Inspection on 20/12/05 for Westmead

This inspection was carried out on 20th December 2005.

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

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

Other inspections for this house

Westmead 05/08/09

Westmead 15/08/07

Westmead 21/11/06

Westmead 02/08/05

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 Y South Unannounced Inspection 20th December 2005 09:30 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 Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Westmead Address Westmead Close Off Ledwych Road Droitwich Spa Worcestershire WR9 9LG 01905 778353 01905 776376 Telephone number Fax number Email address Provider Web address www.heart-of-england.co.uk/care/westmead Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Heart of England Housing and Care Limited Mrs Sueanna Elizabeth Stokes Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (35), Physical disability over 65 years of age (35) Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service user category LD(E) is in respect of a named person only. Date of last inspection 2nd August 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 one named older person with learning disabilities. 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 35 single bedrooms in the two-storey building, and a range of communal lounges, a dining room and a spacious, level, and accessible 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. Heart of England Housing and Care Ltd own the home and the registered manager is Mrs Sueanna Stokes. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over approximately three hours from 9.30am until 12:30pm. The focus was on the requirements and recommendation that had arisen out of the previous inspection and key standards that had not previously been assessed this year. Chloe Boden the Senior Lead Carer, and Chris McGregor the Hotel Services Manager assisted the inspector. A short tour of the home was undertaken and the inspector spoke to five residents and a member of staff. A service questionnaire was sent to the manager prior to this inspection, which was completed and returned to the Commission for Social Care Inspection. The manager was also asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Four responses had been received prior to this inspection. What the service does well: The home provides a warm welcome and a comfortable environment for those who visit and those who live there. The staff are kind and attentive and the residents have a good rapport with them. Residents say that nothing is too much trouble. Comments made in the questionnaires that were returned stated, “All the staff at Westmead have been wonderful in providing an environment in which my relative has settled and clearly feels secure, cared for and happy.” “The home shows ‘Care’ at its best. Good management obviously prevails. Relative and friends visit with confidence. Westmead deserves ‘Flagship’ status.” “Westmead is a very happy home. Everyone is helpful. When my relative was very ill the staff were very caring and got her back on her feet.” Residents told the inspector that they were very happy living in the home and received the best of care. Food was said to be excellent. Their rooms were described as lovely and they appreciated have their own personal possessions around them. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The needs of people are assessed prior to them moving into the home to ensure that the service can provide the necessary care. EVIDENCE: A requirement was made following the previous inspection that the needs of prospective residents be assessed immediately prior to admission. This requirement had been met. The sample of records that were seen indicated that the needs of a resident, who had previously been receiving a day care service, had been reviewed before they moved into the home. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 Residents’ needs are being met but the records do not always provide the information and support the staff need. Medication is well managed so that residents receive their prescribed medicines accurately. EVIDENCE: These standards were assessed in full during the previous inspection following which four requirements were made. These were • 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. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 10 The records that were inspected still demonstrated a lack of consistency in the provision and flow of information. Details describing how an identified risk would be addressed were lacking. It is expected that the new care record system that is to be implemented will address this. However the current system must be fully and accurately used until then. The requirement relating to medication had been met. Medication records were acceptable. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents are able to lead the life styles they choose and have control over their routines and activities. EVIDENCE: Support was readily available from the senior staff and advocates to assist residents with their finances, and lives when necessary. Residents confirmed that they were happy in the home, made their own decisions and choices and were most complimentary regarding the staff and the standard of care they received. They were able to move around the communal areas of the home or stay in their bedrooms as they chose. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed during this inspection. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Residents are able to live in a safe, comfortable environment that meets their needs. Equipment, systems and training is in place that controls and where possible reduces the risks of cross infection. EVIDENCE: The home was clean, well maintained, furnished and decorated. Since the last inspection lounges and corridors had been redecorated and new carpets and curtains fitted. Those residents’ bedrooms that were seen were comfortable and arranged with their own personal possessions. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 14 The programme of routine maintenance, renewal and decoration was not available for inspection, however the maintenance record demonstrated that repairs were soon attended to, and redecoration was in progress. All staff had received training in infection control. Laundry and hand washing facilities were acceptable and appropriate policies and procedures were readily available. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed during this inspection. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 37, 38 Residents who are unable or unwilling to manage their personal finances can rely on the senior staff to protect their interests. Records are maintained but care records need to be more informative and consistent so that communication between the staff is accurate and complete. The home is managed with due regard for the health and safety of people in it. EVIDENCE: Although the residents’ care records had not improved in line with the requirements made following the previous inspection, the senior lead carer said that she expected that the new system will be easier to use and maintain. The current system must be correctly used in the meantime. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 17 The management of the residents’ personal monies was acceptable. Records were well maintained and receipts appropriately given and retained. Access/availability had been improved since the last inspection. The equipment and services in the home were appropriately monitored and maintained. The staff received training in health and safety matters and had ready access to appropriate policies and procedures. The fire risk assessment had been drawn up in October last year and was due to be reviewed. The log indicated that fire safety checks were undertaken as frequently as recommended by the Hereford and Worcester Fire Authority. Staff received training and participated in drills. The staff records could be maintained in a clearer manner. The security of the building had been assessed by the crime prevention officer and his recommendations had been carried out. Accident records were maintained, and collated and summarised monthly. Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X 2 3 Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8OP7 Regulation 15 Timescale for action Care records must be maintained 20/12/05 to identify changes to the wellbeing of residents and health care matters. Risk assessments must be put in 20/12/05 place and reviewed regularly. Requirement 2. OP8 13 (5) 17 3 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Westmead DS0000018696.V268693.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Worcester Local Office 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 DS0000018696.V268693.R01.S.doc Version 5.0 Page 21 - 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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