Inspection on 08/12/08 for Westholme Clinic

This inspection was carried out on 8th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Westholme Clinic 13/11/07

Westholme Clinic 02/11/06

Westholme Clinic 30/06/05

Westholme Clinic 27/09/04

Westholme Clinic 10/05/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

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The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westholme Clinic Clive Avenue Goring-By-Sea Worthing West Sussex BN12 4SG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annie Taggart     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Westholme Clinic Clive Avenue Goring-By-Sea Worthing West Sussex BN12 4SG 01903242423 Telephone number: Fax number: Email address: Provider web address: carol@ashbournegrp.freeserve.co.uk Name of registered provider(s): Type of registration: Number of places registered: Westholme Clinic Limited care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: A maximum of 55 services users may be accommodated. Date of last inspection Brief description of the care home Westholme Clinic is a Care Home providing nursing and is registered to accommodate up to 55 people in the category of DE(E) (persons over 65 years with dementia), DE (dementia), MD(E), (mental disorder over 65 years), MD (mental disorder). It is a detached property located in Goring-by-Sea, in the town of Worthing. The accommodation for service users is arranged over two floors. The ground floor and first floor are served by a passenger lift. The bedrooms comprise predominantly of single occupancy, although there are three shared rooms. Westholme Clinic Limited privately owns the service and the responsible individual on behalf of the company is Mrs Shoai. The registered manager responsible for the day-to-day management of the home is Mrs Patricia Cummins. Current fees are between four hundred and seventy five and six hundred and fifty pounds per week Care Homes for Older People Page 4 of 26 Over 65 55 55 55 55 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: In order to prepare for this inspection visit an AQAA (Annual Quality Assurance Assessment) was sent to the manager for completion , this was returned in the given timescales and gave us good information about the services being provided in the home. Surveys were sent to service users, staff and other stakeholders in the home, five service users and two staff surveys were returned and comments from these have been used in the report. The key unannounced inspection was carried out by Annie Taggart at 9.30am on Monday 8th December and lasted for six hours. During the visit we spent time with Care Homes for Older People Page 6 of 26 service users in communal areas and were also able to see peoples private bedrooms. We spoke to the staff on duty, observed staff practice and were also spent time with six visitors to the home. We saw lunch, the main meal of the day being prepared and served and looked at nutritional assessments in care plans. We tracked four service users care plans and all supporting documentation and we looked at the recruitment records for four new members of staff and training records. Records for the running of the business were seen and this included complaints reporting, incidents and accidents, health and safety records the quality assurance process and Regulation 26 providers visits reports. Feedback was given to the Registered Provider, Mrs Shoai and the Registered Manager Mrs Cummins following the visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their families can be confident that they will be given good information about the services on offer and they will be involved in an assessment process to determine if the home can meet their needs and wishes. Evidence: There is good information available about the services on offer in the home and we saw that the home carries out detailed pre-admission assessments in order to determine if peoples individual needs and wishes can be met. We saw the assessments for three people and these were detailed and had been completed with service users their families or representatives. People are encouraged to visit the home before moving in but the manager told us that as people were sometimes too unwell to visit, their families did this instead. Care Homes for Older People Page 10 of 26 Evidence: We saw that contracts are in place detailing the terms and conditions of residency and those that we saw had been signed by a family member or legal representative. Westholme Clinic does not provide intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are detailed care plans in place to guide the staff team to the needs and wishes of the people they are supporting. Risks are assessed and recorded, people have access to healthcare professionals and medication is being safely managed. Evidence: For each person living in the home there is a detailed plan of care in place that informs the staff team on how each person needs and wishes to be supported. The plans contained personal histories, care preferences, nutritional needs assessments, mobility and dependency assessments and we saw that these had been regularly reviewed and updated. Risk assessments, both personal and environmental have also been completed and for some people there were behaviour management risk plans in place. There is a condensed version of the care plan in each persons bedroom so that the staff team can be informed of and respond to any changes quickly and the Registered Care Homes for Older People Page 12 of 26 Evidence: Manager, Mrs Cummins showed us examples of a new care format she is implementing to make the plans more outcome based and person centred. In the care plans we saw that it was recorded that a number of people do not have the ability to use their call bells and that instead regular checks are made by the night staff to ensure peoples safety. We were also told that at times people are also up and about during the night. There were night staff records in place but from these we could not determine how ofter people were checked or the level of care that was being provided. Mrs Cummins said she would address this at the handover to the night staff. We saw that two people were being cared for in fall back reclining chairs but the reason for this was clearly detailed in their individual care plans. We spoke to several visitors to the home during the day and they were all positive about the standard of care being provided, one person said, they, (the home) provide fantastic care and treat my mother like part of a family, her quality of life is much improved and she can move around freely. From looking at healthcare records we saw that people have access regularly to their doctor and during the day there was an optician on site attending to a number of people. A chiropodist visits the home every six weeks and we saw that people are supported to make visits to other healthcare professionals such as tissues viability nurses when needed. The home has policies and procedures in place for the administration of medication, which is only carried out by trained nurses. We saw the storage and records for the home and found medication to be well managed with MAR charts (Medication Recording Charts) fully completed and up to date. We checked the records against two controlled medications that are in use and found them to be correct. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can see their relatives and friends at any time and are offered a variety of fresh, home cooked meals. There is no clear evidence to show that service users are regularly involved in activities that offer them interest and stimulation. Evidence: In the AQAA we were told that activities are carried out each afternoon in order to provide interest and stimulation for people but because of the lack if individual records this could not be confirmed at the visit. We saw that there was some art work that had been completed with people and were told there had been a clothes party and an outside entertainer but as most day care activities are carried out by the staff team and there are no records in place this also could not be confirmed. There were fourteen people sitting in the front conservatory/lounge at 10am, most people were asleep. The inspector went to this room at regular intervals during the day and apart from people being given regular refreshment and coming to the dining room for meals, most people remained asleep. This was discussed on two occasions with Mrs Cummins who went to members of the staff team at 2.45pm and asked them to start Care Homes for Older People Page 14 of 26 Evidence: providing some activities for people. The need for activity plans and individual records to be kept of peoples day care involvement was discussed with Mrs. Cummins and a Requirement has been made regarding this Standard. During the day several visitors came to the home and told us that they could visit at any time, were always made welcome and could have a meal with their relative. The kitchen in the home provides meals for two other homes owned by the Providers and we saw that a variety of fresh, home cooked meals are on offer. Nutritional assessments are carried out and peoples likes and dislikes are recorded. We saw lunch, the main meal of the day being prepared and served and it looked attractive and appetising and was served with fresh vegetables. Special diets were catered for and where people needed assistance with eating, this was carried out by the staff in a patient and unhurried manner. In a survey we were told that a service users health had improved since coming to the home, that they had put on weight and enjoyed their meals. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place to record and respond to complaints and concerns. The staff team have received training in protecting service users from risk of abuse and harm and are aware of their responsibilities. Evidence: The home has policies and procedures in place regarding responding to complaints and for protecting people from risk of harm or abuse. A copy of the complaints procedure is displayed in the home and families visiting on the day of the visit told us they were aware of the procedure to follow. In the AQAA we were told that three formal complaints had been received by the home and these had also been sent to the Commission. from looking at the homes records we saw that the complaints had been recorded and responded to and that two had been upheld. Records showed us that the staff team receive training in the protection of vulnerable adult from abuse and those that we spoke to were aware of their responsibilities and told us that they would report any suspected abuse straight away. There have been two safeguarding referrals made regarding the home and both were investigated by the West Sussex Safeguarding Team. The investigations have now Care Homes for Older People Page 16 of 26 Evidence: been completed. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and homely environment for the people who live there and the staff team are aware of infection control issues. Improvements are needed to some of the decor and furnishings and the process to add signage should be continued. Evidence: In the AQAA we were told that there was a programme of updating and redecorating the environment in place and since the last key inspection visit improvements have been made by redecorating lounge areas and the conservatory, the bathrooms have been updated and a new hoist purchased. During the visit there was a maintenance person redecorating the communal areas of the home. Although there have been a number of improvements made to the environment there are still areas that are looking tired and furniture in some peoples bedrooms is looking old and shabby. There are a number of service users bedrooms that are in need of redecoration and updating and the manager and maintenance person told us that this was usually carried out when rooms became vacant. Some bedrooms also looked a bit bare but we saw in risk assessments and care plans that this was for the safety of the service user. Care Homes for Older People Page 18 of 26 Evidence: There is no signing or other visual prompts in place to guide people with dementia around the home, Mrs Cummins showed us that she had started a process of pictorial signing for each persons bedroom door and was also looking at other prompts to assist people with orientation. We saw that regular maintenance checks are in place and that any deficits identified are acted upon. An example of this was that some of the hot water temperature valves on sinks had been identified as becoming old and worn, new ones had been purchased and were waiting to be fitted. The atmosphere was homely and comfortable, people were able to move around freely and wander if this is what they needed to do. The environment was generally warm, bright clean and hygienic and we saw that the staff team used protective clothing and were aware of infection control issues. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported by a caring and competent staff team and are protected by there being a robust staff recruitment process in place. Evidence: From looking at staffing rotas and observation on the day of the visit we saw that there were sufficient staff on duty to meet the needs of the people currently living in the home There were two registered nurses, six carers one domestic and one maintenance person. The staffing rota show that there are usually eight carers, two people had phoned in sick and these were replaced by bank cover later in the morning. The kitchen is separately managed and staffed. The staff on duty were kind and patient in their dealings with service users and were aware of the individual needs of the people they are supporting Some of the staff team on duty had English as a second language and there was some difficulty in verbally communicating with them. We asked the manager how effective staff communication with people with dementia was ensured. Mrs Cummins told us that there are always a number of people with English as a first language on duty and that the home supports people to attend a language course at a local college. Training records were seen for one person that confirmed this. Care Homes for Older People Page 20 of 26 Evidence: In order to protect the people living in the home, a robust recruitment process is carried out. We looked at the evidence for four new members of staff and saw that they all had the required documentation in place and this included a current CRB (Criminal Bureau Check) and two references. New staff in the home receive an induction process in line with Skills For Care guidelines and we saw that there is a comprehensive programme of training in place. As well as mandatory training we saw that people attend courses such as communication, palliative care and diabetes awareness and in the AQAA we were told that over 50 of the staff , fifteen people, hold NVQ 2 or above. We also saw that the home makes good use of external training and people had attended courses such as dignity and respect for service users, night care for older people and sensory loss. Service users and visitors to the home were very positive about the attitude and skills of the staff team, a service user told us, they are lovely, very kind and a family member said, my mum has been here for over three years and I have no complaints, the staff are lovely, very efficient and they always make sure that my mum is happy and looks nice. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being run by a competent and caring manager, records are in good order and health and safety issues are identified and addressed. Evidence: The home is being run by a competent and caring manager and the staff on duty and visitors to the home were positive about the way in which the home is being managed. Mrs Cummins is a Registered Nurse and also has the Registered Managers award. A family member said, whilst some parts of the home need sprucing up, the management is very open to new ideas and many suggestions have been readily implemented. As detailed earlier in this report, there is a programme underway to improve the standard of the environment and we told Mrs Cummins that we will assess the progress of this at the next inspection visit. There is a quality assurance process in place that elicits the views of service users, Care Homes for Older People Page 22 of 26 Evidence: their families and other professionals and we saw that the Registered Provider carried out Regulation 26 visits and reports on findings. We were told That the home does not manage monies on behalf of service users and instead bills families or legal representatives. There is a process in place for supervision and monitoring the staff team, we saw that records for formal supervisions were not up to date bu the staff on duty confirmed that the manager worked alongside them every day and as she is a qualified trainer, carried out regular training and support sessions. Mrs Cummins told us that as there was such a large staff team, she had until recently had a trained nurse who assisted with supervisions, this person had left and another person was going to be trained. Records show us that health and safety audits are carried out and action taken where deficits are identified and this included the testing of hot water outlets and ensuring that radiators are kept at a safe temperature. Incidents and accidents are recorded and Regulation 37 reports sent to the Commission when required. There are records of staff fire training having been carried out and there is a fire risk assessment completed. Mrs Cummins told us that she was currently working on an individual evacuation plan for each service user. As recorded in other parts of this report improvements are needed to evidencing the care being provided at night, the activities people are involved in, to improving the environment and to recording formal supervisions for staff. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Records must be in place to show what activities each person is being involved in on a daily basis. This is in order to ensure that evidence is in place to show that are people having regular activities that provide interest and stimulation. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 The programme of redecorating and updating the home should be continued and signage and other aids to communication added to support people with dementia with orientation. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!