Inspection on 27/05/08 for Westmead Elderly Resource Centre

This inspection was carried out on 27th May 2008.

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

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 28/01/08

Westmead Elderly Resource Centre 11/06/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Westmead Elderly Resource Centre 4 Tavistock Road London W11 1BA Lead Inspector Ffion Simmons & Jane Shaw (Pharmacist Inspector) Key Unannounced Inspection 10:10 27th & 28th May 2008 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.V364362.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.V364362.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 nwaenie@westminster.gov.uk Westminster City Council Vacant Post 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.V364362.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. 28th January 2008 Date of last inspection Brief Description of the Service: The home is registered to care for up to 42 elderly residents of either gender. The home is registered to care for residents with dementia and for residents 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 £554.84 per week. Details of what this fee does not include can be found in the home’s brochure. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced key inspection took place over two days on the 27th and 28th of May 2008 and lasted a total of 13 hrs and 45 minutes. During the inspection, we spoke with residents, staff and relatives and their comments have been used as evidence. We observed care practices using the Short Observational Framework for Inspection (SOFI), a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to their cognitive or communication impairments. We tracked the care of three residents, and in doing so we checked their personal records. A number of records and documentation was checked during the inspection, including care plans and risk assessment, staff files, health and safety documentation, the home’s complaint records and quality assurance documentation. A full audit of medication was carried out by a specialist Pharmacist Inspector to assess the home’s management of medication. Questionnaires were sent to residents, relatives/carers and advocates, professionals and staff to comment on the service. We had a 3 return rate, which consisted of two questionnaires, one from staff and one from a health professional. We have used the information within these questionnaires to contribute to the content of the report. The Responsible Individual took time to complete and return the Annual Quality Assurance Assessment (AQAA), which has been used as evidence to inform this report. What the service does well: What has improved since the last inspection? Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 6 The home’s brochure now includes a copy of the last inspection report and the results of the home’s residents’ survey, which was undertaken in January 2008. This provides prospective residents with up-to-date information to enable them to make an informed choice about moving into the home. There has been much improvement in the safe handling of medication in the home, resulting in residents receiving their medication as prescribed. The activities co-ordinator has worked hard to obtain more detailed information about each resident, such as how they would like to spend their day and their interests. This promotes more person-centred care. Improvements were noted in the cleanliness of the home and as a result the home was pleasant and free from odours. A Quality Assurance Officer role has been introduced to monitor administration and systems in the home. This is considered an important role, which is having a positive impact on the quality of some aspects of the service. What they could do better: Risk assessments must be in place for residents who are at risk of falling and must be available at all times for staff reference. This is to ensure that all staff are made aware of the risks and to implement the management plan so that the risk to residents’ safety is minimised. Residents must receive the input of a community dietician and the GP when they have been identified of being at high risk of malnutrition and where concerns about their nutritional and fluid intake and weight loss have been identified. This is so that their health care needs can be fully met. Staff including agency must follow the correct procedures for handling and administering medication safely. This is to prevent error and ensure that medication is administered as prescribed. Controlled drugs must be stored in accordance with the Misuse of Drugs regulations. Robust recording and audit must continue to provide evidence of safe administration of medication. 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 staffing levels must be reviewed again to ensure that residents’ increasing and changing needs are met. The length of the 08:00 to 21:00 shift must be immediately reviewed to ensure that the long hours that staff are on duty, does not affect the quality of care of residents. The high use of agency staff must be reviewed to promote better continuity of care to residents. Individual training records must be kept up-to-date to reflect training attended and to highlight when training updates are required. This is important to promote the Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 7 health, safety and well-being of residents. Staff must receive formal one-toone supervision so that they feel supported and to do their job to a high standard. Personal development plans must be in place so that staff’s individual training needs and interests are highlighted. The reports undertaken on behalf of the registered provider must be undertaken on a monthly basis. The reports must be forwarded to the home promptly so that any action from the visits can be implemented without delay. 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.V364362.R01.S.doc Version 5.2 Page 8 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.V364362.R01.S.doc Version 5.2 Page 9 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, Standard 6 is not applicable. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have access to the home’s brochure to help them make an informed choice whether to move in to the home. Personalised assessments are undertaken prior to a resident moving in. This ensures that the home understands their needs and can be confident that their needs can be met. EVIDENCE: During the inspection we looked at the home’s brochure, which gives an introduction to the home’s facilities and services. The brochure was available at the home’s main reception area for interested parties to take away and read. Since the last inspection in January 2008, we noted that a copy of the last inspection report and the results of the home’s residents’ survey, which was undertaken in January 2008, have been included to the brochure. This provides prospective residents with up-to-date information to enable them to make an informed choice about moving into the home. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 10 We tracked the care of three residents during the inspection and we checked their personal records. One of these residents had recently moved in to the home. Records showed that a full needs assessment had been undertaken through care management arrangements. A copy of the assessment had been sent to the home prior to the resident moving in. This enabled the home to assess whether their needs could be met at the home. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 11 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. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents’ health, personal and social care needs are known and included in an up-to-date plan of care but did not include areas such as financial support. Residents’ health care needs are not always addressed promptly and risk assessments were not consistently in place. Care workers give medication according to the prescriber’s instructions and as a result residents’ health and welfare are therefore better protected. EVIDENCE: During the inspection, we tracked the care of three residents living at the home. Part of the case tracking process involved checking their personal records. Residents’ personal information was in good order and the relevant information could be easily found. The care plans seen were generally up-todate and provided good detail. Generic risk assessments have been introduced to provide brief overall assessment of the risks to residents. We were told that staff aim to supplement these generic risk assessments with more detailed risk Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 12 assessments where specific risks have been identified for example when residents are at risk of falls and to identify manual handling risks. One of the residents whose care was tracked had been identified of being at risk of falling within the initial referral assessment and at risk of financial abuse. We asked to see these risk assessments, but they were not in place. It remains a requirement that risk assessments are in place for residents who are at risk of falling and that the risk assessments are available at all times for staff reference and available for inspection. This is to ensure that all staff are made aware of the risks and to implement the management plan so that the risk to residents’ safety is minimised. It is considered good practice to monitor/audit the incidents of falls on a regular basis and this is a recommendation. Details relating to this resident’s needs around their finances should also be included into the care plan. We noticed that residents have access to a dietician when staff have concerns about residents’ diet and fluid intake. Staff aim to monitor residents’ weights on a monthly basis, although we were told that they do not always have the time to do this because they are “so rushed”. We were concerned to note from checking records that one of the residents case tracked had lost 6.7Kg in weight within one month. There was no evidence that this significant weight loss had been reported to the General Practitioner and no referral to a dietician had been made. We were concerned to see that it was a further month before the residents’ weight was monitored again, with no evidence that food and fluid monitoring charts were completed. Staff should receive refresher training on meeting the nutritional needs of residents. The recording of receipts, administration and disposal of medication was inspected and audited against the stock held. It was pleasing to note that there had been much improvement in the safe handling of medication in the home. No omissions were noted in the Medication Administration Records either for recording the receipts or administration. When tablets were counted all samples taken could be reconciled against the number of signatures. This means that there was evidence that care workers were giving medication according to the prescriber’s instructions and were protecting the health and welfare of the residents. Storage was well organised and secure and there was no evidence of excess stock. Some attention is still needed to accurately record the minimum and maximum temperature of the fridge. Balances of controlled drugs were correct but Temazepam must be stored in controlled drug cupboard meeting the requirements of the Misuse of Drugs Act. It was transferred at the time of the inspection. Changes of dosages including those for variable doses such as warfarin were recorded accurately with the original evidence with the MAR (Medication Administration) for reference. Some attention is still needed though in accurately recording other variable doses e.g. 10 or 20ml. We were able to track dosage changes to the communication book and the residents care plan and health notes. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 13 The district nurse visited twice daily to administer insulin and recorded in her notes .The current dose of insulin should still be listed on the MAR, as this is the list of current medication. There was evidence of visits by other heath care professionals particularly dieticians and the GP and CPN. It is important that there is now a period of consolidation and the robust recording and audit continues in order to maintain the current standards and sustain the improvement achieved. The home‘s procedures on safe administration must be continually reinforced to both contracted and agency staff to avoid careless errors such as a recent missed warfarin dosage. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 14 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. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A varied programme of activities is available but more opportunity for one-toone activity may be of benefit to some of the residents. Visitors are welcomed into the home and residents are supported to maintain important personal and family relationships. The meals offered cater for the varying cultural and dietary needs of individuals. Where residents are not satisfied with the options/quality their views have been taken into account. EVIDENCE: The home has an activity co-ordinator who facilitates the programme of activities. We saw the weekly activity programme and saw that activities take place between 10am and 12 pm and between 2pm and 4pm each day. The activities include crosswords, creative activities, hand massage, quiz games, art and bingo, reading and discussing newspapers and music and movement. Reminiscence sessions take place on Saturday and Sundays, and we discussed the possibility of developing life story books as part of the activities programme. Since the last key inspection in January 2008, the activities are now better advertised so that residents can be reminded of what activity is taking place so that they can take part if they wish. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 15 The activities co-ordinator showed us some of the work that they have completed on gaining more detailed information about each resident, such as how they would like to spend their day and their interests. The care plans seen also contained some information about residents’ interests and religious and cultural needs. Once per month, residents are able to take part in the church service, which takes place at the home. The Responsible Individual within the AQAA also told us “we celebrate the cultural diversity of our service users through music and food”. International days are organised whereby residents can enjoy food and music from different countries if they choose to take part. Residents also have access to a day centre, specifically run for older people of African and Caribbean background. It was encouraging to note that a recent residents’ meeting was well attended and they were given the opportunity to discuss options for going on outings and activities in the home. The activities co-ordinator told us that a group of residents visited Lords cricket ground recently and thoroughly enjoyed this trip. The home is looking at offering residents more options for outings such as visits to Hyde Park, to go for a pub lunch and an outing on the London Eye. The Responsible Individual told us within the AQAA “we are looking at the possibility of training staff as drivers for group trips as well as encouraging more one-to-one trips with service users and key workers”. We noticed from checking the minutes of residents’ meetings that they expressed that they would prefer more one-to-one activity sessions. More one-to-one activities may also be of benefit to residents who experience the symptoms of dementia such as agitation. The home has a four-week menu, which gives an alternative dish for each meal. Vegetarian option is available but it was commented that these “could be spiced-up”. The kitchen staff cater for residents’ cultural dietary needs. We saw that residents were offered soft drinks and water throughout the day to make sure they are well hydrated. We saw fresh fruits on offer in the units. Food was discussed at the residents’ meeting on the 6th May 2008. Residents expressed that they were not happy with the boiled potatoes and commented that they would like different choices of desserts. We were told that the kitchen staff have made arrangements to ensure that their wishes are met. Arrangements are also in place for the kitchen staff to join the residents’ next meeting to discuss menu options. Westmead Elderly Resource Centre DS0000036658.V364362.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. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure is clearly written and easy to understand. Complaints from individuals are not always fully recorded and outcomes and actions are not always being properly logged. Staff understand and follow the procedures for protecting residents from abuse. EVIDENCE: The home has a complaints policy, which is accessible to residents within the home’s brochure. A pictorial version of the complaints policy is now available making the content of the policy easier to understand. A complaints and compliments book is available at the main reception for residents, relatives and visitors to write in any comments they have on the service. When checking daily records at this inspection, we noted that a resident had expressed some concerns about the action of another resident. It was documented that the Manager on duty had been notified, but there were no records of what action had been taken to investigate and whether the resident was satisfied with this outcome. This has been identified as an area for improvement by the Responsible Individual, who wrote in the AQAA “all managers need to make sure they are aware of protocols for recording and dealing with complaints, and ensuring that an audit trail of events and action(s) taken are easily followed”. It remains a requirement that staff are aware of the procedures for recording complaints/concerns and compliments and that complaints are documented and investigated. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 17 Staff follow the Westminster City Council’s safeguarding adults procedure for reporting any incidents and/or allegations of abuse. The referral procedure/pathway to the safeguarding adults team was on display. Staff have received training in the protection of vulnerable adults and more refresher training is planned. Recent referrals have demonstrated that staff have a clearer understanding of the safeguarding procedures resulting in all incidents being reported promptly. Westmead Elderly Resource Centre DS0000036658.V364362.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, 25 & 26. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and well-maintained home, which is homely, and comfortable. The home is accessible and meets the specific needs of the people who live there. EVIDENCE: The home was purpose built and is situated in the Westbourne Park area with easy access to transport links and local amenities. The home is fitted with an intercom monitoring door system, which promotes the safety and security of the residents living in the home. There is a ramp leading to the main entrance of the home and there is a lift in place for accessing the home’s lower ground level. Residents have access to the well-maintained gardens and a new gazebo has been installed within the rear gardens. A café/shop area is currently being constructed in the grounds of the care home. The AQAA confirmed that once completed that both gazebo and Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 19 café/shop area will “give more useable and enjoyable space to service users, whilst facilitating greater independence within a safe environment”. There are no en-suite bedrooms in the home and some bedrooms are a considerable distance from the lavatories, resulting in a high use of commodes. The information provided about the home however makes references to this distance so that prospective residents are aware of this prior to moving in. During the inspection, we noticed that the home was looking cleaner and free from the malodours that were present at previous inspections. There is an urgent need to look further into the management of the temperature in the home as the home was uncomfortably warm during the inspection. One of the residents told us that they found the heat very uncomfortable. The Responsible Individual recognises within the AQAA that this is an area for improvement. Westmead Elderly Resource Centre DS0000036658.V364362.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. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service recognises the importance of training, and tries to deliver a programme relevant to the needs of the residents. There is a high reliance on agency staff and some staff are working long hours. Together this is believed to be impacting on the quality of care to residents and the ability for further improvements in the service. EVIDENCE: The staffing rotas were checked during the inspection. Staffing rotas reflected that there are a minimum of six (occasionally seven) staff on duty in the morning shift and a minimum of five staff (occasionally six) on duty in the pm shift and four staff on during the night. At the home’s random inspection in October 2007, it was noted that staff were working long shifts of 08:00 to 21:00. At this time, the Commission expressed concerns about the impact that these long hours may have on the quality of interaction and care of the residents. The home was required to review the long shifts of 08:00 to 21:00. At this key inspection, we were concerned to note that staff were still asked to work from 08:00 to 21:00 despite the requirements of the October 2007’s random visit. The length of this shift must be immediately reviewed to ensure that the long hours on duty, does not affect the quality of care of residents. Again during this inspection, staff looked busy and they commented that they are short on time to complete the tasks required of them. This was also supported by comments from a relative who explained that sometimes a carer Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 21 works on their own in one of the units, which puts them under great pressure. At the home’s last key inspection in January 2008 we made a requirement that the staffing levels are reviewed again to ensure that residents’ increasing needs are met. Some more one-to-one time with residents may also benefit their well-being, and residents during their meetings have requested more one-to-one time with staff. The AQAA, which was completed by the Responsible Individual, demonstrated that there is a total of 29 staff working in the home, 20 of the 29 are permanent care staff but the remaining 9 are agency staff. In the last three months leading up to the inspection, 240 shifts were covered by agency care staff and 106 shifts by agency senior carers. The use of agency staff remains very high and feedback from staff and relatives was as the last key inspection, which was that this is impacting on the quality of care. The Interim Manager confirmed that three of the five vacant post have been filled but staff have not started work as yet as they are currently processing their pre-employment checks. During the inspection, staff interactions with residents were variable. Some staff were professional in their approach, facilitating choice and recognising the importance of a relaxed atmosphere. Other less positive interactions were noted where staff on a couple of occasions did not allow residents to use the abilities that they have and for example disturbing their sleep. One of the residents told us that the communications skills of some staff are very poor and made them feel useless. Information within the AQAA demonstrated that 48 percent of the total staff group hold a National Vocational Qualification at level 2 or above. A further 25 are working towards this qualification. The Responsible Individual told us within the AQAA “we are now working towards enabling a number of staff to take level 3.” All staff have completed the Alzheimer Society’s Yesterday, Today training but would benefit from updated training in dementia care. It was encouraging to see that planned training includes Therapeutic Activities in Dementia Care. Staff have again received training in the management of medication and there are nine staff due to attend infection control training in July and September 2008. There are also plans in place for delivering mental health disorder training to all staff via the managers. Individual staff training records, however did not reflect that staff are up-to-date in their training in safe working practices. Westmead Elderly Resource Centre DS0000036658.V364362.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, 36 & 38. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has been without a permanent full-time Manager for a significant period of time, which has impacted on service improvements. Systems are in place for safeguarding residents’ financial interest. Staff supervision is infrequent and inconsistent. The health and safety of residents are not always protected due to incomplete documentation and gaps in staff training in safe working practices. EVIDENCE: The home is still without a Registered Manager in post. Since the 25th June 2007, the home has been managed by an interim manager, who is also responsible for the management of another care home. As a result the interim manager has been unable to dedicate full time hours to the management of this home. Some improvements in the home have been noted but there is a need for this to be continued and sustained. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 23 An urgent requirement was made at the homes’ random inspection in October 2007 that permanent full time management arrangements are put in place. Enforcement action was taken by the Commission in February 2008 to make sure that at all times a suitably qualified, competent and experienced person is working at the care home to ensure the health and welfare of service users. Westminster City Council have identified a suitable person to run the home and have suggested that this person will be in post towards the end of July 2008. The following comments were made in a feedback form “we have had no Manager (full time) for a long while. This needs to be corrected as soon as possible. Westmead needs a strong leader, someone who doesn’t put up with any nonsense from Managers and care staff. Then maybe we can get back on track”. It is a legal requirement for providers to complete an Annual Quality Assurance Assessment (AQAA) and return to the Commission. The Responsible Individual completed this document, but did not submit the information within the timescales given. Person in control reports were available for inspection. The latest report available in the home was from March 2008’s visit. The reports include the views of residents and staff at the time of the visit. Steps must be taken to make sure that reports are undertaken on a monthly basis and the reports forwarded promptly to the home so that any action from the visits can be implemented without delay. A resident satisfaction questionnaire was circulated to residents in January 2008 and as previously discussed in this report, the findings are made available to prospective residents within the home’s brochure. A Quality Assurance Officer role has been introduced to monitor administration and systems in the home. This has resulted in robust medication audits taking place resulting in significant improvements in the overall management of medication. We also saw evidence that care plans and risk assessment were being regularly audited. This is considered an important role, which is having a positive impact on the quality of some aspects of the service. We checked the home’s systems for managing and recording residents’ finances. We found that residents’ money was securely stored in a lockable safe. Balances were checked and were correct for the residents we case tracked, and transactions were recorded and receipts maintained. As discussed previously in this report, there is a need to make sure that a risk management plan is in place for the resident who has been identified of being at risk of financial abuse and their care plan must highlight their needs in this area. During the inspection we checked the personal records of staff and were concerned to see that staff are not receiving formal one-to-one supervision on Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 24 a regular basis. The Responsible Individual confirmed within the AQAA that this is an area that the home could do better, and wrote “the management and supervision regime needs to be more consistent and personal development plans need to be kept up-to-date.” The home’s six monthly health and safety audit was taking place on the afternoon of the second day of the inspection. Health and safety documentation was checked and were up-to-date. As discussed previously within this report, it remains a requirement that risk assessments are in place for residents who are at risk of falling. This is to ensure that all staff are made aware of the risks and to implement the management plan so that the risk to residents’ safety is minimised. The incidents of falls should be regularly monitored/audited. We checked the staff training records, which did not reflect that staff are up-to-date in their training in safe working practices in for example food hygiene and manual handling. Staff training records and personal development plans should be kept-up-to date to make sure that staff have received the necessary training in safe working practices to promote the health and safety and welfare of residents. Staff were observed not to be wearing protective clothing when serving meals to residents. This highlights the need for further training in this area. Westmead Elderly Resource Centre DS0000036658.V364362.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 13 Timescale for action Risk assessments must be in 01/08/08 place for residents who are at risk of falling. The risk assessments must be available at all times for staff reference and available for inspection. Original timescales of 01/12/07 not met, this requirement is repeated for the second time. Risk assessments must be in 01/08/08 place for residents who are identified of being at risk of financial abuse. Details relating to resident’s needs around their finances should be included into the care plan. Steps must be taken to ensure 01/07/08 that residents receive the input of a community dietician and the GP when they have been identified of being at high risk of malnutrition and where concerns about their nutritional and fluid intake and weight loss have been identified. That all staff including agency 01/07/08 follow the correct procedures for handling and administering DS0000036658.V364362.R01.S.doc Version 5.2 Page 27 Requirement 2. OP7 13 3. OP8 13 4. OP9 13 (2) Westmead Elderly Resource Centre 5. OP9 13 (2) 6. OP9 13 (2) 7. OP16 22 8. 9. OP25 OP27 23 (2) 18 10. OP27 18 11. OP27 18 12. OP30 & OP38 17, 18 medication safely. This is to prevent error and ensure that medication is administered as prescribed. That there continues to be robust recording and audit in the home to provide evidence of safe administration of medication. That controlled drugs are stored at all times in a cupboard meeting the Misuse of Drugs regulations. 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. Original timescales of 01/08/07 not met, this requirement is repeated for the second time. Urgent steps must be taken to regulate the high temperatures in the home. The staffing levels must be reviewed again to ensure that residents’ increasing and changing needs are met. Original timescales of 01/04/08 not met, this is a repeat requirement. The length of the 08:00 to 21:00 shift must be immediately reviewed to ensure that the long hours that staff are on duty, does not affect the quality of care of residents. The high use of agency staff must be reviewed. Original timescales of 12/11/07 not met this requirement is a repeated for the second time. Individual training records must be kept up-to-date to reflect training attended and to DS0000036658.V364362.R01.S.doc 01/07/08 01/06/08 01/08/08 01/09/08 01/08/08 01/08/08 01/08/08 01/08/08 Westmead Elderly Resource Centre Version 5.2 Page 28 13. 14. OP30 OP31 18 8 Registration Regulations 15. OP33 26 (4) 16. OP36 18 (2) highlight when training updates are required. Original timescales of 01/04/08 not met, this is a repeat requirement. Staff must receive training on how to respectfully communicate with all residents. The person appointed to run the home must, within 3 months of employment, lodge an application to the Commission’s Regional Registration’s team to become the Registered Manager of the home. Steps must be taken to make sure that reports undertaken on behalf of the registered provider are undertaken on a monthly basis. The reports must be forwarded promptly to the home so that any action from the visits can be implemented without delay. Staff must receive formal oneto-one supervision and personal development plans must be in place. 01/09/08 30/10/08 01/08/08 01/08/08 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 OP33 OP8 OP12 Good Practice Recommendations The incidents of falls should be monitored/audited on a regular basis Staff should receive refresher training on meeting the nutritional needs of residents. More one-to-one activities may be of benefit to residents who experience the symptoms of dementia such as agitation. Westmead Elderly Resource Centre DS0000036658.V364362.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V364362.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!