Inspection on 06/02/07 for Westmead Elderly Resource Centre

This inspection was carried out on 6th February 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 11/06/07

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, Sheila Lycholit & Jane Shaw. Key Unannounced Inspection 6th February 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westmead Elderly Resource Centre DS0000036658.V329000.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.V329000.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.V329000.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. 30th June 2006 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 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. Whilst most rooms are close to lavatories, others are some distance away. The fees as outlined in the pre-inspection information is £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.V329000.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection took place between 09:30 and 17:30 on the 6th February 2007. This was the home’s second key inspection for the inspection year 2006/2007. The inspectors spent time talking to service users, the Manager, Care Managers and staff. A range of documentation was checked including care plans, risk assessments, accidents and incidents records and daily reports. Medication storage and recording was inspected in all four units. The inspection also included a period of observation to assess the care being given to a group of service users with dementia. Service users 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? Improvements were noted in the number of service users with a contract of terms and conditions of residency. The home has been successful in their application to vary their registration to provide care for up to 42 residents who are over 65 years of age with a diagnosis of dementia or mental health disorder. The home’s application to vary the home’s registration to provide care to the service user under 65 years of age was also granted. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 6 The care plans, individual risk assessments and daily notes seen during the inspection indicate that the work being undertaken on care planning is resulting in higher quality care plans and recording. All staff have received training on the reporting of allegations and incidents of abuse. Since the home’s last key inspection, there has been an increase in the staffing numbers on duty by one care worker during the day and night. What they could do better: At total of 17 requirements and 8 recommendations were made following the inspection process. At senior management level, links with the Commission need to be strengthened and the Council needs to be more open and proactive in the area of protection. The Commission has concerns about the standards of management within the home. Supervision and development of staff are inconsistent. There is overwhelming evidence that working relationships within the home have broken down and this must have a negative impact on the care of service users. It was disappointing that the recording of medication administration had not improved throughout the home. Endorsements were not always accurate and complete. No system was in place to re-order a medication, which had run out. More work is needed to make sure that service users’ cultural needs are identified and met in the home. While mealtimes for some people are a positive experience, this needs to be extended to all people living in the home. Staff comments about what the home can do better included: “Listen to us and not to ignore us.” “Go back to listening to its staff and making them feel part of the decision process, residents should be the main focus/priority I feel we have lost this.” “Follow the policies and procedures” “The home could employ permanent staff and service users would not feel confused” “Listen and respond to the written complaints made by staff.” Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 7 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.V329000.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.V329000.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, 2 and 3 (Standard 6 is not applicable). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home is available to service users, but this information must also contain a copy of a recent inspection report and service users’ views. Service users are given a written contract of terms and conditions and a full needs assessment is undertaken prior to service users being admitted into the home. EVIDENCE: “ My care manager told me about the home and I visited before I came in”. (Comment from a service user). Information about the home is provided in an attractive Westmead folder containing a range of handouts, including the complaint’s procedure, which are printed off as needed. The folder does not contain a copy of a recent inspection report or any survey of service users’ views. Service users who provided feedback about the home commented that on the whole they had received enough information. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 10 The 3 service users’ files seen during this inspection each contained a signed copy of a contract, as had the 6 files looked at during a thematic inspection on 10th January 2007. The Manager said that contracts were being revised to include the number of the room allocated to the service user and that copies of the financial agreements for publicly funded service users were being obtained to be placed on their files. Each of the service user’s files contained a needs assessment carried out by the Social Worker/Care Manager before their admission. Since the last inspection, the home has been successful in their application to vary their registration to provide care for up to 42 residents who are over 65 years of age with a diagnosis of dementia or mental health disorder. An application was submitted to the CSCI also to vary the home’s registration to provide care to the service user under 65 years of age, that had been admitted to the home outside the home’s registration category. Westmead Elderly Resource Centre DS0000036658.V329000.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each service user has a care plan that includes the basic information necessary to plan the individual’s care and includes a risk assessment element. The management of medication must be further improved and there is a need to make sure service users’ health care needs are always met safely. EVIDENCE: Steps have been taken to improve care plans and their implementation by commissioning two experienced agency staff to review care plans and recording. The Manager undertook to share the final report on this project with CSCI. The 3 care plans, individual risk assessments and daily notes for Sun Up looked at during the inspection indicate that the work being undertaken on care planning is resulting in higher quality care plans and recording. Care plans were detailed and up to date and showed that service users had been involved in their plans, for example regarding frequency of bathing and whether they wished to be monitored during the night. Service users preferences should be further explored and noted in the care plan, such as preferred time of getting up and going to bed and for having a bath and shower. Improvements have also been made in daily recording, for example with a number of entries cross-referenced to the care plan. Staff must ensure that Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 12 issues noted in earlier entries are followed up, for example action taken regarding a possible sign of the early stage of skin breakdown was recorded for one service user but subsequent entries did not note whether his condition was checked again. No body chart was used to note the site of the redness, though these are available in the ‘at a glance’ folder. As the care plan and risk assessment identify that this service user has suffered from pressure sores in the past, it was particularly important that follow up action was taken. This service user was also observed to be sitting in his room without his prescribed cushion, which had been left in the dining room. No action to elevate his feet, as noted in the care plan, had been taken. The risk assessments for one unit were looked at. These were detailed and reviewed monthly. Records of accidents show that since the beginning of January, a 5 week period, service users have had 17 falls. Fortunately none has resulted in serious injury, though a number required the emergency services to be called. Risk assessments were not always reviewed following a fall. It is recommended that senior staff receive training in falls prevention and that further steps are taken in the case of the 4 service users most prone to falls to try to reduce the incidence. In discussion, the Manager undertook to contact the local ‘Falls’ clinic and District Nurses for advice regarding training. The homes medication policy had been updated with respect to the current pharmacy supplier. The home’s procedure for residents who go on leave and take their medicines with them is still outstanding. There was good record keeping of medicines received into the home and disposed of. It was noted that the allergy section was not always complete on the MAR. Some omissions were noted for administration in two of the units.eg Tiotropium on 29/1,procyclidine 31/1 in one unit and quinine, senna and chloramphenicol eye drops in another. Alendronic acid weekly was not marked or signed as administered on the MAR for one resident and the code O meaning out of stock was written for three days for a resident previously receiving pain relief four times a day. There was good recording of warfarin with evidence of the INR and current dosage with the MAR and the date this information was faxed to the pharmacist. Medicines in the home were administered by the home’s care managers and trained care workers. No resident was self-medicating. One resident was prescribed a small dose of a liquid medicine and although there was a syringe available for measuring there were no written instructions on how to use it. Another resident was documented as allergic to penicillin and prescribed a penicillin-containing antibiotic. This was with full knowledge of the GP and pharmacist and care manager but the care worker administering the medication was not aware. Further medication training was undertaken by care managers and other care workers the week prior to the inspection. The manager should ensure that Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 13 there are regular assessments of competency to ensure good practice is maintained. Care workers in one unit were not familiar with the medicines they were administering and it would be good practice to update the lists of medication and uses, side effects and dosage for information purpose. Other useful information for care workers are patient information leaflets which are supplied by the pharmacist and could be filed for reference .A copy of the BNF/Mims was available in the main office but copies in each unit would be a useful tool for learning. The home had controlled drugs cupboards in each unit. No residents were prescribed controlled drugs at the time of the inspection. Medicines were generally stored securely in each unit. In one unit the key press was left open and contained the medicine cupboard keys Dates of opening were written on all liquid medicines and eye drops. The medicine fridge contained several medicines –antibiotics and eyedrops. It should have the temperature-recorded daily using a minimum and maximum thermometer. The temperature should be between 2 and 8 degrees. The Spare stock cupboard was better organised and there was no excess stock. It was noted that the description of the contents was still not listed on the monitored dosage system and this should be again discussed with the pharmacist. Care workers should be able to identify the contents. Residents received good care from the GP who visited regularly. Blood glucose monitoring was carried out by the GP and there was evidence of district nurses visiting to administer injections and suppositories. It was noticed in the stock cupboard a finger-pricking pen for self-testing, which the pharmacist inspector was informed, was used for several residents with a change in lancet. The attention of the manager was drawn to the MHRA advice of 12/06, which stated that in care homes only professional lancing devices must be used to prevent the risk of infection. In two of the units care workers were recording accurately receipts and administration of medication. In the other two there were gaps noted in the recording of administration of medication on the Medication Administration Records (MAR). In one of these units a resident had run out of her pain killer three days before the inspection and was not able to receive pain relief if she needed it. Overall the home was not providing the evidence that the health needs of the residents was always met. Staff were seen to knock on service users’ doors before entering, although a recent accident where a service user who had got up to open the door and was knocked over by the staff member coming in, suggests that not all staff knock and wait before entering. Westmead Elderly Resource Centre DS0000036658.V329000.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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More work is needed to make sure that service users’ cultural and faith needs are identified and met in the home. While mealtimes for some people are a positive experience, this needs to be extended to all people living in the home. EVIDENCE: “I would like more Caribbean food, especially on Sundays”. “Home do activities but I like the quiet, like to keep myself to myself” (Comment from service users). Care plans give some information about service users’ background and previous interests, as do the personal possessions, photos and pictures displayed in their rooms. The care plan of one service user stated that he wished to be informed when the Church of England services were held as he wanted to attend. His daily notes do not record any attendance. The Manager said that no C of E or Catholic services had taken place for some time as the Clergy and Priest taking the services had left the area. No up to date newspapers and magazines are displayed. The Manager said that staff bring in the free newspapers and read them to service users and that service users can order their own newspapers. It is recommended that a selection of papers and magazines are regularly purchased, including those from the West Indian press. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 15 The inspectors noted that staff have started to collect objects and materials to be used as part of the one-to-one and reminiscence sessions. During this visit the Inspector saw two service users enjoying positive interactions with therapeutic dolls brought into the home. A number of visitors were seen at Westmead during the inspection. They were made welcome by staff and were offered a cup of tea. The Manager said that she has held a number of meetings for relatives and friends, though the two most recent meetings have been poorly attended. No residents meetings take place. The Manager confirmed that the Residents Forum will be re-started. Meals are served from the central kitchen on the units or in service users’ rooms if they prefer. Tables were attractively set out, with table-cloths and napkins. Service users who choose to eat in their rooms must be provided with suitable furniture. One service user was seen to be eating with her meal on her locker. The Manager promptly obtained a table from the store cupboard as soon as the situation was raised with her. Soft drinks, water and fruit juices are given to service users throughout the day. Most service users were observed to have a glass of juice next to them. The 4 week rolling menu gives an alternative dish for each main meal, ensuring that a vegetarian option is always available. In view of the number of service users of West Indian origin, consideration to providing a regular alternative dish reflecting Caribbean cooking should be considered. One service user commented that the Chef had made an excellent Caribbean dish a couple of weeks previously, which he had very much enjoyed. The timing of lunch and the evening meal, which are served at 12.45PM and 5.30PM, should be reviewed, with consideration given to a later start for the evening meal or more flexibility about when it is served. One service user commented that the evening meal is served much too early for her and where possible she tries to save the food until later. The views of service users regarding the catering should be regularly sought. One service user complained to the Inspector that the roast chicken and chips were both cold on the day of the inspection. Evidence obtained from the service user satisfaction surveys indicated that 33 of the service users always like the meals at the home, but 50 of the service user group commented that they only sometimes like the food on offer. A supply of food for staff to make snacks for service users in the evening or in the night were seen on the units. Staff confirmed that they can also obtain provisions from the main kitchen at any time. Food for snacks includes bread, milk, soup, yogurts and cheese. Service users should have the choice of butter Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 16 as well as the margarine currently supplied. Bowls of fruit were available on each unit. Staff should ensure that snacks given to service users are recorded in their daily notes. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. While the home has effective policies and procedures for managing complaints from service users, there is evidence that concerns raised by staff working in the home are not responded to appropriately. At senior management level, links with the Commission need to be strengthened and the Council needs to be more open and consistent in the application of it’s safegurding procedures. EVIDENCE: “I believe they (safeguarding adults policy and procedures) are not carried out effectively.” “We told the Manager about a service user who was attacked five times therefore could not come out of their room.” “ Locking away all policies and procedures. A recent emergency left me stuck with no access to Westminster Policy on infection control.” “I am up to date with CSCI Regulation 37 POVA training – I am also aware that at night there is an on call system at City Hall – however in an emergency outside normal practice I would not have a clue what to do as all books regarding to policies are locked in the office.” (Comments received from staff). Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 18 As discussed under Standard 1, information relating to the home’s complaints policy is available to service users within the service user’s guide. All service users who completed comment cards commented that they were aware of how to make a complaint if they were unhappy with the service. The Registered Manager confirmed that following recent inspections, all Managers have received training in the appropriate procedures for responding to allegations of abuse and the protection of vulnerable adults. Follow-up training has been organised for April to consolidate training. The Commission has received information that staff are very concerned that important information, including safeguarding adults issues, are not always passed on to the Commission, a requirement of the Care Homes Regulations 2001. The Council must ensure that the Commission is notified of any incidents, events or complaints that seriously affect the well-being of service users. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 19 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, 20, 23 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from good standards of private and communal accommodation. 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. There is an attractive courtyard garden for service users. Bedrooms are clean, in good decorative order and contain a range of service users’ personal possessions. Some bedrooms are a considerable distance from the lavatories, resulting in a high use of commodes. The Manager said that the home is assessed as unsuitable for some prospective service users because of the distances that have to be travelled. Information provided about the home should make it clear that while most rooms are close to lavatories, others are some distance away. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 20 On the day of the inspection the macerator and one of the dryers was out of order. The Manager said that the macerator had been out of order for a number of weeks and the home was relying on a twice- weekly collection of yellow bags. These were seen to be stacked at the side of the building awaiting collection. Since the last inspection, no further structural changes have been made to the home. Compensatory space has been provided to replace dining room/lounge space lost when a new office was constructed. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 21 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. While permanent staff try hard to provide good standards of care, reliance on high numbers of agency staff means that care for some people can be rushed and not sufficiently individual. EVIDENCE: “When the unit is full there can be strains on the staff to complete all tasks and spend quality time with the residents.” “Residents and relatives are not happy that we have agency staff all the time. Residents say they find it confusing and sometimes scared as all those different people going into their rooms.” (Comments from staff). Since the home’s last key inspection, there has been an increase in the staffing numbers on duty by one care worker during the day and night. Staffing rotas reflected that there are now seven staff on duty in the morning shift, five staff on duty in the pm shift and four staff on during the night. As previously mentioned in the report, the home has commissioned two experienced agency Staff to review care documentation and quality in the home. Rotas demonstrated that agency staff are currently used to cover some of the shifts, with a rate of up to four agency member of staff working per shift during the day. This is impacting negatively on their knowledge and familiarity with the individual needs and wishes of residents. The Manager is asked to supply to Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 22 the CSCI a report showing how the continuity and quality of care from temporary staff will be improved. Thorough recruitment procedures are in operation and checks are completed on staff, which include past work history, references and CRB/POVA checks. All except one staff member felt that their recruitment was done fairly and thoroughly. The staff team including domestic and catering staff have received training in dementia care developed by the Alzheimer’s Society. Future planned training includes mental health training for all staff, commencing mid March and to run to the end of May. Other training that has been organised for staff includes skin integrity training and training and support sessions from the dietician in the use of the MUST tool. The Manager also confirmed that steps are being taken to train staff to give massage to service users. The inspector felt that this was a very positive step forward in view of recent published guidance on the benefits of the use of massage in the care of people with dementia. All staff who completed comment cards felt that they are given training which is relevant to their role, helps them to understand the needs of service user and keep them updated with new ways of working. During the site visit the Inspector saw evidence of good interaction between some staff and service users. Some staff were expressing humour, were being facilitative and used touch appropriately. Interactions from other staff were less positive. One person came into the dining room singing ‘Mary, Mary quite contrary’ to two service users named Mary. This was inappropriate. On two occasions, another care worker spoke to service users in an accusing and blaming tone of voice. The Inspector also saw this person preventing one service user from taking food from her own dinner plate and getting up and leaving a service user she was meant to be helping with her lunch. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Commission has concerns about the standards of management within the home. Supervision and development of staff are inconsistent. There is overwhelming evidence that working relationships within the home have broken down and this must have a negative impact on the care of service users. EVIDENCE: “The Duty Manager cannot support care staff, because they do not usually have enough time and they have a big amount work to do. For the past few months the atmosphere in the home is very uncomfortable. I personally felt stressed and cannot put up with this pressure any longer. I felt often unwell when I had to come to this place and now I suffer from chronic headaches. I wish that things would improve soon”. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 24 “Recent information is ad hoc – different Managers told different procedures.” (Comments from staff). The home has a full time permanent Manager who has been in post for more than 12 months. The Manager is a qualified nurse. Since February 2007, the Commission has been aware of information from a number of sources that indicates that there is a breakdown in trust and confidence between staff and managers at this home. This is likely to be having a negative impact on the lives of residents. The Council must investigate allegations made by staff and report the outcome of the investigation to the Commission. The investigation must consider comments from staff about the manager’s leadership and management styles. Monthly visits on behalf of the registered provider are completed and the reports are forwarded to the CSCI. The reports provide a good level of information. As outlined under Standard 1, the results of the service user satisfaction questionnaires must be published in the service user’s guide. 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. Since the last key inspection, there have been no changes in the systems for managing service users’ finances. Where required, procedures are in place for the home to hold money for service users. The money is securely stored in a lockable safe. Transactions are recorded and receipts maintained and signatures obtained. The administrator confirmed since the last inspection that an audit of the finances had been undertaken with positive results. Individual files seen were in good order. Daily records were generally of a good standard, although night staff must note the times of care given. Staff must ensure that concerns noted in earlier reports are followed up (see this report under Standard 7). The Inspector saw staff putting into practice their training in food hygiene by wearing protective clothing whilst serving food to service users. The Manager confirmed that the recommendations of the fire officer from the London Fire and Emergency Planning Authority have been met. No issues were noted with regard to health and safety of the building. Westmead Elderly Resource Centre DS0000036658.V329000.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 X X 3 X 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 3 X 2 3 Westmead Elderly Resource Centre DS0000036658.V329000.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. Individual risk assessments must 30/04/07 be reviewed following a fall or other accident. Further steps should be taken to reduce the incidence of falls, including training for senior staff. Medicines must be recorded 14/02/07 accurately in the home when administered. If not administered the correct endorsements must be used. The allergy section must be completed. Repeat requirement. Original timescale of 07/10/06 not met. The medicines policy must be 01/03/07 updated to include procedures for supplying medicines to residents who go on leave from DS0000036658.V329000.R01.S.doc Version 5.2 Page 27 Requirement 2 OP7 15 3 OP9 13.2 4 OP9 13.2 Westmead Elderly Resource Centre 5 6 OP9 OP9 13.2 13.3 7 8 OP9 OP9 13.2 13.2 9 OP10 12 (4 and 5) 10 OP12 16 11 OP15 16 12 OP18 13 the home. Repeat requirement. Original timescale of 01/12/06 not met. That the manager continues to audit weekly at least, the MAR to ensure accurate recording. That the home follows the advice of the MHRA in the safe use of blood testing lancets and devicesThat care workers familiarise themselves with the medicines they administer That the home has systems in place to maintain the continuity of supplies of medication and the relay of medicines information to the care worker administering. Staff must ensure that they treat service users with dignity and respect at all times and communicate with them appropriately. This is a repeat requirement. Original timescale of 01/10/06 not met. Service users who have expressed a wish to continue their religious observance must be supported to attend services either at the home or in the community. 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. Service users who choose to have meals in their rooms must be provided with furniture and equipment so that they can eat in a comfortable position. The Manager must make sure that all incidents and allegations of abuse are reported to the local authority’s safeguarding adults DS0000036658.V329000.R01.S.doc 14/02/07 14/02/07 01/03/07 14/02/07 30/04/07 30/04/07 30/04/07 30/04/07 Westmead Elderly Resource Centre Version 5.2 Page 28 13 OP19 & OP31OP32 9, 10, 21,22 14 15 OP26 OP27 16 18 16 OP33 24 17 OP37 17 officer and the Commission. 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. Satisfactory arrangements for the disposal of soiled and infected waste must be made. The Manager must report to the Commission the proposals for filling the vacant permanent care positions. The home’s quality assurance systems must be reviewed to include suitable ways for securing the views and experiences of people with dementia living in the home. Night staff must note the times of care given, including drinks and snacks. Concerns, such as skin condition, identified in earlier notes must be followed up. 30/04/07 30/04/07 30/04/07 01/06/07 30/04/07 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 4 Refer to Standard OP7 OP9 OP9 OP9 Good Practice Recommendations Service users preferred time of getting up and of going to bed and of having a bath or shower should be noted on the care plan. That the home has a blood glucose chart for the GP and other healthcare professionals to complete That the pharmacist is requested to identify the contents of the monitored dosage system on the packaging. That the pharmacist is requested to provide patient DS0000036658.V329000.R01.S.doc Version 5.2 Page 29 Westmead Elderly Resource Centre 5 6 7. 8. OP9 OP15 OP12 OP14 information leaflets and instructions for measuring where appropriate. Those regular assessments of competency to manage medication safely are undertaken. Butter as well as margarine should be offered to service users. A range of newspapers and magazines should be available, including those from the ethnic minority press. A schedule of dates for 2007 for the new Residents Forum should be published. Westmead Elderly Resource Centre DS0000036658.V329000.R01.S.doc Version 5.2 Page 30 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. 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