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Inspection on 23/08/05 for Westmead Elderly Resource Centre

Also see our care home review for Westmead Elderly Resource Centre for more information

This inspection was carried out on 23rd 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users` needs are assessed prior to admission and care plans for meeting the identified needs. The home provides a safe, comfortable and homely environment with adequate communal areas both indoors and outdoors. Service users` own rooms are equipped with good quality furniture. The staff team is well established and well qualified. Seventy five percent of the staff team have either obtained NVQ qualification at level 2 or above or are currently studying. The home provides very good training opportunities.

What has improved since the last inspection?

The home has successfully been granted registration to care for seven service users with dementia and eleven service users with mental health needs. Details of the fees payable have now been made available to service users as part of their contract of terms and conditions. Staff have worked to ascertain the wishes and feelings of service users regarding death and dying and have incorporated these wishes into their care plans. A signature list of all staff who administer medication has been put together since the last inspection to ease identification. The inspector also noted that full initials are used when recording the administration of mediation to minimise signatures being misinterpreted as codes.

What the care home could do better:

A total of seven requirements and three recommendations were set following the inspection. One of the requirements were repeated from the last inspection, which was to ensure that appropriate interventions are put in place for those identified of being at risk of falling. The inspector noted that any allergies must be noted on service users` Medication Administration Records and codes used when medication is not administered must be clearly defined. The Registered manager of the home has left her post and the Commission must be formally notified of the arrangements for managing the home. The strong smell of urine in one of the units must be removed and all incidents/accidents that fall under regulation 37 must be reported to the Commission without delay.

CARE HOMES FOR OLDER PEOPLE WESTMEAD ELDERLY RESOURCE CENTRE 4 Tavistock Road LONDON W11 1BA Lead Inspector Ffion Simmons Unannounced 23 August 2005 @ 10.45 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 ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Westmead Elderly Resource Centre Address 4 Tavistock Road, London W11 1BA 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) 020 7641 4595 020 7641 5781 Westminster City Council Mrs Anna Ray-Kidger Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22 March 2005 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 total 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. The home 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, with a residential care manager allocated to each to oversee the care. Each resident has their own bedroom, and there is a range of communal areas within the home. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place in August 2005 and lasted a total of 6½ hours. The inspector spent time touring the building, talking to service users and staff and checked records and other documentation. The inspector also tracked the care of service users and received feedback forms from service users, relatives and/or visitors and professionals. Some comments from these have been incorporated into the body of the report. A preinspection questionnaire was also completed. The inspector felt that the standards of care in the home are very good. What the service does well: What has improved since the last inspection? The home has successfully been granted registration to care for seven service users with dementia and eleven service users with mental health needs. Details of the fees payable have now been made available to service users as part of their contract of terms and conditions. Staff have worked to ascertain the wishes and feelings of service users regarding death and dying and have incorporated these wishes into their care plans. A signature list of all staff who administer medication has been put together since the last inspection to ease identification. The inspector also noted that full initials are used when recording the administration of mediation to minimise signatures being misinterpreted as codes. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 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. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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 ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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) 2,3 Standard 6 is not applicable. Service users have a written contract of terms and conditions of residency, which includes the fees payable. This ensures that service users are aware of their rights and responsibilities. Full information is available on the needs of service users prior to them moving, allowing the home to admit service users whose needs they can meet. EVIDENCE: The home’s terms of residence was seen during the inspection. The contract included details on services provided. Since the last inspection, the details of the fees payable have been made available to service users and was on file for a recently admitted resident. All residents admitted to the home undergo a needs assessment, which are carried out by the Care Managers. The care needs assessment was on file for a recently admitted resident. The assessment was comprehensive and included any identified risk factors and was forwarded to the home prior to admission. A care plan is completed for each resident based on the needs identified within the assessment. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 9 The home does not provide intermediate care. Two beds have been allocated to provide respite care. Where residents are admitted for respite care, they have access to the same facilities and equipment as permanent residents. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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) 7,8,9,10,11 Good information is available on the needs of the service users and care plans are regularly updated enabling staff to identify and meet their needs. Risk assessments and risk management strategies should be in place for all service users identified at being at risk of falling to minimise risk and protect service users from harm. The systems in place for the management and administration of medication are good but staff need to ensure that when codes are used that they are defined so that it is clear why medication was not administered. Any allergies should also be clearly identified on the MAR sheet. EVIDENCE: The inspector viewed the care plans of four service users during the inspection and the care of service users were tracked. The quality of the care plans is good and there was evidence that the plans are updated regularly. Waterlow assessments are completed on all service users to assess the risk of developing pressure sores and service users weights are well monitored. Two of the four service users tracked had a history of falling. No risk assessments were in place to minimise this risk. It remains a requirement that appropriate interventions are put in place for those who are identified of being at risk of falling and that they should be regularly updated. Positive comments were received from professionals associated with Westmead and included “The WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 11 Managers and staff are excellent. The keyworking staff have excellent knowledge of their residents and advocate with them well.” Since the last inspection, the service users’ wishes regarding death and dying have been obtained where possible and recorded within the service users’ care plans. Westmead aims to be a home for life and external support from district nurses and Macmillan nurses would be sought to enable the needs of the service users to be met. Should this not be possible then an alternative placement would be sought. The medication was checked on two of the four units. The inspector noted that the Medication Administration Records on the whole were well completed. A signature list of all staff who administer medication has been put together since the last inspection to ease identification. The inspector noted on the MAR sheets that the code O was sometimes used when medication was not administered. The code O was occasionally not defined and other times the definition was not clear. The inspector also noted that service users’ allergies were not clearly noted on the MAR sheet and this should be done and also that all medication no longer prescribed should be removed. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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, 14 Service users on the whole are satisfied with the activities on offer but commented that they would like more opportunities to go out into the community. Service users are encouraged to maintain contact with their friends and families. EVIDENCE: On the day of the inspection, a birthday party was taking place during the afternoon. Service users also enjoyed commemorating VJ day the previous week. A BBQ also took place in July. Other activities include bingo, art, quizzes and one-to-one. All service users who completed a comment card felt that the home provided suitable activities. One service user expressed during the inspection that they would like to be supported to go out into the community a lot more frequently but staffing levels do not permit this. Staffing levels should be reviewed to ensure that there are sufficient staff on duty to provide the flexibility for service users to be supported to go out of the home. All relatives/visitors commented in the feedback cards that staff welcome them into the home and that they can visit their relative in private. One of the service users commented, “I like living at Westmead. The staff encourage me to keep in contact with my family in Canada.” WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 13 During the inspection, service users were observed assisting staff with chores around the house such as sorting the laundry and setting the tables. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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 The complaint policy is well publicised resulting in service users being aware of whom to speak with if unhappy with their care. Robust systems are in place for dealing with complaints. EVIDENCE: A complaint policy is available and is well documented. All service users who completed a comment card answered that they knew who to speak with should they be unhappy with their care. Details for referring complaints to the Commission was on display in the home. There have been no formal complaints recorded about the service within the last twelve months. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 15 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) 19, 20, 23, 24, & 26 The home provides a safe, and comfortable environment with adequate communal areas both indoors and outdoors. Service users’ own rooms are equipped with good quality furniture and are homely. The smell of urine in one of the units must be removed. EVIDENCE: The home was purposely built in 1975 and designed specifically for providing care for the elderly. The home is situated in the Westbourne Park area with easy access to transport links and local amenities, which include shops, banks, restaurants, pubs and coffee shops. The home is fitted with an intercom monitoring door system. Service users in the comment cards commented that they felt safe at the home and liked living there. Each unit has its own kitchen, dining and sitting areas, equipped with a TV and hi-fi system. The communal areas provide adequate spaces for social activities and individual activities. The shared spaces were seen to be well furnished and comfortable. Service users can see their visitors in private if they choose. The home has two outside gardens and an inner courtyard offering an attractive WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 16 outside space for service user. The inner courtyard area is accessible to wheelchair users. Each service user have their own single bedroom equipped with good quality furniture and fittings. Service users are encouraged to bring their personal possessions into their rooms. A relative expressed satisfaction and commented “my relative’s room is always kept clean and tidy by the staff.” Laundry facilities are on site and situated away from kitchen areas. The washing machines have the required programmes for ensuring that clothes are washed at appropriate temperatures. The home was clean and tidy throughout, but there was a strong smell of urine on one of the units, which needs to be removed. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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 percentage of staff qualified with NVQ or working towards this qualification is high and the home must be complemented on obtaining this percentage. The home offers good training opportunities including dementia training. Recruitment procedures are thorough. Service users therefore benefit from receiving care from suitable, well-established and well-qualified staff team. Staff appeared very busy on the morning of the inspection and staffing levels should be reviewed during the morning shift. EVIDENCE: On the morning of the inspection there were six staff on duty in the morning and their care supervised by a Residential Care Manager. Staff appeared very busy in the morning and service users commented that they were unable to go out into the community as often as they wished due to staff being very busy. It is a recommendation that staffing levels are reviewed during the morning shift. Staffing levels at night are currently being reviewed and proposals are in place to increase the night carers by two. A staff member is currently being employed for 30 hours per week to assist with cleaning service users’ rooms. Eleven care workers are qualified to NVQ level 2 or above and four staff are working towards this. This means that 75 of the staff team have either obtained a qualification or are working towards this. All new employees are registered on the TOPSS induction programme and are able to undertake other relevant training. Three of the care staff have a diploma in dementia with opportunities for other staff to undergo dementia training in house. The home has recently been registered to care for eleven service users with mental WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 18 health needs. It is a recommendation that training in caring for service users with mental health needs is offered to staff to ensure their needs are fully met. Thorough recruitment procedures are in operation with checks seen to have been completed on staff. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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, 32, 35 standard 38 was parly inspected. The home’s Registered Manager has recently left her employment at the home. Future arrangement for managing the home must be confirmed. The care provided on each shift is overseen by experienced and well-qualified residential care managers. Systems are in place for safeguarding service users’ financial interest. EVIDENCE: On the day of the inspection the inspector was informed that the registered manager has left employment at the home. She was a very experienced manager and had managed the home for a number of years. The Commission must be formally notified of the change in management arrangements and must be notified of the arrangements for appointing a suitable person for managing the home. The assigned person must also make an application as the Registered Manager with the Commission. A Residential Care Manager is on duty at each shift to oversee the care provided to service users. They are well qualified and experienced. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 20 Accurate records are maintained where the money of service users is handled and kept for safekeeping. Receipts are kept and signatures obtained. The financial records and balances of five service users were checked during the inspection and were found to be correct. The accident and incident book was checked during the inspection. The inspector noted that some accidents/incidents reportable under regulation 37 had not been reported to the Commission and should be done. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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 x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 x COMPLAINTS AND PROTECTION 3 3 x x 3 3 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x x x 3 x x 2 WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 22 yes 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 8 Regulation 13 [4] Requirement Appropriate interventions must be in place for those identified of being at risk of falling and risk assessments should be regularly updated. This is a repeat requirement. Staff must ensure that codes used to explain why medications are not administered, are clearly defined/explained. Any known allergies must be noted on the service users drug charts. The stong smell of urine on one of the units must be removed. The Commission must be formally notified of the change in management arrangements and must be notified of the arrangements for appointing a suitable person for managing the home. The appointed Manager must Register with the Commission as the Registered Manager The Commission must be given notice without delay of those situations which fall under regulation 37. Timescale for action 30 September 2005 2. 9 13 [2] 30 September 2005 30 September 2005 30 September 2005 15 September 2005 3. 4. 5. 9 26 31 13 [2] 16 [2] (k) 39 6. 7. 31 38 Care Standards Act 2000 37 01 November 2005 15 September 2005 WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 23 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. 3. Refer to Standard 9 13 & 27 30 Good Practice Recommendations Medication no longer prescribed should be removed. Staffing levels should be reviewed to ensure that there are sufficient staff on duty to provide the flexibility for service users to be supported to go out of the home. Staff should be offered appropriate training in caring for serice users with mental health needs. WESTMEAD ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26/28 Hammersmith Grove London W6 7SE 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 ELDERLY RESOURCE CENTRE G60-G09 S36658 WESTMEAD ERC UIV237570 230805 STAGE 4.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. 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