CARE HOMES FOR OLDER PEOPLE
West Winds North Shore Workington Cumbria CA14 3YP Lead Inspector
Nancy Saich Unannounced Inspection 14th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address West Winds DS0000038992.V248933.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. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service West Winds Address North Shore Workington Cumbria CA14 3YP 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) 01900 870880 Keycare Services Miss Alison Adair Care Home 14 Category(ies) of Dementia (3), Old age, not falling within any registration, with number other category (11) of places West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 14 service users to include: up to 11 service users in the category OP (Older People not falling in any other category) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 18/04/05 Date of last inspection Brief Description of the Service: West Winds is situated in a residential area of Harrington. It is near to the harbour and within walking distance of the village amenities. The home has been adapted and extended to provide residential care for up to fourteen older adults, three of whom may have dementia. Key Care, who also operates three domiciliary care agencies in Cumbria, owns the home. The previous manager has left the home and a new manager; Lorraine Irving, is in the process of registering with the Commission for Social Care Inspection. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted by Nancy Saich and Collette Hibbert. The visit started at ten o’clock on the morning of the 14th October 2005 and lasted for over five hours. The inspectors spoke to all the residents and to the staff on duty. They met with the new manager who had been in post since July. They toured the building, met with family members and a visiting health care professional and also read documents that backed up what was said and observed. What the service does well: What has improved since the last inspection?
West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 6 There was evidence to show that the providers continue to improve the décor and furnishings in the home. 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. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 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 West Winds DS0000038992.V248933.R01.S.doc Version 5.0 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 the following standard(s): 3 Usually there are suitable arrangements in place for new residents only being admitted after staff have made sure that they will fit into the existing group and can have their needs met. EVIDENCE: There had been two people admitted since the last inspection. A resident and a relative said that staff had visited them from the home before they came in. They said that they had been asked about their needs and preferences. The inspectors found that one of the files was a little lacking in detail as the person who had visited the new person had not used the company’s own form. The files did have social work documents in place that showed the person’s needs had been carefully considered. It is recommended that the registered person ensure that all admissions have appropriate documentation of these visits. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 The home provides good levels of health and personal care and residents said they were happy with the way they were cared for. EVIDENCE: The inspectors read all of the care plans and found that they focussed on the needs and wishes of each individual. Staff knew how important the plans were to give residents consistent care. The residents were aware of the plans and had signed them. The monthly review of the plans was a little out of date but the inspectors were happy for the new manager to update these as soon as possible. Residents said that they saw the doctor or the nurse if they were unwell. People with dementia saw mental health professionals and the manager agreed to refer another person to the psychiatrist. The inspectors spoke to a visiting health professional who was happy with the way people are cared for in the home. The inspectors observed staff giving out medication and they did this with care and attention to detail. The staff said they had completed training on the safe
West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 10 administration of medication. They also said that the home’s pharmacist visited and gave them advice. The stored medication was being managed correctly. Residents and visitors said that staff were polite and friendly and cared about them. Residents said that the staff were “all very good…nothing is too much trouble for them…”. The inspectors observed pleasant and appropriate interactions between staff and residents. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14,15 The home helps people to live as full a life as possible despite the challenges of ageing or ill health. EVIDENCE: One person said, “I am glad I came to live here. I don’t have to struggle with washing or cooking and I have company or time on my own when I want it. I get out and we have parties and entertainments in the home…. I couldn’t ask for more….”. Residents spoke about going out to the theatre and about activities in the home. They said that staff tried to do things with them every afternoon. On good days residents go out to the harbour or to the pub or local shops. One person has a voluntary job. It was obvious that residents enjoyed each other’s company and the atmosphere in the home was very happy and caring. Staff helped people to have private time and to spend time together. The visitors’ book showed a high volume of visitors and several people came on the day. They said they were made most welcome and were kept informed of any issues with the residents. Residents said they chose what to do when and got up and went to bed when they wanted. They said that staff asked them their preferences and offered them different options. This could be seen in practice. Residents were asked about food preferences and activities. People joined in activities and went out
West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 12 with staff. One or two people said they had refused to have their room redecorated and this choice had been respected. The inspectors enjoyed a well-cooked and sociable lunch with the residents. The cook was very enthusiastic about providing nutritious meals that the residents would want to eat. She has managed to introduce lots of healthy eating options in the home and residents were happy with this. She was looking forward to attending a special course on nutrition. There was a good range of stored food in the home and plenty of choices available. The food safety standards in the kitchen were very high. West Winds DS0000038992.V248933.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): 16,18 There remains a flaw in the way staff are trained to handle an abusive situation and this could put residents at risk of being mistreated. EVIDENCE: There had been no complaints received since the last inspection. Residents said that they would complain to a member of staff, the manager or directors of the company. Staff said they could help them with this and could access the complaints procedure. They also said they could help people contact the inspector if necessary. The staff spoke about their understanding of abuse and they showed that they had a good understanding of what was abusive. They were, however unsure about how to manage things if an abuse allegation was made. Some staff had received adult protection training when they first started the job but longstanding staff (who residents might well confide in) had not had this training. Residents and visitors said that they had no concerns about this matter and they would report anything like this straight away. There is a previous requirement that has been extended to allow all staff to be trained and for the staff team to look together at how they would manage a potential mistreatment. West Winds DS0000038992.V248933.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): 19,20,21,22,23,24,25,and26. On the day of the inspection the whole building was safe, clean, tidy and very homely. EVIDENCE: The home has three lounges that can be used as one large area when the communicating doors are opened. Residents said this was nice when they had parties. On the day of the inspection all three areas were in use, with some residents in one area watching the TV, the second lounge had a resident enjoying a family visit and residents who chose to sit quietly were using the conservatory. There was also a dining area. Smoking is allowed in a designated area and residents were using this part of the building. All the bedrooms were single occupancy and were nicely decorated and furnished. The rooms were clean, homely and personalised with photographs, ornaments and religious statues out on display. The residents spoken to were very happy with their rooms and said they could go to them whenever they wanted to. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 15 Some of the double glazed window sealed units were broken, resulting in condensation inside the units, therefore obscuring the view from the window for the residents. A recommendation is made about the windows in the home. Many of the bedrooms had en-suite toilets and wash hand basins and there were two separate bathrooms. The home has a mobile hoist, handrails and a stair lift which gave residents access to all areas. Residents said that staff were good at helping them use these facilities. Residents were happy with the level of cleanliness in the home, and they said their personal clothing was properly washed and ironed. The inspectors observed nicely stacks of fresh co-ordinating towels in each en-suite room. The house smelt fresh due to the very good system in place for dealing with continence problems. One bedroom had a bolt outside the door. This issue was discussed with the manager and the resident. The bolt was in place to prevent other residents wandering into the room. It was decided that that a lock and key would be more appropriate and a requirement is made about locks on bedroom doors. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 16 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): 27,28,29,30 The registered person needs to improve specialised training and checks on competence to ensure that the staff team have all the skills they need to care for the residents. EVIDENCE: The inspectors saw the rosters for the four weeks before the visit. There were enough staff on duty to deliver good levels of care to residents. Staff said they had completed their NVQ awards and were keen to do more qualifications. Recruitment for new staff was checked and was in order. Some of the documents related to this were kept at the company headquarters and were not immediately available for inspection. Residents felt the staff team were competent and capable and they were confident that they were in safe hands. The inspectors thought that the staff worked well with residents and they had grown in confidence in their job role. Staff had received training in core subjects like manual handling, first aid and managing pressure sores. Not all staff had received training on helping people with dementia. The inspectors had asked that staff receive training on dealing with other aspects of mental ill health and on challenging behaviour. This had not been arranged. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 17 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): 33,34,36,38 The management systems in the home are failing to ensure that residents’ safety and wellbeing are as good as possible. EVIDENCE: The home has a new manger who is beginning to settle into her role. Residents, staff and visitors were happy with these arrangements. The inspectors were surprised that the responsible individual for Key Care had not started to work with the manager on the required actions from the last inspection. The new manager had not seen the last report and it was not available to residents. None of the four requirements and the one recommendation had been acted on. The company had not completed a quality audit on the home nor had they gone over the business plan with the new manager. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 18 The manager said she received support and supervision but did not have copies of her supervision notes in the home. The inspectors did see notes for a number of staff. These were somewhat brief and didn’t give enough detail of how senior staff checked that staff were working appropriately. Not all staff had received formal supervision as frequently as they should have. Some of the records were appraisals and didn’t record in detail how staff were dealing with individual residents or specific tasks. The record of the weekly rostered hours are still informal, using staff first names only and they don’t show when staff are absent, nor the reasons for this. Again this was a requirement from the last inspection and has not been met. There was evidence to show that food hygiene was very good in the home and the cook kept appropriate records. There was a major problem with the fire logbook. A requirement was made at the last inspection about completing checks regularly and giving instruction and drills to staff at appropriate times. This had not been done. There had been a recommendation that the fire risk assessment was updated. This had not been done. The manager had attended a fire warden training course but admitted that she had not started to use what she had learnt. The inspectors suggested that she contact the fire officer for advice. Other health and safety matters were in order. West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 19 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 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 2 x 2 2 1 West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 20 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 24 Regulation 13 (4) and 16 (2) 13 (6) Requirement Key Care ltd must decide how they will ensure that residents can secure their individual rooms without compromising their safety. The registered person must ensure that all staff complete training in Adult protection. (This is an outstanding requirement from 30.06.05 and the timescale has been extended) The registered person must ensure that all staff receive training on supporting people with depression. (This is an outstanding requirement) It is required that Key Care ensure that an audit of the home’s quality systems are completed by the due date It is required that Key Care provide an up to date business plan showing their future plans for the home that reflects the wishes and needs of residents. Key Care must ensure that all staff, including the manager receive regular supervision that
DS0000038992.V248933.R01.S.doc Timescale for action 30/11/05 2 18 30/11/05 3 30 18(1) 30/06/05 4 33 24 30/11/05 5 34 25 30/11/05 6 36 18 (2) 30/11/05 West Winds Version 5.0 Page 21 7 37 26 8 37 17 (2) 9 38 23 (4) is recorded in detail. It is required that Key Care resume their monthly visits and reports on how the home is operating. The registered person must keep a copy of the weekly staff roster that shows all changes and absences. (This is an outstanding requirement) The registered person must ensure that checks on fire equipment, drills and instruction are completed in line with the advice given by the fire service. (This is an outstanding requirement) 30/11/05 30/06/05 30/06/05 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 Refer to Standard 3 19 30 Good Practice Recommendations It is recommended that staff always complete the company’s assessment form when admitting a new resident. It is recommended that Key Care develop a plan to replace or repair windows where the sealed double glazed units have been compromised. It is recommended that Key Care consider how they can develop their existing training to include more strategic training for staff in how they handle mental ill health, challenging behaviour and the problems associated with disorientation. It is recommended that the company review all of their record keeping arrangements so that all relevant information is recorded in detail and available for inspection or for future reference. 4 37 West Winds DS0000038992.V248933.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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