Inspection on 07/09/07 for Weston House

This inspection was carried out on 7th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Weston House 26/09/06

Weston House 28/02/06

Weston House 10/08/05

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Weston House Weston Road Stafford ST16 3TF Lead Inspector Mr Keith Jones KEY Unannounced Inspection 09:00 7th September 2007 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 Weston House DS0000063822.V345111.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. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Weston House Address Weston Road Stafford ST16 3TF 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) 01785 228324 01785 220815 home.weq@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Janet Marie Coulston Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Mental registration, with number disorder, excluding learning disability or of places dementia (48) Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Weston House is owned by the Methodist Homes for the Aged, which provides 24hour-nursing care for 48 mentally infirm and mentally ill service users. The home was first opened on 1st March 1993 and taken over by MHA in April 2005. MHA was created in 1943 and is a registered charity. The home is divided into four house groups. Each house group provides a comfortable, homely atmosphere for the individuals. Within each house group there is a fully fitted kitchenette where relatives and visitors are invited to help themselves to refreshments. The lounges were sensitively organised to allow service users space and choice of where to sit. The dining areas were also well arranged to allow a feeling of space. Each service user has their own bedroom, which has en-suite facilities. Each service user is encouraged to bring in their own personal possessions to personalise their bedrooms, which assists them to settle easily into their new home. Each bedroom has a TV aerial point, if the individual wishes to have their own TV and also a telephone socket too. Three hot meals are served daily, which were freshly prepared and cooked by the homes fully trained Chef and his assistants. Laundry services are also undertaken within the building. Fees - £575 - £668 Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted with the Deputy Care Manager and senior nursing staff. The Registered Care Manager was on annual leave at the time. The last inspection report was discussed, and it was noted that there were no outstanding requirements or recommendations. There were 48 Residents in the Home, with eleven care staff on duty including two Registered Nurses, plus the Deputy Care Manager, Deborah Moseley. The tour of the home was carried out in a relaxed, courteous and professional manner. It was felt throughout the inspection that a sense of sympathetic confidence pervaded into all aspects of daily activity expressed by those people met. Five residents were case tracked, which confirmed the establishment of a well run, comfortable and ‘homely’ establishment. 15 comment cards were received from relatives, residents, and professionals, all generally complimentary of standards. A sample of comments from residents included: “Staff are helpful and respond to the buzzer” “Meals have improved, and I can talk to the Nurse if I don’t like anything” “Could ask for something if you needed anything” “Very caring staff” “Not very happy with other people wandering into my area” Three responses from Social Services and one from a GP were professionally pleased with the standard of care and service given. Relatives who were present were complimentary of the family approach to care, the freedom they enjoyed and the involvement that the manager and her staff encouraged. It was evident that they were inclusive in the process of care. Everyone appeared comfortable and at ease with their surroundings. A sample review of the administration confirmed solid practice and effective management. Discussions with residents and staff over the general standards of care and service proved to be enlightening and very constructive. A full report was offered at the end of the inspection with open discussion with the Deputy Care Manager. Overall the attitude in meeting caring and organisational demands is highly commendable, with forward thinking, planning and application, contributing to a good quality service. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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. Weston House DS0000063822.V345111.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 Weston House DS0000063822.V345111.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): 1,2,3,4,5 The quality in this outcome area is good. This judgement is based on the examination of the homes policies, procedures, practices and discussions with management. The Home ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. It is recognised that the formal Statement of Purpose represents the foundation on which the home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live, through the Service User Guide. Following an assessment the senior Nurse assessor determines the suitability of the application in view of the facilities available, and of the capacity of the home, to manage the individual and any special needs. The Home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a home to meet individual needs. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Statement of Purpose and guidelines reflects an expression of philosophy, and has been well established in representing the foundation on which the home operates upon. It presents an excellent description of the Home’s aims and objectives, philosophy of care and terms and conditions. All the requirements prescribed in Schedule 1 are addressed, which would be enhanced with larger print, and clearer reference to CSCI for making complaints. A ‘Values Statement’ offered to all staff supports the ethos of care. The Residential Care Agreement (contract) document reflects changed circumstances and conditions, including an identification of allocated bedroom agreed. The care management adheres to a strict admission policy of personal supervision of the pre-admission assessment. Case tracking of five resident’s files demonstrated the presentation of a highly personal approach to prospective residents and their relatives on pre-admission. A detailed assessment was examined and found to collect a full profile of physical and psychological needs, as well as social, cultural and environmental circumstances. An appraisal is made, and discussed, to ensure the Home can satisfactorily meet those needs. Case tracking and discussion with some residents and staff confirmed that this standard is well met. Following an assessment the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. Evidencing family involvement would be advised in the assessment and review process. Case tracking confirmed that a valuable exchange between resident and assessor took place and resources made available. These resources were seen to be a deployment of staffing skills, equipment and general environment. Prospective residents and their relatives are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. The management style is highly personable and inclusive, generating a warmth and comfortable environment. Relatives are welcome to view the facilities and participate in the planning and assessment of care. Weston House DS0000063822.V345111.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 and 11 The quality in this outcome area is good. The residents’ assessment provides the base, from which care planning is formulated. It is recognised that this reflects an individual profile of needs, discussed fully with family. The Home has access to a number of GPs that visits the Home frequently, and the majority of service users are registered within 48 hours, with care plans established. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. The inspector observed the free, courteous interaction between residents and staff, based on a level of confidence of essential mutual trust and respect. The provision of a secure and safe medicines administration is managed effectively, although recording of medicines administered, updating of policies and training require review. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 11 EVIDENCE: There was evidence to show that a review of the care process has produced a satisfactory standard of meeting care needs. The pre-admission assessment represents the foundation for an informative care planning process. Five residents’ care files were tracked and demonstrated a system of detailed information on the individual, their life style and needs, events and contacts, procedures and actions measured on a daily basis and reviewed monthly. The process has established a life story, for each resident, as an addition to care records, which has proved to be useful in enhancing understanding of personal needs. The first 2 months acts as a trial period, in which named Nurses and keyworker care staff are allocated. The policy of the Home is to maintain residents own GP support wherever practical; otherwise residents are registered with the local surgery. District nursing services are also received, and the home has an established and positive professional rapport. There was evidence that suitable equipment was deployed effectively. Carers were seen to interact with residents with purpose and compassion. The facilities and bedrooms were presented to facilitate privacy for the individual, which included medical examinations and personal care procedures, being performed in private. Notices displayed in bedrooms would be better situated in a more discreet manner. The administration of medicines generally adhered to procedures to maximise protection to service users. The storage was secure, with satisfactory added security for controlled drugs. The record of administration of systemic medicines was inconsistent, with consistent omissions observed. A controlled drug register was examined and found to be up to date. The deputy Care Manager was advised to obtain a formal register from the pharmacy supplier. Staff training has been undertaken by Boots, and continues to be pursued actively by the Care Manager. It was advised to establish a list of recognised nursing staff, with specimen signatures. The continued use of a ‘Homely Remedy’ process would require updating. Oxygen stored at ground level would be safer secured by chain to the wall. There was no resident self-medicating at the time of inspection. Each service user has the opportunity of their own lockable facility in their bedrooms on request. The procedure for handling accidents and incidents was inspected and found to be satisfactory. Reports were informative, detailed and meaningful. Family and friends have relative freedom of visiting, those spoken to remarking on the importance of maintaining social contact. There was also an observed knowledgeable, and positive attitude by staff towards residents, and feedback from the residents: “ Warm comfy atmosphere”, “ I would have liked to have Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 12 seen the place before I came”, and “excellent care, although décor could be improved”. Regular family/resident forum meeting are helpful, contributing to improve communications and understanding. Questionnaires through an ‘Annual Residents Satisfaction Survey’ are sent out to reinforce the importance of consultation and involvement. The Statement of Purpose clearly and openly states that the wishes concerning arrangements after death would be discussed and respectfully carried out. The spiritual needs of service users were recorded and observed by the staff, with due respect. Discussion with the newly appointed part time Chaplain indicated a valuable approach in enhancing the quality of service and support. Contacts with families, to reinforce their levels of awareness, are a significant objective. Issues of cultural, personal and ethnic diversity was discussed, reiterating an open policy on admissions, and consistency of care plans in respecting and celebrating diversity. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 13 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 The quality in this outcome area is good. This judgement is based on discussions with residents, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. MHA’s main objective is to respect the individual, thus delivering care in a relaxed and easy environment, with routine flexible to accommodate needs, and not dictate daily life of service users. Personal choice and relative selfdetermination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. These policies are designed to match expectations and to achieve a harmonious relationship throughout. Activities and ‘well-being practices were in evidence on the inspection day, and a programme of in-house entertainment was available. Choices were available for every aspect of daily living and menus provided a varied and good choice of food available on a four weekly programme. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of residents. Service users’ life-styles and interests are recorded in their care plan, discussed with their relatives prior to admission, and documented as far as possible to enhance a position of supported independence. Personal choice and relative self-determination are respected in policy and action. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 14 EVIDENCE: The daily routine was seen to be flexible and non-institutionalised, offering choice for meal times, personal and social activities. Discussions with residents and staff clearly identified a relaxed and informal atmosphere in which the resident’s needs were paramount, with the security that there are familiar events to the day they could relate to. An activity co-ordinator (well-being co-ordinator) has a high profile in contributing to the care planning process, and is clearly well accepted by residents and staff alike. The recording of social activities was seen to be an integral part of care reporting and planning. Service Users life histories are discussed and used as a basis for individualised social care offering choice and support. The Home boasts to ‘celebrate resident’s special days and magic moments’. There is a positive cognitive stimulation therapy programme, with sessions organised to stimulate and engage people with dementia, crediting the principles of ’Introduction to Quality Dementia Care’. A Snoezelan room to facilitate sensory stimulation was available, although spasmodically used. The Home operates an established open visiting policy, which was seen during the inspection. Relatives and friends are encouraged to maintain social links as part of the planning of care. One relative comment card response was appreciative and complementary of the relaxed procedure, especially at the early days following admission. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Those service users’ rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. The tour of the Home demonstrated a degree of expressed individuality in each of the bedrooms inspected. The deputy Care Manager emphasised that the strength of protecting service user’s rights was secured through the robustness of the procedures in place. This was confirmed on examination of records. Advocacy procedures and services are available to those who require them. The Home offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. Lunch was served during the inspection and found to be an attractive and well-presented meal of fish and chips. Special diets were accommodated with the cook making effort to engage with service users to discuss personal preferences. Staff were seen to offer discreet assistance to those who required it. Arrangements are in place to accommodate a more resident centred catering service, through a hospitality style presentation, as stated in the MHA ‘Catering Manual’. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 15 The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. The manager was advised to have available a protective coat at the kitchen door. A cleaning schedule was in place, but needed a consistent record. The kitchen was seen to be clean, well equipped and kept in good preparation. COSHH signs and notices were in evidence with cleaning chemicals secure, appropriate and under control. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The Home has systems and procedures and to protect residents from abuse. EVIDENCE: The complaints policy was seen and records examined. There were few complaints, none recent, to assess. CSCI had received two allegations involving a POVA response, neither being upheld. All residents had received information on the procedure to complain, including reference to the CSCI. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. A ‘complaints’ book would enhance quality control on this issue, with clear recognition of concerns, complaints and allegations. Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to service users needs and readiness to test the robustness of their information and report structures. Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place i.e. the complaints procedure. This process was evidenced on examination, and case tracking as previously reported upon. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 17 The care management showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes led by the wellbeing co-ordinator, clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 The quality in this outcome area is adequate. This judgement was based on discussions with residents, staff and a tour of the premises. The building has been structurally well maintained, but in need of refurbishment and an ongoing upgrading programme. The interior state of general repair is at an adequate standard; bedrooms are well appointed, of a satisfactory size. There is a program planned to commence a room-by-room upgrade this October. Communal areas are furnished and decorated to a satisfactory standard to present a comfortable environment. Service users live in a safe and well-maintained environment, with a planned preventative programme designed to sustain the standard. Each of the bedrooms provided a satisfactory level of furnishing and facilities to which each resident has been encouraged to add their personal belongings, furniture and décor as the wished. The standard and presentation of all the toilets and bathrooms were of a good quality, well equipped and clean. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 19 EVIDENCE: The location of the Weston House is conducive for a care home, situated in an urban setting with good access to road links, and a short drive to Stafford town. External car parking and grounds are spacious and well maintained. The 3 patio gardens offer pleasant areas for fresh air and reflection, shared with the adjacent Queensway Care Home. Service Users were seen to be enjoying the opportunity to sit with staff, or with visitors. Interior state of repair is at a good standard, although the décor is at the stage awaiting the commencement of a full unit redecoration programme, beginning with a major refurbishment of the four lounges and connecting corridors. Bedrooms are well appointed, of a good size and accessible, but identified for a full redecoration plan to commence in October. Plans to use a decanting bedroom are well advanced. It is expected that the refurbishment and redecoration programme is a development feature for 2007/08, to be submitted to CSCI. The care manager will arrange for a full unit risk assessment appraisal to be undertaken by the next inspection. Bedrooms were well maintained to meet resident’s personal preferences. There are some 4 variable height beds available, with a further 20 due for delivery. Individual assessment ensures the special needs of residents are accommodated. Evidence was seen of well-maintained movement and handling equipment, supported with written policies and procedures, and regular training sessions. The deputy Care Manager expressed a willingness to meet any reasonable demand for special needs. Most bedrooms had been furnished to meet individual preferences, personalisation was enhanced with own furniture and personal belongings. The outcome is a comfortable and familiar private domain that reflects the resident’s preferences. All bedrooms are ensuite. Fire protection facilities are in place, having had a recent fire inspection. There was one extinguisher with a broken fixture, freestanding on a corridor floor. Each service user has a lockable bedroom door and facility in their own room, and have the choice to hold the key. All bedroom windows are secure with restrictors, over-bed lights and a smoke alarm. The nurse call system has been dismantled in preparation of the installation of a new system, due to be completed within the week. Arrangements are in place to increase surveillance, especially at night. It was advised that oxygen supplies in the treatment room be kept secure. The four lounge areas provide comfortable, odour free and a popular centres for socialising and relaxation. Each has a kitchenette area to provide for snacks and drinks. The furnishings are of a good quality compatible with the needs of Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 20 the elderly. The areas offer options, through layout of the rooms, to either socialise or seek a little peace and quiet. Staff were seen in attendance, providing social diversion, and attentive personal care. The well-being coordinator ensures a programme of events and meaningful diversions, in which social activities have a direct influence in care reporting and evaluation. The dining areas offer clean and pleasant environments. At the meal time staff were seen to assisting residents, reinforcing contact and confidence. The standard and presentation of all the toilets and bathrooms were of a good quality, clean and odour-free. One bathroom was presently being serviced due to a ‘feed-back’ smell from the drains. Showers are placed in each en-suite. Adequate attention has been given to ensure maximum privacy, within riskassessed boundaries. Toilets are accessible to all and within close proximity to all communal areas. There are two sluice facilities, each having suitable arrangements to meet requirements, although neither are used due to toilet arrangements elsewhere. Notices regarding chemical handling in the areas that store chemicals displayed appropriate COSHH posters and information charts. The heating arrangements throughout the home are by central heating with guarded radiator convection. Lighting facilities, including individual bed lights and overall emergency lighting are regularly maintained by routine maintenance. During the inspection a power failure demonstrated the effectiveness of emergency measures in place. It is recognised that there is no stand-by generator available. Water temperature were randomly tested and found to be within normal limits, although a bath thermometer is needed for each bathroom. A recent routine inspection had identified the need for a cleaning of the water supply system, which was effected immediately. Ventilation is by direct door and window airing. Corridors were seen to be free from obstruction, fitted to aid mobility, and well lit to facilitate safe access throughout the home. Communal areas were equally well served with utilities. Servicing records were examined and found to be up to date and accurate. An awareness of health and safety issues was high on training and supervision priorities. The standard of cleanliness was seen to be excellent throughout, with no offensive odours in any of the rooms inspected, although there is a persistent, unpleasant odour noted in the ground floor reception and corridor links. The laundry was well organised and equipped to a good standard. COSHH regulations were displayed and relevant to solutions in use. Infection control Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 21 was efficiently organised from frequent and regular appraisal of cross infection procedures. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 22 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 and 30 The quality in this outcome area is good This judgement was based on the examination of staff files, working rotas, training and supervision programmes, and discussions with staff. Staffing stability has been maintained with consistently high levels to ensure equilibrium between numbers, skills and qualifications, with a strong presence of long serving experienced staff. Agency and Bank staff are rarely used, with agreed overtime and flexible rostering accommodating shortfalls. The management have a consistent procedure for interview, selection and appointment of staff. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of service users. All staff receive training in care issues within the home from registered nurses and external trainers. Training and supervision records need to demonstrate the observed high standards of training taking place. EVIDENCE: Duty rotas were made available, and inspected, with staffing levels seen to be satisfactory. The overall general skill mix and numbers of staff working in the Home meet the needs of up to 48 service users. There was a proportionally Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 23 high trained Nurse representation on each shift, with the Care Manager supernumerary, and the deputy contributing to shifts on occasions. The daily care staffing rota showed adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. Agency coverage has been infrequently used since the last inspection; overtime and flexible rostering meet shortfalls. An average daily coverage was recognised based on 48 nursing service users. a.m - 2 RN 9 carers p.m - 2 RN 8 carers N.d - 2 RN 3 carers The catering, domestic and laundry hours were determined and found to be appropriate for the size of the home and the needs of the residents. There is a full time administrator, maintenance man, part-time voluntary co-ordinator and an activity/well-being coordinator. A part-time chaplain had commenced duties that week. The deputy Care Manager emphasised the home’s commitment to training and to achieving targets for NVQ. There are 28 staff with NVQ level II and level III, representing an 87 achievement. There are 4 certificated first-aiders, and 12 Registered Nurses on the home’s staffing establishment. A training course for 12 carers is organised for this month, to ensure a comprehensive awareness in meeting first-aid needs. Four staff files were sampled and found to be consistent in the process of appointing staff. It was evidenced that POVA and CRB checks have been made. The management have a consistent procedure for interview, selection and appointment of staff. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of service users. Staff photographs on file would be advised. Three on-duty members of staff were interviewed, each expressing their working conditions openly and with confidence. Each individual was complementary as to the level of training they receive, and the management arrangements. Supervision was seen to complement an effective induction and training programme. Diversity issues with staff were discussed and confidence expressed as being recognised and accommodated. Staff induction programmes are meaningful and well established, forming the base upon which in-service supervision and training are planned. Overall the evidence shows a satisfactory account of a comprehensive training programme. It was noted that there is andE-learning’ facility of randomly available training packages, managed by the well-being co-ordinator. It was advised that a personal training record be kept on file that would offer a full Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 24 understanding of training needs. Evidence showed attention to a supervised training involving a shared aspect of responsibility between staff and trainer. Training plans drawn up were examined and found to offer a meaningful commitment to the educational, supervision and appraisal process. Mandatory training was seen to be complied with, and awareness of the soon-to-beintroduced Mental Capacity Act. It was advised to establish a formal training package for all care staff to meet the implications of the Act. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 25 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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is good. The inspector was impressed by the openness and confidence in the observed interactions of staff, relatives and service users. The relationships were seen to be of mutual trust and respect. Evidence was secured to confirm a quality monitoring system has been well maintained, based upon audit of standards, care plans and feed back from service users and relatives. The process of quality assurance is efficiently directed by clear policy and leadership from MHA. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Care Manager, although unable to be present at the Inspection, has demonstrated competence in establishing a solid policy and practice, that has been implemented, to achieve a high standard of set aims and objectives. An experienced Registered Nurse with a professional portfolio of practical and managerial experience, ably supported by a well qualified, experienced deputy, Registered Nurses, and a solid foundation of able carers, whom represent an effective care management team Staff meetings are held regularly in which staff are encouraged to participate fully in the management and direction within the home. The inspector observed at first hand the confident interrelationship that exist, not only between management and staff, but also between staff and residents. Evidence was secured to acknowledge achievements, ongoing and planned objectives. Involved within this process are the views of service users and relatives, confirmed at case tracking and informal discussion. Social Workers’ review meetings are often a vehicle for assessing quality. There was strong evidence of openness and honesty in receiving comments and speaking with service users, relatives and staff, in which day to day events and episodes are freely discussed. Evidence was secured to confirm a quality monitoring system of Standards and Value Assessment, broad-based upon audit of standards, care plans and feed back from residents and relatives. Standards are discussed at staff meetings, daily reports, direct observation involvement and one to one staff meetings. The Provider was asked to prepare a development plan for 2008/09. The deputy Care Manager was advised to prepare an inventory of risk for all areas of the Home, to meet the ongoing standards for fire protection, and to establish a firm foundation for development planning. The procedures manual was randomly examined, and found to offer a very comprehensive reference. First aid, clinical waste disposal, Infection control and managing dementia procedures were examined and found to be informative, and up to date. Fire safety remains high priority for all staff evidenced in routine maintenance checks, regular fire drills and frequent staff training sessions. Policies have been reinforced in accordance of requirements made at the last inspection. A sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. This was confirmed by Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 27 inspection of service agreements for gas supply, hoist maintenance, PAT and water supply. Accidents were seen to be addressed, risk assessed, actioned and recorded in an effective way, with access to Riddor if needed. No serious accidents have been recently reported. A complaints record would secure information indicating that the management were suitable responsive to concerns, complaints and allegations. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 4 3 4 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X X 3 2 3 Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 29 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 OP9.3 Regulation 13.2 Requirement That all instances of nonadministration of medicines be recorded to determine reason for non-administration. The Registered person must ensure that the Service Users individual documentation is reviewed and signed by a relative or representative following consultation. That a schedule of cleaning and fridge/freezer temperature recordings be maintained Timescale for action 07/09/07 2. OP7 15 (2c) 01/10/07 3 OP38 16 2 (g) 07/09/07 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. Refer to Standard OP16 Good Practice Recommendations A concerns, complaints and allegations book be established. DS0000063822.V345111.R01.S.doc Version 5.2 Page 30 Weston House 2. 3 4 5 OP19 OP33 OP30 OP9 The homes refurbishment and redecorating programme must continue and be completed in a timely manner. Provide a development plan for 2007/08/09 A training matrix was recommended to easily identify individual team member training needs. Secure a suitable CDA register, that a list of suitably qualified signatories, and an up to date Homely Remedy statement are attached to the MAR file. Residents’ photographs are inserted on the MAR front sheet. Fire extinguishers are secured Service User Guide to be updated. The practice of storing items on toilet pedestal lids cease To address offensive odour on ground floor Ensure bath thermometers are placed in each bathroom That oxygen cylinders be secured. That staff photographs be provided in each staff file. That Home notices are placed more discretely in residents’ bedrooms That a full unit risk assessment inventory be established. 6 7 8 9 10 11 12 13 14 OP38 OP1 OP38 OP26 OP25.8 OP38.3 OP37 OP10 OP24.6 Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office 1st Floor Ladywood house 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Weston House DS0000063822.V345111.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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