Inspection on 11/06/07 for Westmead Elderly Resource Centre

This inspection was carried out on 11th June 2007.

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 Elderly Resource Centre 27/05/08

Westmead Elderly Resource Centre 28/01/08

Westmead Elderly Resource Centre 06/02/07

Westmead Elderly Resource Centre 30/06/06

Westmead Elderly Resource Centre 23/08/05

Westmead Elderly Resource Centre 22/03/05

Westmead Elderly Resource Centre 19/07/04

Westmead Elderly Resource Centre 02/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

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

CARE HOMES FOR OLDER PEOPLE Westmead Elderly Resource Centre 4 Tavistock Road London W11 1BA Lead Inspector Ffion Simmons, Jane Shaw & Ann Gavin Key Unannounced Inspection 11th & 25th June 2007 10:30 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 Elderly Resource Centre DS0000036658.V340204.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. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westmead Elderly Resource Centre Address 4 Tavistock Road London W11 1BA 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) 020 7641 4595 020 7641 5781 Westminster City Council Ms Julia Patton Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (42), Old age, not falling within any other category (42) Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 5th September 2006, one named service user under the age of 65 years can be accommodated. The CSCI must be advised when the service user no longer resides at the home. 6th February 2007 Date of last inspection Brief Description of the Service: The home is registered to care for up to 42 elderly residents of either gender. There are forty permanent beds and two respite beds. Of the 42 service users, the home is registered to care for seven service users with dementia and eleven service users with mental health needs. The home is owned and run by Westminster City Council and is situated in the Westbourne Park area with easy access to transport links and local amenities. The home was purpose built in the 1970’s and is a two-storey building. There is a passenger lift fitted in the home making all areas in the home accessible to residents. The home is divided into four units, and each resident has their own bedroom, and there is a range of communal areas within the home. The fees are £528.62 per week. This fee does not include the following items: hairdressing, personal toiletries, clothing, newspapers, cigarettes, alcohol, taxis for shopping and outings, television sets in bedrooms, phone installation and hand sets, pet food and veterinary expenses, transport and storage for own furniture, repair and maintenance of own equipment and furniture, sweets, postage and extra recreation. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over two days on the 11th and 25th June 2007. This was the home’s first key inspection for the inspection year 2007/2008. The inspectors spent time talking to duty managers, care managers and residents and members of the care team. The inspectors also observed care practices over the two days. A range of documentation was checked including several care plans, risk assessments and staff files. Medication was audited in each unit and record keeping was inspected. Residents and staff were invited to provide feedback on the service in person and through the use of satisfaction questionnaires. What the service does well: What has improved since the last inspection? The home has now met the requirement made to use only professional lancing devices in the home. This will reduce the risk of infection when sampling blood. The medicines policy has been expanded and the new pharmacist supplier is providing information on medication and training. This should update care workers knowledge in understanding the actions of the medication and possible side effects to expect. The Commission, has been kept informed of plans and strategies for improving the service and the involvement of external facilitators in this process, which have included fortnightly monitoring meetings and team building events. Staff have received further training in the protection of vulnerable adults from abuse to consolidate knowledge. Vacant posts have been advertised, which has generated a positive response from potential applicants. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 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 Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A brochure about the home is available to service users, but this information does not include all required information. Some people who have moved in feel that they had insufficient information and one resident spoken to said, this is not where they want to be. EVIDENCE: Information about the home is available to prospective residents and other interested parties in the form of a brochure. The information is printed out as needed and contains information on how to make a complaint. It remains a requirement that the Service User’s Guide must include a copy of the most recent inspection report and service users’ views of the home. Information about the home should include reference to the distance between a small number of the bedrooms and lavatories. Fifty five percent of the residents who completed comment cards said that they felt they had received enough information about the home. One resident confirmed that they had received a booklet about the home. Twenty seven percent of the residents who completed comment cards felt that they had not received enough information and a resident commented that they just bought Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 9 her here, nobody told her where she would be going. Another resident commented “I was told to come here, arranged by social worker” A resident also said that no one told them about the home, when they got there they wondered where they were and was not happy at first when they got there. One person who moved into the home directly from hospital has been wanting to leave since admission. Talking with the resident and looking at their notes the staff do not appear to have addressed the issue directly. The resident’s only personal items from their flat are photographs. Their room is small and they were not clear as to what had happened to their flat. Care needs assessments are undertaken prior to admission, which forms that basis of residents’ care plans. Information from the Annual Quality Assurance Assessment indicates that the home enables prospective residents and their relatives and friends to visit prior to admission. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Medicines were not always administered as prescribed. Poor recording dose not provide enough evidence that the health and welfare of the residents is maintained. EVIDENCE: Care plans are in place, which are based on residents’ needs assessment. A care plan of one resident indicated that they have received the input of a dietician who had provided advice on their diet. The daily notes were checked and the notes did not fully reflect that the advice of the dietician is being followed by staff. Steps must be taken to ensure that the advice of health professionals is followed and documented. The home had a medication policy, which had been updated. It needs to be placed in each unit so that all staff have ready access. The new pharmacist supplier had written a procedure on the new systems and this was available for inspection. Signatures and initials must be updated for all staff understanding the new procedures and must be kept at the front of the MAR folder for audit purposes. The recording of receipts and disposal was generally accurate in the home. When receiving medication all staff must be reminded to document the date of receipt. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 11 Lapses in recording of administration still gives grave concerns that residents may not be receiving their medication as prescribed. On an upper unit a tablet of aspirin had been left in the monitored dosage systems but recorded as given. There were three consecutive omissions for administration of two medicines for another resident and for a third there were three tablets left in the blister on the 29th but signed as given. In another unit on the ground floor there was good recording of administration. There were concerns on the unit however that the current dose of a medicine on the MAR did not correlate with recent discharge information from hospital. On the lower units recording of administration was improved with the exception in one unit on the first day of the cycle when the evening medicines had not been recorded for one resident. Although there had been problems with the introduction of the new monitored dosage system, staff appeared to be using the system reasonably well. They need to ensure that residents are all on the same cycle and if not, that the medicine is still removed from the correct day of the cycle. No residents were able to self-medicate. One resident was having insulin injections administered by the district nurse and she expressed her concern to the inspector that the evening injection was often rather late. Care workers must be reminded that they must observe medication being taken before signing the administration record. In the daily notes for one resident it was noted that a care worker had found 3 tablets on a bedside table at 6.42 am and they had been signed as given. There are also grave concerns that warfarin is still not being handled safely and the correct dose being administered despite the introduction of new procedures. During the second day of the inspection, the reports that warfarin was not administered on 19th June for a resident was confirmed and the inspector noted in the message book that an incorrect dose was also administered on 16th June 2007. Many of the residents in the home were having their medication changed either by the GP, CPN or hospital. In one unit there was good practice of keeping these dosage changes with the MAR. The home needs to develop consistent practices in maintaining records of dosage changes and current medication. All staff had received induction training on the new system by the new pharmacist supplier. Further advanced training was being rolled out to all care workers. No controlled drugs were stored in the home at the time of the inspection. One of the upper units was very warm with temperatures reading 29 degrees centigrade at the time of the inspection. Most medication needs to be kept at 25 degrees or below so the homes must review the location of the new medicines trolley. The fridge was unlocked at the time of the inspection and Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 12 only intermittent recording of temperature was being done. The manager was advised in the last pharmacist report to obtain a maximum and minimum thermometer and this has not been done. Audits of medication could not be located at the time of the inspection and were therefore not inspected. Enforcement action has been taken by the Commission to ensure compliance and improvement in the management and administration of medication. Observing practise throughout the day highlighted a culture of task centred care focusing on jobs to be completed by a schedule. This needs to be reviewed to move towards a person centred approach involving residents in all aspects of their care. One staff member was seen entering a resident’s room checking their wardrobe and taking out a cardigan. When spoken with they explained that they were doing their laundry rounds taking out items that need washing before the next task of ‘toileting’ people before lunch. One resident later was distressed as a new pair of pyjamas had been removed from their room which they had not yet put their name on nor worn. The staff could not see what had happened as the laundry was closed for the day. The staff must review the way they involve residents in all aspects of their care and review the practise of removing clothing from residents’ rooms when they are not there. Another member of staff accompanied a health professional to look at a residents leg at the beginning of lunchtime whilst everyone was seated at table awaiting their food. This resident was quite disorientated. This practice does not uphold the dignity of the person. It is also difficult to see how this type of health assessment can fully meet their needs. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. While mealtimes for some people are a positive experience, this was not the case for all residents living in the home. Staff interaction with residents, in particular during mealtimes needs to be improved to ensure that residents receive the support and reassurance they need. EVIDENCE: ‘I am very happy here I have everything I need. A roof over my head, my laundry done. I enjoy the bingo and the art. ’ “Westmead care team and Managers and activity officer do promote individual interests and their right to live quietly, both in and out of their own rooms.” “The main staff have always treated me with courtesy and friendliness and welcomed my visits to Westmead” “There are activities, but not for me. “I have complained about the food and that old people do not eat very much they seem to pile it on their plate some old people can’t eat very much and the food does not look very appetising. If they can’t eat their lunch there is no alternative.” “they should have more people to assist with their meals.” Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 14 “have no choice in what you get, two set choices main and alternative” (Comments from resident and relatives and professionals) Since the last inspection, the home has facilitated a residents forum meeting, which generated discussion with residents about their preferences such as activities in the home. Care plans give some information about service users’ background and previous interests and Westmead have identified people’s cultural and religious needs. To promote cultural awareness and appreciation and to reflect the diversity of the client group, the home has introduced an international day. One day a month is assigned to one country, the culture is celebrated and residents have the opportunity to sample the food if they wish to. One person is awaiting a referral by the activities coordinator to have a volunteer who speaks their mother language. One person is being seen regularly by their minister. Another person was no longer able to attend the services due to deterioration in their mental health. This person’s care plan stated that their religious practice was the only thing they were interested in. Given that the staff feel they are no longer able to attend services it is recommended that the staff look into other ways that they can support this resident in this key area of their life. For example through CD’s, music, video’s and contact with people from their same religion. In looking for examples of how people have spent their days a request was made to look at the daily logs of residents for the past month. These were not available in the residents’ folders. Staff needed to look through a pile of papers which contained all the daily logs for various residents. There needs to be a system in place to enable this information to be retrieved easily and referred to. The lunch and the evening meal, were served at 12.30PM and 5.00PM, on the day of the inspection. It remains a requirement that mealtimes should be reviewed, with consideration given to a later start for the evening meal. Soft drinks, water and fruit juices are given to service users throughout the day. Observing the lunch period in one of the units dining room highlighted a number of issues. There were two staff serving lunch both of whom were agency staff. The level of interaction with residents was minimal. One person who was wheeled in by staff was asked to ‘stand up please’ but there was no reason given as to why or no help to orientate them to where they were or that it was lunchtime. There were long periods of waiting in silence with nothing done to enhance the enjoyment of the residents. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 15 The level of attention given to each resident was varied. One person who was able to respond was given more attention and constantly asked if everything was ok if they wanted more. On another table both the male residents were asked if they wished to have more the woman resident was not asked. One woman spent the main part of the lunchtime saying’ I don’t know what to do, I can’t do this’. They were not spoken to directly no attempt was made to orientate them or reassure them. On one occasion they were asked if everything was ok but staff did not wait for the response. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. A policy is in place for managing complaints. There is evidence that concerns raised by a relative and staff working in the home are not always recorded and responded to appropriately. EVIDENCE: “I have never had any concerns” “Any problem is addressed immediately” (Comments received from a resident and a professional). The service user’s guide contains information about how to make a complaint. The majority of residents commented that they knew how to complain should they not be happy with aspects of the service. A relative however felt that the care service never respond appropriately when concerns have been raised about the care. The inspector asked to see complaint records. Old complaint/compliment records were found in a filing cabinet in the Manager’s office. The latest entry in the file was dated August 2006, and at the time of the inspection, it was unclear where complaints/concerns and compliments have been recorded post August 2006. Steps must be taken to ensure that staff are aware of the procedure for recording complaints/concerns and compliments. The complaint file should be accessible so that concerns, complaints and compliments can be recorded, investigated and responded to effectively. During the evidence gathering process of the last inspection, the Commission received information that staff were very concerned that important information, including safeguarding adults issues, were not always passed on Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 17 to the Commission. These concerns were referred to the Social Services Department responsible for safeguarding adults and are currently under investigation. The Commission has asked to be kept informed of the outcome of the investigation into these concerns. Some staff commented that they still feel that concerns raised with the senior management team are not and have not been taken seriously. Since the last inspection, staff have received further training to consolidate knowledge of how to refer concerns and allegations of abuse as per the local multi-agency policies. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 18 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 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is safe and has a programme to improve decoration, fixtures and fittings. The home however is not always clean and fresh and can be uncomfortably warm at times. EVIDENCE: “The place is always lovely and clean” “I have sometimes found that the cleanliness in the bedroom wasn’t as it should be. On three occasions dead flowers have been left well past their best.” “I love this room” “The toilets don’t always be clean nor fresh, but the rest of the home is clean. (Comments from relatives and residents) The home is situated in the Westbourne Park area with easy access to transport links and local amenities. The home is fitted with an intercom Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 19 monitoring door system and is safe and secure. The home is a purpose built home, which benefits from very well maintained and beautiful gardens. A number of residents were observed to be enjoying being outside and listening to music on one of the inspection days. The inspectors viewed the communal areas of the home and some of the residents’ bedrooms during the inspection. The home has within the last twelve months been redecorated, and the residents were involved in the choosing of the decor in their own bedrooms. Some of the rooms contained residents’ personal possessions, but one resident only had personal photographs from their flat. Residents who had completed comment cards commented that the home is usually or always fresh and clean. The inspectors noted however that there was a strong smell of urine in the home, especially on the upper units and the carpet in some areas was sticky. Steps must be taken to ensure that these issues are addressed so that the environment is fresh and clean. The bathrooms were seen in the units and were clean. Some bedrooms are a considerable distance from the lavatories, resulting in a high use of commodes. It remains a requirement that information provided about the home should make it clear that while most rooms are close to lavatories, others are some distance away. Since the last inspection, the inspectors noted that the macerator has been repaired. The temperature in some parts of the home was very warm on one of the inspection days with temperature reaching 29 degrees Celsius. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 20 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 judgement has been made using available evidence including a visit to this service. The service recognises the importance of staff training and thorough recruitment procedures. Permanent staff are dedicated but there is a high reliance on agency staff, which is impacting on the quality of care to residents. EVIDENCE: “The people who work in the care home are very well trained in understanding to the ways of the elderly. They also make the families and friends very welcome” “the people who work there are a dedicated group” “I find that some of these care assistants are not very qualified and have not much experience in line of work but I’m sure they do their best” “There has been some feedback that because of the current high useage agency support and managers, there is an eroding of the previous very high standards with permanent staff leaving fewer permanent staff to manage.” The staffing rotas were checked during the inspection. Staffing rotas reflected that there are seven staff on duty in the morning shift, five staff on duty in the pm shift and four staff on during the night. As identified at the last inspection, there is a high use of agency staff to cover shifts, which is impacting negatively on the continuity and quality of person centred care and interactions with residents. The inspector was informed that these vacant posts have been advertised, and have generated a positive response from potential applicants. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 21 At the time of the inspection, interviews were being arranged to recruit suitable candidates into vacant posts. The files of three members of the staff team were checked. The recruitment procedures are thorough and checks are completed on staff, which include past work history, references and CRB/POVA checks. The inspector noted that there have been some improvements noted in the provision of staff supervision since the last inspection. Inspectors noted that each staff member had attended induction training at the start of their employment. The staff team including domestic and catering staff have received training in dementia care developed by the Alzheimer’s Society. Information included in the Annual Quality Assurance Assessment indicate that at least 85 of care staff have achieved NVQ level 2 in care, which is commendable. The home has commissioned mental disorder training, which is due to be rolled out to all staff shortly. Through discussion with staff, it was noted that recent training opportunities have included Mental Capacity Act training, Risk Assessment training for Managers and Adult Protection training. The home has received general diabetes training from the diabetic nurse and staff have receive training in the use of the MUST tool from the dietician. The training records of three care staff were checked, and demonstrated that some staff are in need of training updates in safe working practices, including health and safety, infection control and manual handling. The inspector noted that in some cases, this training had been booked, but it was difficult to establish from the individual training records if staff had attended the training. The inspector has been informed that the next improvement priority for the home is to review the staff training plans to ensure they are reflective of the training undertaken by staff. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 22 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, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Commission still has some concerns about the standards of management within the home. The provider however has strategies in place for strengthening the management support and leadership within the home. EVIDENCE: “There should be a radical rethink of the management provision to allow RCM more time to work on the needs of their own Unit Service Users and not be forever trying to manage Duty for the whole home. They are becoming far too stressed. “ The home has a full time permanent Registered Manager who has been in post for more than 18 months. The Registered Manager is currently on sick leave and an interim Manager from another Westminster City Council home has been brought in to manage the home during this time. The second day of the inspection was his first day as the Manager of the home, and he was very helpful during and following the inspection process. The Commission has been Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 23 notified that he will continue to manage the home until at least the end of August 2007. Since February 2007, the Commission was made aware of information from a number of sources, indicating a breakdown in trust and confidence between staff and managers at the home. The Commission had concerns that the breakdown was likely to be having a negative impact on the lives of residents. The Council was asked to investigate allegations made by staff of poor practice by the Manager and report the outcome of the investigation to the Commission. To date, the Commission has not been notified of the outcome of this investigation. The Commission however has been kept informed of plans and strategies for improving the service and the involvement of external facilitators in this process, which have included fortnightly monitoring meetings and team building events. Staff feedback relating to these strategies were mixed, with some seeing improvements in the communication at the home, whilst others felt that concerns raised with senior management team are still not being taken seriously. Senior staff in particular are working very long hours and working often over their allocated shift time including their days off to ensure all their work is completed and up to their expected standards. The quality assurance systems in the home were checked during the inspection. A copy of the home’s business plan for the year 2007/2008 was forwarded to the lead inspector. The inspector noted from the quality assurance file that the latest satisfaction survey sent to residents and or relatives and other stakeholders was in February 2006. It remains a requirement that the home’s quality assurance systems should also be reviewed to include suitable ways for securing the views and experiences of people with dementia living in the home. As outlined under Standard 1, the results of the service user satisfaction questionnaires must be published in the service user’s guide. Internal audits of how the service is meeting the National Minimum Standards should take place at least annually. Audits of medication could not be located at the time of the inspection and therefore were not inspected. The Manager located the person in control reports during the inspection and it was noted that the last report on file was dated November 2006. Steps must be taken to ensure that monthly reports on behalf of the person in control are completed. There have been no changes to the management of residents’ finances. There are good systems in place for managing and recording residents’ finances. Residents’ money is securely stored in a lockable safe. Transactions are recorded and receipts maintained and signatures obtained. The financial procedures and practices are audited and past audits have been positive. The health and safety documentation was checked during the inspection. This provided the evidence that equipment is checked and maintained as required. Records were in place to illustrate that staff have received fire safety training and weekly fire alarm checks are performed to ensure that the alarm system is Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 24 fully operational. Weekly water temperature checks are undertaken and the inspector noted that the temperatures were within safe temperature for ensuring the safety and prevention of the residents from scalding. COSHH datasheets are in place and generic and fire risk assessments had been completed. Certificates were in place to demonstrate that the gas and electricity supplies to the home have recently been checked. There are nine trained first aiders employed in the home. Information taken from the Annual Quality Assurance Assessment completed by the Responsible Individual illustrated that four of the staff team have received training in infection control. It is important that all staff receive training and refresher training in the prevention of infection so that all staff have a clear understanding of their responsibilities to prevent the spread of infection. Managers must also ensure that staff have received refresher training in other safe working practices also (see staffing). It is a good practice recommendation that the Manager of the home produce an annual report containing information and incidents and outbreaks of infection, risk assessment, training and education of staff and infection control audit and the actions taken. During the inspection, one of the accident and incident books, which included incidents from January 2007 to 13th May 2007 could not be located and therefore could not be checked. Following the inspection, the CSCI were notified that the book has been found. Westmead Elderly Resource Centre DS0000036658.V340204.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 2 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X 3 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X 2 2 Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 26 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 OP1 OP21 Standard Regulation 5 Timescale for action The Service User’s Guide must 01/09/07 include a copy of the most recent inspection report and service users’ views of the home. Information about the home should include reference to the distance between a small number of the bedrooms and lavatories. This requirement is being repeated but is still within the original timescales given. Steps must be taken to ensure 01/09/07 residents receive the information they need to make an informed choice about where they live. The placement of the resident 01/08/07 referred to during the inspection who has been wanting to leave the home since admission must be reviewed and their wishes and feelings taken into account. Steps must be taken to ensure 01/08/07 that advice from health care professionals are followed so that residents’ healthcare needs are met. Medication must be administered 01/08/07 as prescribed DS0000036658.V340204.R01.S.doc Version 5.2 Page 27 Requirement 2 OP1 5 3 OP4 12.1, 2, 3, 4, 4 OP8 13.1 5 OP9 13.2 Westmead Elderly Resource Centre 6 OP9 13.2 7 OP9 13.2 8 OP9 13.2 Immediate requirement notice left Enforcement action has been taken by the CSCI to ensure compliance. Medicines must be recorded 01/08/07 accurately in the home when administered. If not administered the correct endorsements must be used. Repeat requirement. Original timescale of 07/10/06 and 14/02/07 not met. Immediate requirement notice left Enforcement action has been taken by the CSCI to ensure compliance. Staff must be competent to 01/08/07 administer medication safely Enforcement action has been taken by the CSCI to ensure compliance. That the manager continues to 01/07/07 audit weekly at least, the MAR to ensure accurate recording and administration. Records must be available for inspection. The home develops systems of improving communication and records between prescribers and staff in the home particularly around dosage changes. The fridge must be kept locked and the minimum /maximum temperature recorded daily. Storage in areas where the temperature reaches 29 degrees must be reviewed. 01/07/07 9 OP9 13.2 10 OP9 13.2 14/06/07 11 12 OP10 OP12 OP7 12 (4 and 5) 12 Steps must be taken to ensure 01/07/07 that the privacy and dignity of residents are upheld. The culture of task centred care 01/09/07 focusing on jobs to be completed by a schedule must be reviewed DS0000036658.V340204.R01.S.doc Version 5.2 Page 28 Westmead Elderly Resource Centre 13 OP15 16 14 OP15 12 (4 and 5) 15 OP16 22 16 OP18 OP31OP32 9, 10, 21,22 17 18 OP26 23 17, 18 OP30 & OP38 19 OP33 24 to move towards a person centred approach involving residents in all aspects of their care. Mealtimes, in particular the timing of the evening meal, must be kept under review. Staff must record when snacks are offered to service users in the daily notes. Original timescales of 30/04/07 not met this is a repeat requirement. Staff interaction with residents, in particular during mealtimes must be improved to ensure that residents receive the support and reassurance needed. Steps must be taken to ensure that staff are aware of the procedures for recording complaints/concerns and compliments and that they are effectively documented and investigated. The Social Services Department must make sure that any allegations of poor practice by the Manager are investigated and the Commission must be notified of the outcome of the investigation. This requirement is repeated as the investigation is ongoing. The home must be kept clean, free from malodours and comfortable. Steps must be taken to ensure that staff are up-to-date in their training in safe working practices and that their individual training records are updated to reflect this. The home’s quality assurance systems must be reviewed to include suitable ways for securing the views and DS0000036658.V340204.R01.S.doc 01/08/07 01/07/07 01/08/07 01/07/07 01/07/07 01/08/07 01/10/07 Westmead Elderly Resource Centre Version 5.2 Page 29 20 OP33 26 experiences of people with dementia living in the home. Original timescales of 01/06/07 not met, this is a repeat requirement. Steps must be taken to ensure 01/09/07 that monthly reports on behalf of the person in control are completed. Night staff must note the times 01/08/07 of care given, including drinks and snacks. Original timescales of 30/04/07 not met, this is a repeat requirement. A better system must be put in 01/08/07 place to enable information in previous daily notes to be retrieved easily and referred to. 21 OP37 17 22 OP37 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP9 OP9 Good Practice Recommendations That two care workers administer complex medicines such as warfarin That the pharmacist is requested to provide patient information leaflets. A British National Formulary must be available for reference at all times. That the time of insulin administration in the evening is recorded and adjusted if necessary on discussion with the community nurse. Staff should look into other ways that they can support a resident to meet their religious needs. For example through CD’s, music, video’s and contact with people from their same religion. Internal audits of how the service is meeting the National Minimum Standards should take place at least annually. DS0000036658.V340204.R01.S.doc Version 5.2 Page 30 3 OP9 OP12 4 5 OP33 Westmead Elderly Resource Centre 6 OP38 The Manager of the home should produce an annual report containing information and incidents and outbreaks of infection, risk assessment, training and education of staff and infection control audit and the actions taken. Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Westmead Elderly Resource Centre DS0000036658.V340204.R01.S.doc Version 5.2 Page 32 - 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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