3 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 2 2 2 Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(a) Requirement All people who live in this home must be fully assessed by a suitably qualified person prior to admission. Timescale for action 30/06/08 2 OP7 12(1)(a) 12(3) The care requirements for people 30/06/08 who use this service must be clearly documented in individual care plans to ensure that care is delivered with continuity and in a way that they prefer. People who live in this home must be treated with dignity and respect at all times. The people who use this service must be offered activities that are delivered competently in order to provide them with appropriate stimulation. People who use this service must be offered choices in a way that is appropriate to the individual. Records of all complaints relating to the care home or the people who live there, must be clearly recorded as identified in schedule 4 (11) DS0000012656.V364169.R01.S.doc 3 4 OP10 OP12 12(4)(a) 16(2)(m) (n) 31/05/08 30/06/08 5 6 OP14 OP16 12 (2) 17(2) 30/06/08 30/06/08 Westgate House Nursing Home Version 5.2 Page 27 7 OP18 13(6) 8 OP19 16(2)( c) 9 OP26 23(2)(d) 10 OP29 19(1)(b) People who live in this home must be protected by the all staff being appropriately trained in safeguarding and the safeguarding processes being followed at all times. People who live in this home must be provided with equipment, furniture and fittings, which is clean and well maintained. All areas of this home must be kept clean, free from offensive odours and reasonably decorated so that people who use this service feel comfortable as they would in their own home. People who live in this home must be protected by the homes recruitment policy. People who live in this home must be protected by accurate personal expenditure records. Staff must receive a minimum of six supervision sessions a year. Accurate and up to date records must be completed in order to protect people who live in this home. People living at Westgate House must be protected by the appropriate reporting processes, both to CSCI and the Safeguarding team. 30/06/08 30/06/08 30/06/08 31/05/08 11 12 13 OP35 OP36 OP37 13(6) 17(2) 18(2) 17(3) 31/05/08 30/06/08 31/05/08 14 OP38 37(1) 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 28 No. Refer to Standard Good Practice Recommendations Westgate House Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 29 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 Nursing Home DS0000012656.V364169.R01.S.doc Version 5.2 Page 30 - 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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