Inspection on 02/08/05 for Westmead

This inspection was carried out on 2nd August 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 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

Westmead 05/08/09

Westmead 15/08/07

Westmead 21/11/06

Westmead 20/12/05

Westmead 24/03/05

Westmead 02/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Westmead Westmead Close, Off Ledwych Road Droitwich Spa Worcestershire WR9 9LG Lead Inspector Yvonne South Unannounced 2 August 2005 7:30 am 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. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Westmead Address Westmead Close, Off Ledwych Road, Droitwich Spa, Worcestershire WR9 9LG 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) 01905 778353 Heart of England Housing and Care Limited Mrs Sueanna Elizabeth Stokes Care Home 35 Category(ies) of DE(E) Dementia over 65 (35) registration, with number LD(E) Learning disability over 65 (2) of places OP Old age (35) PD(E) Physically disability over 65 (35) Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service user category LD(E) is in respect of named people only. This situation has changed and the registration will need to be amended. Date of last inspection 24 March 2005 Brief Description of the Service: Westmead is a purpose built home offering a residential care service to a maximum of 35 people over the age of 65 years. Two places are reserved for people who require respite care only. The home offers permanent residential care to older people who have care needs associated with physical disabilities and/or dementia illnesses. Care is also offered to two named older people with learning disabilities. Only one of these places is now needed. The home provides a safe, homely environment for people who are no longer able to cope in the community, and enables them to lead a full and active life within a risk management framework. There are 33 single bedrooms and 2 double bedrooms in the two storey building, and a range of communal lounges, a dining room and a spacious, level, accessable garden. A shaft lift facilitates movement between floors. The home is situated in a small housing estate on the outskirts of Droitwich Spa and public transport facilities are within reach. The home is owned by Heart of England Housing and Care Ltd and is managed on a day-to-day basis by Mrs Sueanna Stokes the Registered Manager, and a Home Services Manager. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over four and quarter hours during a weekday morning. It was undertaken by two regulatory inspectors who were assisted by the Registered Manager, a Lead Care Assistant, two staff and five residents. What the service does well: What has improved since the last inspection? What they could do better: Peoples’ needs should be re-assessed immediately before there is a change in the service they are offered. For example from day-care to respite or permanent residential care. The systems in place for care planning are complex, and, if kept up to date meet the standards. However, it would be in residents and staff interests to simplify the systems to make recording and retrieval of information easier. After the residents’ and communal areas of the home have been refurbished some of the staff facilities on the ground floor would benefit from attention. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 6 The times when people can be provided with their personal money from safekeeping need to be extended to correspond with the written information available about the home. The design of the duty roster needs to be changed so that it is possible to identify who is responsible for the home if the managers are off duty. The content of the training programmes for new staff needs to be checked to ensure staff are fully trained to care for the people who live in the home. Records concerning food provision need to be more descriptive so that it is possible to check that everyone receives the food and nutrition they prefer and need. 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. Westmead E52 S18696 Westmead V239890 020805.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 Westmead E52 S18696 Westmead V239890 020805.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) 1, 2, 3, 4 Information is available for prospective residents and their families to help them make an informed decision about moving into the home. Assessment processes are in place although more attention needs to be paid to filling them in fully to ensure that residents’ needs are understood at the point of admission. EVIDENCE: A Statement of Purpose and Service Users’ Guide were readily available. These documents had just been reviewed and draft copies were being assessed by the manager and made personal to the home. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 9 A resident’s assessment file was seen during the inspection. A community care assessment was available which had been carried out prior to the resident being admitted to day care. The home had also completed an assessment for day care, which was written in detail. This was dated several months before the resident started to come in for respite care. A further assessment filled out before the resident came in for respite did not accurately reflect their changing care needs. It was also difficult to ascertain from care records whether the resident was in for respite and when they became a permanent resident. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The recording systems in place for meeting residents’ needs are comprehensive, but they are not consistently filled in by staff. This could put residents’ health and welfare at risk. The staff have a very good understanding of the residents’ needs and this is evident from the relationships between them and the comments made by the residents. Personal support is offered in a way, which promotes the privacy and dignity of the residents. EVIDENCE: Three care plans were inspected. There were shortfalls in the information provided in order for staff to be able to meet the residents’ needs. One care plan did not have the personal care needs of the resident recorded regarding foot care, mouth care or bathing. There was no risk assessment filled in for nutrition or moving and handling. Daily records indicated that they had not had a bath for 12 days but no reason was recorded. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 11 Another resident’s care plan did not indicate the deterioration in their health. The main body of the care plan had not been reviewed since 23/10/03 although some risk assessments had been carried out more recently. The pressure care risk assessment had not been up dated since 18/4/05. The resident had lost weight but was no longer able to be weighed. The foodmonitoring chart had not been completed. The moving and handling risk assessment had not been up dated since 5/2/04. Care records indicated that the resident was unable to bathe, but there were no instructions as to how washing was to be carried out. It was noted that an assessment had identified a mental health need of a resident which had not been transferred to the care plan. Individual activities were not recorded. Whilst the care records showed shortfalls, staff that were spoken to were conversant with and sensitive to the needs of the residents. Residents who were spoken to were very complimentary about the care they received. Comments made included “Excellent care”, “Quite satisfied”, “Definitely”(when asked if they were happy with care provided). A visitor to the home was also very satisfied with the care their relative received. A district nurse stated that she was happy with the home and that she was called out appropriately to residents. The medication system had just been replaced by the Boots system of blister packs. Staff authorised to give out medication had received training from Boots and the senior lead carer was working alongside all seniors during the transition. Medication administration record sheets, which had been handwritten, did not have a second signature on them. There was no risk assessment or care plan in place for a resident prescribed warfarin. All other documentation was in place and correct. Observations made during the inspection indicated that residents’ privacy was respected by staff and their dignity was being maintained. Staff were able to give details about how their practice promoted privacy and dignity. This was also confirmed by residents who said staff were “Very polite”. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15. Routines in the home are flexible and allow for individual residents to live their lives as they wish. Activities are offered and available which meet the residents’ social needs. The choices of meals and standard of food meets the residents’ dietary needs including specialist needs. EVIDENCE: Routines in the home were relaxed and unhurried. Residents were able to get up and go to bed as they chose. There was a list of varied activities on display in the corridor. Although there was no specific activities organiser in post, staff confirmed that they were able to spend time with residents during their shift. Residents confirmed that they “Had enough to do”, “will always find something”. The home had recently acquired a small kitten, which had had a huge impact on the residents who thoroughly enjoy his company. There was evidence of individuals going out into the community and of communal social events. Visitors confirmed that they were welcomed into the home at any time. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 13 Residents were very complimentary about the food, which was served in the home. There were three daily choices available at lunchtime, and in addition individual tastes were catered for. There was a “surgery” held by the cook on a regular basis to consult with residents about the menus. Comments made by residents about the food included; “Lovely, choose what we like”, “Excellent, plenty of choice”, and “Very good”. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 Residents and their supporters are able to raise their concerns and confidently do so. The legal rights and well being of residents are being protected. Staff have access to policies and procedures and training to enable them to safeguard vulnerable people. Residents do not always have access to their personal monies at the times stated in the Statement of Purpose. EVIDENCE: An acceptable complaints procedure was available in the Statement of Purpose and Service Users’ Guide. There was also a copy of the corporate procedure displayed. In the dining room there were further facilities to enable and encourage people to make their feelings (both positive and negative) known. The records indicated that advantage was taken of this and people had confidently brought issues to the attention of the staff in the sure knowledge that they would be listened to and an appropriate response would be received. Residents and their families and friends had also made a pleasing number of compliments. Everyone who was on the electoral role at the time of the election had been able to vote if they wished. The register was regularly updated. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 15 Information regarding access to advocacy services was available and one person received support from a volunteer visitor. Policies and procedures were available to guide staff in the protection of vulnerable adults. These had been drawn up in 2002 and 2003 and were now under review. There was written evidence that when anxieties arose they were responded to according to the procedures and the local protocols. The training records indicated that appropriate training was available to staff and was undertaken. Policies and procedures were also available relating to the safe keeping and the management of people’s personal monies and valuables. There was good secure storage and maintenance of records. However there were times when monies were not accessible. It was advised that people should be able to access their money at a minimum, during the times described in the home’s Statement of Purpose. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 16 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) EVIDENCE: These standards were not assessed during this inspection. However it was observed during a tour of the premises that everywhere was clean and in a good state of repair. Some areas had been refurbished and others were either being attended to at the time or there were plans to attend to them in the near future. It was noticed that the décor in the staff cloak room and toilet needed attention. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 17 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) 27,28,29,30 The home is staffed to provide the service needed by the residents. A sound recruitment policy and training structure ensures that carefully selected people, who have been appropriately trained are employed to provide a competent care service care for residents. EVIDENCE: The care staff team numbered 21 persons. The duty rosters indicated that 4 care assistants and a Lead Carer were on duty each day. At night there were 2 care assistants awake on duty and a Lead carer asleep on call. Staff were supported by the Registered Manager, the Home Services Manager, and a team of ancillary staff. All the differing roles of the staff needed to be identified on the rosters and in the absence of the two managers the identity of the person responsible for the home should also be identified on the roster. The training records indicated that 14 of the care staff were either qualified, or were undertaking courses to achieve qualifications to NVQ level 2 or above. This is more than 50 of the care staff team and is commendable. The records of two members of staff were assessed and were complete. An acceptable recruitment procedure was available and had been implemented. Induction training had been undertaken and the new recruits had been supported throughout. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 18 A requirement had been made following the previous inspection for a foundation-training programme to be implemented with all newly appointed staff. It was not clear if the rolling training programme in core subjects met the NTO specifications for foundation training. The manager needs to do a comparative study to clarify this. Staff confirmed that training was actively provided and valued by them. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 19 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 to 37, The home is well managed and run in the best interests of the residents. The financial procedures safeguard the viability of the home and protect the residents. Staff are well supported and trained to enable them to provide the care the residents need. Good record keeping provides information and protection for the residents and staff with the exception of detailed dietary information. Fire safety systems provide protection for everyone in the home. EVIDENCE: The registered manager was competent and experienced in her role. It was observed that staff and residents found her approachable and a ready listener. She was aware of her responsibilities and the extent of her authority. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 20 Meetings were held with residents and staff. The minutes of these meetings indicated that they provided a forum in which to discuss issues, ideas and suggestions. It was observed that suggestions had been successfully actioned. In addition the annual questionnaires, the regular monitoring of systems and records, the monthly visits by the provider’s Director of Care and the personal contact between residents and their key workers provided an open, positive and inclusive atmosphere that worked in the best interests of those who lived in the home. It was not clear if the requirement to implement a foundation-training programme had been met through the rolling programme of core training subjects that was in place. Clarification was requested. Corporate financial procedures were in use to protect the interests of residents. The Home Services Manager who was off duty during this inspection managed this. Therefore the system will be checked during a future visit. However the manager confirmed that computer and hard copy records were kept. Resident’s monies and valuables were well managed and securely stored when placed in safekeeping. Records indicated that staff received regular supervision. The senior team who had been appropriately trained by the registered manager undertook this. The records required by legislation were being maintained. However the care record system was considered to be overly complex and not ‘user friendly’. Please see the comments made earlier in this report. The record of food provided was maintained as ‘amended menus’. These must be dated. Nutritional assessments should be undertaken and actioned when necessary. Detailed individual records of food provided should be maintained for those people receiving special diets. Health and safety was not assessed in full. However the fire log was inspected and the records indicated the routine fire safety equipment and systems were being regularly checked, a fire risk assessment had been undertaken on the house, and staff were receiving training in fire safety and participating in fire drills. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 21 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 3 3 2 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 4 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 2 3 2 x Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 22 No 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 3 Regulation 14 Requirement Assessments of need must be completed for all residents moving into the home and show up-to-date needs. Care plans must reflect accurately the residents care needs. Care plans must be regularly reviewed and show the changing needs of residents. Risk assessments must be put in place and reviewed regularly for moving and handling, nutrition and skin care. Handwritten instructions on the medication administration sheets must have two signatures. A record must be maintained in detail of any special diets provided for individual service users. Timescale for action 31st August 2005 31st August 2005 31st Augusr 2005 31st August 2005 2nd August 2005 2nd August 2005 2. 3. 4. 7 7 8 15 15 13 (5) 17 schedule 3 13(2) 17 5. 6. 9 37 7. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Westmead Refer to Good Practice Recommendations E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 23 1. 2. Standard 7 9 A record should be made when residents visit the home prior to moving in describing the event and the outcome. A risk assessment and care plan should be in place for residents who are prescribed warfarin. Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 24 Commission for Social Care Inspection The Coach House, John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Westmead E52 S18696 Westmead V239890 020805.doc Version 1.40 Page 25 - 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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