CARE HOMES FOR OLDER PEOPLE
Westminster House Care Ltd 41 Westminster Drive Westcliff-on-Sea Essex SS0 9SJ Lead Inspector
Nicola Dowling Unannounced 18 July 2005 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Westminster House Care Ltd Address 41 Westminster Drive Westcliff-on-Sea Essex SS0 7SJ 01702 333034 01702 333034 linda.reilly@btinternet.com Westminster House Care Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sally Ann Ayittey CRH Care Home 12 Category(ies) of DE(E) Dementia - over 65 (12) registration, with number MD(E) Mental Disorder -over 65 (12) of places Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18/07/05 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. Westminster House is situated in a residential area of Westcliff on Sea and the premises are inkeeping 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 the garden. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day and the manager was present throughout this time. The inspection consisted of a tour of the home, talking with staff, residents and relatives, observing the care given, and reading of documents. The relatives that visited that day were asked their view of the home, which was complimentary towards the care. All the residents were seen and several were spoken with. One resident was able to say that the staff were “very nice” and that the food was “very good”. The décor and the furniture in the home was tired and worn however this did not detract from the warm atmosphere and caring staff attitude shown to the residents. What the service does well: What has improved since the last inspection?
The home has a continuous improvement plan for the premises. Windows are going to be replaced throughout the home and have been replaced in the lounge area so that there is better ventilation. New staff that have started in the home have had the proper checks carried out to make sure that they are suitable to care for this group of people. The home have also developed a basic plan of action for staff to follow if they think
Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 6 that abuse has taken place in the home. Written information on care is being developed and includes the monitoring of what the residents eat and the prevention of pressure sores. Information from the manager suggested that currently none of the residents have pressure sores due to the good care staff provide. Training for staff is ongoing with staff doing National Vocation Qualifications in Care at various levels. An aromatherapist visits the home and residents are offered hand and foot massages. An entertainer is also due to visit the home on a regular basis to play the piano and tell jokes. Complaints that were received in 2004 have now been written into a complaints file with details about the complaint and what action was taken to correct it. Complaint forms are made available and written information on how to complain is on the wall in the entrance hall. 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. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 and 6 The staffs’ training and practical attention to care means that the residents needs are met. EVIDENCE: Staff have received relevant training on the care of people with dementia. Most of the staff at the home are undertaking National Vocational Qualifications (NVQ). Staff are aware of residents spiritual and cultural needs and maintain them in the home. The home does not provide intermediate care therefore standard six is not applicable. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 There is poor documentation of changes in care needs leading to areas of care not being actioned. Lack of staff attention to the administration of medication places the residents at risk. EVIDENCE: The residents care plans are still being developed and not all have had a review that reflects the changes needed to the residents care. A new format is being used to document the care and this will need good detail to ensure that the written plan can be easily followed. The risk assessments were written in a clear step-by-step way that was easy to follow. Families are invited to see the care documentation however there has been little uptake in this area. Relatives spoken to said that they are always kept informed of changes in their relative’s condition, however this is not reflected in the care documentation. Progress has been made on the health and welfare of the residents. For example a nutritional record is kept for each resident. However for one resident, weight records were not maintained even though it had been written into a risk assessment. Improvements have been made to the storage of medication and the recording of medicine in and out of the home. It was still of concern to find that
Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 10 medicine had been signed for as given, but had not been administered. This is unsafe practice and needs immediate attention. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 There is little variety of activities and stimulation at the home however the food is considered very good by residents and their relatives. EVIDENCE: Small activities are undertaken by the home. For example a resident helped with the kitchen jobs and others went to the shop. One resident said he passed the time watching TV and reading a paper. Through the day old time music played for those that were immobile. There was no other stimulation for residents who were chair bound. An entertainer is to start visiting the home and an aromatherapist visits and gives hand and foot massages. Otherwise residents remain sitting in the lounge area or are assisted to sit in the garden. All those spoken to commented on how good the food was. Residents that were fed were attended to in an unhurried way and were spoken to respectfully during this time. Seating arrangements in the dining area should be reviewed. This refers to one resident who had to sit next to a lady in a wheel chair leaving him little room to put his feet under the table. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 More progress on the Protection of Vulnerable Adult policy is needed to support residents’ safety. There is a satisfactory complaint process in the home. EVIDENCE: There has been progress from the last inspection regarding the documentation of complaints. No complaints have been made since October 2004. Relatives spoken with said that if they had reason to complain they would approach the manager. A procedure has been written on what to do if abuse is suspected. There is a very brief policy in the home on abuse. This should be developed further and be informed by the Southend Borough Council adult protection policy. Staff spoken with understood what to do if abuse is suspected and have received training on this topic. A resident at the home described a feeling if being safe in the home. Family members also said that they felt their relative was in a safe environment. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The storage for the disposal of sanitary products is poor. EVIDENCE: Yellow clinical waste bags are collected weekly (Thursday). The inspection took place on a Monday. The bin that contained the yellow clinical waste bags was overflowing and the yellow bags were stacking up alongside it. This bin is situated down the side way of the home and residents have easy access to this area. For hygiene purposes there needs to be better storage of these waste bags. The communal bathroom also had a used incontinence pad placed in a domestic bin with no lid on it. Used incontinence products must be disposed of properly to maintain a good standard of hygiene. Standard 19 was not fully inspected on this occasion. It was noted that improvements to ventilation had taken place in the lounge area. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The staff team is sufficient to meet the needs of the residents and the recruitment practice has improved. EVIDENCE: The staff rota, records staff on duty, their role and hours worked. The signing in sheets were used as supporting evidence of the rota. Changes had been made to the rota and these did not correspond with the signing in sheets. The rota must be properly maintained to ensure that shifts are properly staffed for the care of the residents. There has been good progress with recruitment records. New staff have had proper checks undertaken before they commence work. The home must continue to pursue the outstanding criminal records bureau check on one current staff member. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 37 and 38 There is a poor money audit trail and records are not kept properly. There is no self-review of the home’s performance to indicate that residents’ views are heard and acted on. EVIDENCE: The financial records that were available for the residents in the home were unsatisfactory. The home do not hold any personal allowances for the residents at all, however residents do borrow money from the home’s budget. This money is then claimed back from relatives by the proprietor. In the home each resident has a sheet with their name on it and amounts that are to be charged to them at the end of the month. Not all amounts were receipted for example cigarettes and not all sheets had a name on them. There was also no system for double-checking these amounts. No other financial records were held in the
Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 16 home for example chiropody and aromatherapy receipts, or final amounts actually charged to relatives. There has been no progress on the annual report for quality assurance, which measures the success in meeting the aims and objectives of the home. The records kept in the home are secure, however some are not up to date or maintained properly. This includes the duty roster, financial records and care plans. A random sample of safe working practices were inspected and it was found that the fridge temperatures were not being recorded and food stored in the fridge was not covered or dated. Some recommendations from the environmental health office had not been actioned. The kitchen fly screen that covered the door also had holes in it. No COSHH register was held however, some manufacturers safety data sheets were available. Fire records were available however the home did not have all information regarding RIDDOR. Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 1 x 2 2 Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 18 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. 2. Standard op7 8 Regulation 15(2b&c) 12(1) Requirement The registered person must ensure care plans are detailed and regularly reveiwed. The registered person must maintain records of weight, exercise and physical activity ensure the health and welfare of the residents. The registered person must ensure the safe administration of medication. The registered person must consult with residents about their interests and provide a varied programme of activities that meets their needs and interests. Timescale of 28.01.05 not met. The registered person must ensure that there is proper provision for the storage of soiled clinical waste. The registered person must persue the outstanding criminal records check for one staff member The registered person must maintain a quality assurance system for reviewing and improving the quality of care provided Timescale of Timescale for action 31.08.05 31.08.05 3. 4. 9 12 13(2) 16(2m&n) 18.07.05 31.08.05 5. 26 16(2k) 31.08.05 6. 29 19 Sch2(7) 24 31.08.05 7. 33 31.08.05 Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 19 28.01.05 not met 8. 35 Sch 4(8) The registered person must maintain accurate records of residents money that is borrowed from the home. The registered person must ensure that all the records required by legislation are maintained. Timescale of 28.01.05 not met Food stored in the fridge must be coverd and dated The registered person must maintain a COSHH register, accident records for RIDDOR and fire practice records. 31.08.05 9. 37 Sch3&4 31.08.05 10. 11. 38 38 16(2g) 12(1a) 31.08.05 31.08.05 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 15 18 27 38 Good Practice Recommendations The seating arrangements at the table in the dining room should be reveiwed so that residents have adequate space to put their feet under the table. The home should have a more detailed policy on adult abuse. The staff rota must be kept up to date and changes recorded accurately The recommendations from the environmental health report regarding gauze over the kitchen window should be followed Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Kingswood House BAxter Avenue Southend-on-Sea Essex, SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westminster House Care Ltd I56-I06 S62663 Westminster House V238986 180705 Stage 4.doc Version 1.40 Page 21 - 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!
