CARE HOMES FOR OLDER PEOPLE
Westminster House Care Ltd 41 Westminster Drive Westcliff On Sea Essex SS0 9SJ Lead Inspector
Nicola Dowling Unannounced Inspection 18th December 2006 10:00 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 Westminster House Care Ltd DS0000062663.V324184.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. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Westminster House Care Ltd Address 41 Westminster Drive Westcliff On Sea Essex SS0 9SJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company Name of registered manager Type of registration No. of places registered (if applicable) 01702 333034 01702 333034 Westminster House Care Ltd Manager post vacant Care Home 12 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (12) Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18/07/06 Brief Description of the Service: Westminster House is a care home offering care and accommodation for up to twelve older people who have dementia or a mental health disorder. The cost of care at this home is from £73.00 - £80.00 per day. Westminster House is situated in a residential area of Westcliff-on-Sea and the premises are in keeping with the houses in the locality. Accommodation comprises of a large lounge with dining area. There are twelve single bedrooms situated on the ground and first floor. There is a five person passenger lift. The home has a non-smoking policy and staff and residents who wish to smoke make use of a cabin in the garden. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection site visit took place over an eight hour period on one day. The site visit consisted of a tour of the home, talking with staff and residents, observing the care given and reading of documents. All the residents were seen and some spoken to. The acting manager and proprietor assisted with the inspection. In addition the survey forms that were received back from the residents were used and contributed to this report. Residents and relatives reported that they were generally satisfied with the care at Westminster House. The inspector would like to thank the staff and residents for their help and hospitality during the visit. During this inspection an immediate requirement form was issued to ensure that the proprietor checked a new member of staff against the protection of vulnerable adults list. What the service does well: What has improved since the last inspection?
Since the last inspection the smoking cabin now has heating and lighting. The proprietors continue to improve the environment, with residents rooms redecorated with new flooring and windows. For the purpose of good hand hygiene new soap dispensers have been fitted in the toilets. Residents’ contracts have been amended regarding the packaging of medication. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1. 2. 3. 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home in the Statement of Purpose and some documentation is not complete. A new resident can expect a lot of contact with the home and provider before admission. EVIDENCE: Information in the statement of purpose about how the resident can expect their care to be reviewed is not detailed enough. The Statement of Purpose is in text format, however the Service User Guide is in picture format. This is more suitable to the resident group. The home gain pre-admission assessments from the local authority and also nursing assessments of the residents’ physical and mental health. The provider or acting manager undertake a number of visits to a prospective
Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 9 resident and arrange meetings with family so that they know the person before admitting them. This also includes a visit to the home. The home undertake their own assessment. Some areas of this form were incomplete, as information was not known. Important information such as weight had not been collected. This was discussed with the provider and acting manager who will seek to improve this. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7. 8. 9. 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The presentation of care plans is unsatisfactory and incomplete risk guidelines leave residents and staff vulnerable. However, staff show dignity and respect when caring for residents. EVIDENCE: The service user plans have been drawn up and presented in the form of a profile for the resident. Discussion was held with the acting manager and proprietor about how to move on from this format. Information about the resident is being documented however risk assessments were incomplete. For example one resident that has a history of aggression did not have the management of this risk completed. The monthly summary of the care profile was informative however changes in care were not reflected in the care profile.
Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 11 Residents have access to healthcare facilities and district nurses and community psychiatric nurses have good links with the home. A member of staff always escorts residents that go out for hospital appointments. Weight records are kept in the home however it was found that these are not recorded on admission. The administration of medication and the storage of medication was good. It is one member of staffs’ role to co-ordinate prescriptions. There is a clear audit trail of medicines in the home. However, the home’s medication policy needs amending to include the procedure to follow if a drug is given in error and keeping of medicine after death. Staff were seen to speak to residents in a friendly way and used their preferred names. The staff knew all the residents and were observed to treat residents with respect. For example explaining what they were doing and attending to them on a one to one basis. The proprietor reported that health care is undertaken in the privacy of the resident’s room. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12. 13. 14.15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a quiet and routine lifestyle with friendly staff and home cooked food. EVIDENCE: Generally activities are undertaken with residents on a one–one basis. This is due to the residents mental health needs. Residents said they enjoy dancing and listening to music and some residents attend local church clubs. The home also provides an entertainer. Families are encouraged to visit when they want to. One visitor to the home said that she was “very happy” with the care her husband receives. The home is also hosting a Christmas and New Year party that relatives are invited along to. There was evidence that residents can have their own possessions in their rooms and residents all wore their own clothes. Residents confirmed that they can go to bed and get up when they choose. For example one resident stayed up to watch snooker and retired to bed when that had finished.
Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 13 Home cooked meals are provided with a hot meal at lunchtime. Drinks are offered between meals. Nutritional records are kept for each resident and those residents that need help with feeding are not hurried. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16. 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is satisfactory. The policy on adult protection is inadequate. EVIDENCE: The policy on the protection of vulnerable adults is brief and needs a procedure to follow if abuse is suspected. The Acting manager has recently attended a course on adult protection training and was able to verbally explain the procedure to follow. The home use advocates for residents. One complaint has been made to the home since the last inspection. This was made via a district nurse and was about a resident using a lift. The home responded to the complaint and followed the complaint procedure and the complainant was satisfied with the outcome. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 21. 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable and homely. EVIDENCE: The home have an on going maintenance programme. The residents have had their bedrooms repainted and new flooring in some rooms. Residents have been involved in choosing the colours that they like. Currently the entrance hall and stairway are being redecorated. The home have consulted with the fire authority and magnetic catches are fixed to fire doors. Residents have access to all areas of the home. The smoking cabin now has heating and lighting and residents were seen to take themselves out for a smoke when they choose.
Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 16 The home have one operational bathroom that contains a shower and assisted bath. The other bathroom is not in use as the size of the bath is too small. The proprietor is considering turning this room into a wet room. However at the moment residents have access to one bathroom only. There have been improvements to the hand hygiene facilities, with toilets having liquid soap dispensers and paper towels available. Laundry baskets are now covered and no soiled linen was left around. There was no odour in the home. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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. There are sufficient numbers of trained staff to care for the residents. However the recruitment process is not robust enough. EVIDENCE: There is evidence that the home have a regular staff team that are familiar with the residents. The provider also keeps in regular contact with the home. The staff rota records staff on duty and no staff work excessive hours. The home does not use agency workers. Currently the home have six staff with the NVQ2. The acting manager has commenced the NVQ4. Staff have received training in first aid, protection of vulnerable adults, manual handling amongst others. Courses have been booked for next year in managing challenging behaviour and dementia. Also the inspector had a discussion with the proprietor about other training courses relevant to the needs of the residents in the home. The home does have staff that can speak a different language and two staff are able to communicate using signing. Recruitment records were checked. Most recruitment documents were in place however a new worker did not have all the required documentation in place.
Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 18 This resulted in an immediate requirement to ensure that the care worker is safe to work with vulnerable adults. There was also no evidence that the new care worker had undertaken an induction. The proprietor was able to confirm verbally that an induction had taken place however no records were found. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31. 33. 35. 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is maintained for the safety of the residents, visitors and staff. EVIDENCE: Currently the home does not have a registered manager in post. The acting manager has worked on the care team at Westminster House for some time and has resumed this role since July 2006. Currently he is undertaking the NVQ4. Quality assurance information is being collated at the moment but has yet to be developed into a report.
Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 20 The home keep clear records on how money is spent on the residents and copies of receipts are kept. There is a record kept of the resident’s possessions and secure storage is available. A random sample of safety certificates were checked. These were all up to date. Hot water temperatures were tested and these were within normal limits. The home have also fitted a special wash basin plug to each residents wash basin. When water is too hot the plug lights up indicating hot water. There is sufficient protective clothing in the home for staff to use. The home have also addressed recommendations made from the environmental health department. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 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 3 17 x 18 1 2 x 2 x x x x 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 3 Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4. Schedule 1(15) 15.(2)(b) (c) Requirement The Registered Person must provide more detail in the Statement of Purpose regarding the review of resident’s care plans. The Registered Person must ensure that the care of the resident is reviewed and recorded on the plan. That risk assessments are completed The Registered Person must update the drugs policy to include the • Procedure to follow in the event of a drug given in error. • How long to keep drugs following the death of a resident. The Registered Person must keep policies on the protection of vulnerable adults up to date and make reference to a procedure to follow if abuse is suspected. The Registered Person must maintain a good standard of furnishings and décor in the home
DS0000062663.V324184.R01.S.doc Timescale for action 28/02/07 2 OP7 28/02/07 3 OP9 13 (3) 28/02/07 4 OP18 13(6) 28/02/07 5 OP19 23(2)(d) 28/02/07 Westminster House Care Ltd Version 5.2 Page 23 Timescale ongoing 6 OP21 23(j) The Registered Person must ensure that the downstairs bathroom is functional for the use of the residents. The Registered Person must ensure that there are induction records available for staff. The Registered Person must keep records that evidence. • Criminal Record Bureau checks are carried out. • Checks are made against the protection of vulnerable adults list. Immediate The Registered Person must appoint an individual for the position of registered manager The registered person must develop a quality assurance system for reviewing and improving the quality of the care provided. Timescale of 31.08.05 and 28.01.05 and 24/01/06 and 18/12/06 not met. 28/02/07 7 8 OP28 OP29 18(c) (i) 19 Schedule 2. 2(a) 28/02/07 03/01/07 9 10 OP31 OP33 8. 1(a) 24 28/02/07 28/02/07 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 Refer to Standard OP3 OP30 Good Practice Recommendations The Registered Person should complete weight records on admission to the home. It is recommended that the Skills for Care induction standards are used. Westminster House Care Ltd DS0000062663.V324184.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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
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