Inspection on 22/12/05 for Westport Care Centre

This inspection was carried out on 22nd December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Westport Care Centre 26/10/08

Westport Care Centre 01/06/07

Westport Care Centre 03/05/06

Westport Care Centre 15/08/05

Westport Care Centre 11/01/05

Westport Care Centre 15/09/04

Westport Care Centre 06/02/04

Westport Care Centre 25/09/03

Westport Care Centre 14/07/03

Westport Care Centre 30/05/02

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

CARE HOMES FOR OLDER PEOPLE Westport Care Centre 24-26 Westport Street Stepney London E10RA Lead Inspector Seka Graovac Unannounced Inspection 22nd December 2005 2:45 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 Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 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. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Westport Care Centre Address 24-26 Westport Street Stepney London E10RA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7790 1222 020 7423 9701 Excelcare Holdings Basilide Sonia Ramier Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (88) of places Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2005 Brief Description of the Service: Westport Street Care Centre is a registered residential care home that caters for 44 older people of both gender that require support and care. It also offers respite services dependant on the availability of beds. The home has a block purchase contract with Tower Hamlets for all the beds. The premises are a large three-storied building that is purpose built. All bedrooms have en-suite toilet and shower facilities. Thirty-eight bedrooms are single and three bedrooms are registered as double. A range of communal areas including two smoking rooms and a patio garden are available. Parking is available underneath the building. The home is conveniently situated close to public transport and other local amenities. The Registered Provider is Excelcare holdings that owns and manages several other registered care homes in the area. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted approximately three hours and three quarters. The main aims of it were to check the home’s compliance with four requirements that were made at the previous inspection in August 2005 and also to assess the home’s performance against the core national minimum standards that were not previously covered. The inspector spent her time talking with the registered manager, a staff member and several service users. She checked the home’s register, four service user’s files and supervision records for three staff. She also checked some medication records. She saw the reception area, the office and the dining room / lounge on the ground floor. The responsible individual was present during the inspection feedback. What the service does well: What has improved since the last inspection? The registered manager stated that the home continued to improve its care planning system and that most of the carpeted areas of the home had been shampooed since the previous inspection. She also stated that the majority of service users had their medication reviewed. Unfortunately, although the inspector wishes to acknowledge the efforts made, none of the issues that had been identified at the previous inspection were resolved. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 6 What they could do better: All four requirements with the targets expired on 15th November 2005, had to be restated. All of them had been restated at the previous inspection as well. As the Westport Care Centre continued to fail national minimum standards and breach legislation, it has become subject to the Commission for Social Care Inspection’s improvement and enforcement strategies. In addition to restated requirements, eight new ones were made, totalling twelve identified breaches of Care Homes Regulations. Out of thirteen national minimum standards assessed on this occasion, only one was found to be meeting the standard. Eight standards were assessed as partly meeting the standards and four as not meeting the national minimum standards. The home must provide the service that consistently meets the national minimum standards. In order to achieve that, each service user must have a written care needs assessment, an individual care plan and the individual risk assessments that promote service user’s dignity. Those documents must be dated and signed to demonstrate that the agreements had been reached between all relevant parties. All other records must be appropriately kept, including the medication sent beck to the chemist and the home’s register. The service users must be encouraged and assisted to maintain their dignity and personal hygiene, including nail care. All the staff must be appropriately supervised and the care staff must not be asked to make professional nursing judgements such as grading of wounds and associated care required. The environment must be free from offensive smells. The home’s performance must be regularly monitored by Excelcare holdings as required. A current business plan that contains correct information about the home must be available. The results of service users’ and other stakeholders’ satisfaction questionnaires must be also available and inform the future actions and development of the service. The inspector also recommended that staff and service users’ meetings were held on a more frequent basis. Please contact the provider for advice of actions taken in response to this Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home sometimes lacks the evidence that the service user’s care and support needs have been appropriately assessed. EVIDENCE: The inspector checked records of care and support needs assessments for two people. One of them, who used the home regularly on a respite care basis did not have the appropriate form completed. The Registered Persons must ensure that each service user’s care and support needs are assessed prior to their admission and that written records are available. This includes service users who use the home on a respite care basis. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. Meeting the service users’ care and health needs was not appropriately planned by the home. The appropriate medication procedure was not always followed. EVIDENCE: The inspector viewed four service users’ individual files. One of them did not have a current care plan. The inspector noted that one service user was wearing a nightdress at 5pm. The service user stated that the staff always put her nightdress on around that time. At first she told the inspector that she did not understand it, but then she also said that she wanted to wear a nightdress. The carer informed the inspector that the home respected this person’s own choice regarding time when she had her nightdress on. This was documented in her individual care plan. However, given the short conversation the inspector had with this person, the inspector was left questioning if enough of encouragement was given to this person to promote her dignity. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 11 The inspector noted that one service user was wearing two dresses on top of each other. Again, the inspector was reassured that the home was following this person’s individual choice. This was not documented in the individual care plan. The carer stated that the home tried to encourage this person to wear new clothes or more appropriate layers of clothes, but without success. The inspector noted that one service user had long and dirty nails. Her individual care plan did identify regular nail care. The carer stated that sometimes, this person did not allow the staff to look after her nails. This was not indicated in her care plan or other documentation that the inspector saw. The Registered Persons must ensure that each service user has an individual care plan that is comprehensive and agreed by the parties involved and promotes service user’s dignity. The home used a care plan format that was developed for nursing care provision. The inspector was concerned that non-qualified care staff was asked to make nursing assessments and judgements such as grading of the wounds. On one occasion, a service user had a laceration less then an inch long on the outside aspect of their hand and a care worker assessed it as a wound grade 2. The inspector was informed that no district nursing or other health professional advice was sought by the home. The accident was not recorded in the accident book. Apart from a wound being recorded on a body map and a nursing assessment sheet, no other related records were made until the day of the inspection. On that day, it was recorded that it was getting better. The Registered Persons must ensure that service users’ health and wellbeing is monitored and that the appropriate referrals are made to health professionals when it was needed. The inspector checked some medication records. Since the previous inspection, the home had been recording the medicines that were received by the home and also the medicines given back to the chemist for disposal. However, when the inspector checked it for the person that had been persistently refusing her medication, the administration and the returned medicines records did not match. The carer stated that this person’s medicines had been sent back to the chemist every cycle (four weeks) and the new ones were ordered, but the records could not be found to confirm that. The Registered Persons must ensure that the appropriate medication procedures are followed at all times including recording the medicines returned to the chemist for disposal. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14. Individual risk assessments were not always recorded. The home kept a visitors book. EVIDENCE: One of the examined service users’ files did not contain updated individual risk assessments. The only risk assessment found on this file was regarding selfmedication and it was not current. A requirement made at the previous inspections regarding availability of written risk assessments had to be restated again. The inspector was asked to sign a visitors book when she entered the home and before she left the premises. The service users files contained information regarding their next of kin. The inspector was informed that there was a visitors-room on the first floor. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 0. Not inspected on this occasion. EVIDENCE: Both core standards covering this aspect of service were assessed as met at the previous inspection. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19 and 26. The environment was not fit due to offensive smell. EVIDENCE: The inspector smelt an offensive urine smell as she entered the home. The smell was not perceptible in the office. However, as the inspector approached the communal areas on the ground floor, the smell became more offensive. Although the inspector spent more then one hour in the dinning area on the ground floor, her sense of smell could not adapt and the inspector continued to feel uncomfortable as the smell was so offensive and so strong. The manager stated that the majority of the carpeted areas had been shampooed prior to the inspector’s visit. However, the problem had not been resolved and the requirement was repeated again. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0. Not inspected on this occasion. EVIDENCE: Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 37. The home was not run in the best interest of service users. EVIDENCE: The management of the home did not manage to secure compliance with Care Homes legislation. All four requirements had to be restated again and eight new requirements were made at this inspection, totalling twelve breaches of legislation. In the interest of service users, the Commission for Social Care Inspection would be leading the Westport Care Centre through its improvement and enforcement strategies. The inspector noted with concern that she had to explain differences among care needs assessment, care plan and individual activities assessment on several different ways to the manager, before she seemed to have understood it. The manager also seemed uncertain if service users’ injuries that had not been witnessed needed to be recorded as accidents. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 17 The Registered Persons must ensure that all injuries are recorded in the home’s accident book. The inspector also noted that the home’s register was not appropriately kept, as on several occasions, it was not recorded when the service users left the home. The Registered Persons must ensure that the correct records are kept regarding service users leaving the home. A current development/ business plan was not available for inspection. The inspector was shown a copy of a plan for 2004/05 that contained some incorrect information such as: number of service users the home is registered for and a number of lounges. The Registered Persons must ensure that there is a current business/ development plan for the home that truthfully represents the home and is based on the stakeholders’ views. The inspector was shown completed service users’ satisfaction questionnaires. However, the information was not analysed. The manager was not aware that service users’ views about the home should be included in the service user’s guide. The Registered Persons must ensure that service users’ views of the home are written in a form of a report and are available to service users, other stakeholders and the Commission. The home held separate staff and service users’ meetings. The minutes seen indicated that they were not held on a regular basis. The inspector recommended that frequency of these meetings were increased. The responsible individual visited the home and the inspector saw the reports she produced regarding the conduct of the home. The reports seen indicated that the frequency of these visits did not meet the related requirement. The Registered Provider must produce reports regarding the conduct of the home at least on a monthly basis. The inspector checked minutes of staff one-to-one support and supervision sessions for three staff members. The records seen indicated that two staff did not receive these sessions in a required frequency. The related requirement had to be repeated again. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 18 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 X X 2 X X X 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 X 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X X X X X X 1 STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X 2 1 X Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes, all of them. 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 OP3 Regulation 14 Requirement The Registered Persons must ensure that each service user’s care and support needs are assessed prior to their admission and that written records are available. This includes service users who use the home on a respite care basis. The Registered Persons must ensure that each service user has an individual care plan that is comprehensive and agreed by the parties involved and promotes service user’s dignity. The previous target expired on 15/11/05, the other previous target expired on 31/03/05 and the one before that one on 30/11/04. The Registered Persons must ensure that service users health and wellbeing is monitored and that the appropriate referrals are made to health professionals when it was needed. The Registered Persons must ensure that the appropriate medication procedures are DS0000010309.V272557.R01.S.doc Timescale for action 31/01/06 2 OP7 15 31/01/06 3 OP8 13 31/01/06 4 OP9 13 31/01/06 Westport Care Centre Version 5.0 Page 20 5 OP14 13 followed at all times including recording the medicine returned to the chemist for disposal. Registered Person(s) must ensure that any activities in which service users engage in are assessed for risks and that the related records are available. The previous target expired on 15/11/05, the other previous on 31/03/05 and the one before that on 31/12/04. The Registered Person(s) must ensure that all the areas of the home are free from offensive odours. The previous target expired on 15/11/05 and the other previous on 31/01/05. The Registered Persons must ensure that there is a current business/ development plan for the home that truthfully represents the home and is based on the stakeholders’ views. The Registered Persons must ensure that service users’ views about the home are written in a form of a report and are available to service users and the Commission. The Registered Provider must produce reports regarding the conduct of the home at least on a monthly basis. The Registered Person(s) must ensure that all staff receive regular, formal supervision that is documented and that is available for inspection, at least every two months. The previous target for compliance with this Requirement expired on 15/11/05, the other previous on 31/03/05 and the one before DS0000010309.V272557.R01.S.doc 31/01/06 6 OP26 16 31/01/06 7 OP33 24 31/03/06 8 OP33 24 28/02/05 9 OP33 26 31/01/05 10 OP36 18 28/02/05 Westport Care Centre Version 5.0 Page 21 11 OP37 17 12 OP37 17 that on 30/11/04 The Registered Persons must ensure that all injuries are recorded in the home’s accident book. The Registered Persons must ensure that the correct records are kept regarding service users leaving the home. 31/12/05 31/12/05 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 Refer to Standard OP33 OP33 Good Practice Recommendations The inspector recommended that the frequency of staff meetings was increased. The inspector recommended that the frequency of service users’ meetings was increased. Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Westport Care Centre DS0000010309.V272557.R01.S.doc Version 5.0 Page 23 - 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!