CARE HOMES FOR OLDER PEOPLE
West Winds North Shore Harrington Workington CA14 3YP Lead Inspector
Nancy Saich Unannounced 18 April 2005 09:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service West Winds Address North Shore Workington Cumbria CA14 3YP 01900 870880 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Keycare Services Alison Adair Care Home 14 Category(ies) of Old age, not falling within any other category: registration, with number Dementia of places West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 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. Date of last inspection 23 September 2004 Brief Description of the Service: West Winds is situated in a residential area of the village of Harrington, near to the harbour and local amenities and is within walking distance of the railway station. The home is owned by Keycare Ltd, who also own domicillary care services in Cumbria.Alison Adair manages the home on their behalf. The home can accomodate up to fourteen older people, three of whom may be older people with dementia. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection commencing at 9.15 a.m and finishing at 4.45p.m. The inspector spoke with Alison Adair, the registered manager and the staff on duty. She met with all fourteen residents and spoke to some of them in depth. She also met with five relatives, a community psychiatric nurse and a mental health support worker. All areas of the home were seen. Residents’ files, plans of care and daily notes were read. Records relating to health and safety and maintenance of the property were seen. Staff files and notes were seen. Some relevant policy and procedural documents were checked. What the service does well: What has improved since the last inspection?
West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 6 A number of things had improved in the home since the last inspection. The owners of the home and the manager had dealt very well with most of the issues that had been highlighted at the last inspection. Service users were happy with the information they got before they came to the home and the way staff discovered what they wanted and needed from the home. One person said “coming here is the best choice I have ever made”. Residents said that staff were very good at the way they helped them. These comments and the observations on the day showed that staff confidence in the way they cared for residents had improved. The written plans for care were much improved, giving details of strategies for staff to give individualised, appropriate and consistent care to everyone New door locks and a new conservatory gave people privacy in their own rooms and when receiving visitors. The management of medication was much improved. The manager had improved the timescales for meeting each member of staff on a one-to-one basis. This had encouraged staff to look in more depth at they way they work with residents. One resident said “ I am spoilt to bits by the care these people give me”. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5 Residents received thorough assessments of their needs before they came to the home and they were given enough information to make decisions about whether they wanted to live in the home The care and services provided met the needs of the residents. EVIDENCE: Residents could talk about why they chose to come to the home. They said that they or their relatives had visited prior to admission. They also said that someone from the home had asked them about their needs before they came to Westwinds. There were records confirming that this had happened. Residents, relatives and health professionals said that residents’ needs were very well met by the care and services provided. One person said “coming here is the best choice I have ever made”. There were no residents who were out of the categories the home was registered for. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 The planning for care delivery was good with an approach centred on each individual’s needs. Residents were in good health due to being given access to all the health care they needed. This included good systems for ensuring everyone received the right medication. Residents were given due respect, and their right to privacy and dignity was protected by the care approach in the home. EVIDENCE: At the last visit the inspector was concerned that the plans of how care was to be delivered were lacking in detail and not up to date. She read these ‘care plans’ and found that the format had changed. The plans are now written from the residents prospective and say things like “I need help with…”, “I want encouragement with…”, “I don’t like…”, “I don’t want disturbed…” and “I do this independently…”. All the plans were signed. Residents and relatives said they had been involved in compiling the plans
West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 10 Residents said that staff would get the doctor or the nurse for them if necessary and would advise them on health matters. The care plans and daily notes showed that staff followed through any instructions given so that residents’ health was as good as possible. Two residents needed complex home nursing procedures and they said these were done in a way to maintain their comfort The medication was checked and the systems were operating correctly to ensure safety and precision in administration and storage. All the residents said that their privacy was respected. New locks were being tested on downstairs rooms. Residents thought they were easy to use and would keep their possessions safe and give them privacy. People with dementia were allowed to move freely around the home but were monitored and advised gently when they were putting themselves at risk. All but one of the residents thought the care given was excellent. One resident said “ I am spoilt to bits by the care these people give me”. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Residents had right to choose how they managed their lives and were supported in making choices. Residents said they ate well and they looked healthy and well nourished. EVIDENCE: Residents said they could arrange their lives very much as they wanted. People with dementia were helped with daily lifestyle choices. Residents said that they went out with staff when the weather was good and had enough activities and entertainments provided to make their lives interesting. They had especially enjoyed a recent project reminiscing about how life was in the past. The visitors’ book showed a lot of visitors came to the home. Relatives spoken said they were made very welcome and could visit whenever they wanted. Residents said that the food in the home was very good. They said the cook asked them everyday about what they wanted. Residents were able to influence what was on the menu. The kitchen was clean, tidy and orderly with a varied range of food available. A positive report from an environmental health visit was seen. Residents looked well with healthy skin and hair and this is a reflection of good nutrition. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 The home’s complaints procedure allowed residents to feel free to voice any concerns and to have them dealt with openly. Residents were given the right levels of support to allow them to continue to exercise their rights as citizens. The staff group in the home had a basic awareness of how to protect residents from abuse but their knowledge was limited by lack of training. EVIDENCE: Residents and their relatives said they knew how to complain and who to complain to. Residents had no complaints on the day. Relatives and residents said that the residents had access to solicitors if necessary. Most residents were going to have postal votes for the general election but one or two were going out to the polling station. Residents and their relatives said that they had never seen or heard anything abusive in the home. There were strategies in the care files showing how to minimise risk to residents. Staff were not quite sure about all aspects of dealing with potential abuse and had not received in-depth training on the subject. They were a little unsure of who to turn to other than the company. Key Care Ltd do have a full day’s training on their training plan but staff had not completed this. The residents are all potentially vulnerable to abuse and the staff need to have a full understanding of how to recognise and address this if it were to happen. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24 and 26 Westwinds has the appearance of a normal house and the whole building was safe, clean, tidy and homely. The residents felt that the building was a real home and they were relaxed and comfortable in their living environment. New furniture and equipment ensured that the residents were safe and comfortable and lived in a relaxing environment that met their physical and psychological needs. There were very good systems in place to allow for the prevention of cross infection. EVIDENCE: The home is situated in a residential part of Harrington and is near the marina. It is easy to reach by public transport. The home had a new conservatory that had increased the available communal space for service users. The double doors to the conservatory could be opened wide to make a large space with the lounge. Residents said this was nice when they had parties and that they could close the doors and be quiet and private.
West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 14 There were two further lounge spaces and a dining area. Residents enjoyed using these different areas. Smoking is allowed in one area of the home. All the bedrooms were single occupancy and were nicely decorated and furnished. The company have upgraded all the bedrooms to very good effect. The rooms were clean, homely and warm. Residents were very happy with their rooms and had been able to choose their own carpets, wallpaper and furniture. The home has two bathrooms. Service users said they never had to wait for a bath and that the facilities were suitable for their needs. The home had a mobile hoist, a functioning call bell system, handrails and security measures in place. These things meant that service users were as safe and comfortable as possible. Service users said that the mobile hoist and the bath hoist were comfortable and staff were competent in using them. Residents were happy with the levels of cleanliness in the home. They said their sheets and personal clothing were properly washed and ironed. The home had good systems for dealing with cross infection and very discreet ways of handling things like continence problems. Staff had been trained in these things. The investment in these systems made the home a safer and more pleasant place for residents. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 There were enough staff on duty at all times to ensure that residents get proper care and attention and that the home is clean and meals prepared. Recruitment practices were good with suitable checks in place to ensure that the people taken on were the right kind of people to care for the residents. Staff had received a lot of training that had improved their skills and knowledge but the staff group need further training in understanding mental health problems. EVIDENCE: Residents and staff said there were always two members of staff on duty and at times there were three. The manager, the cook and a domestic were also on the roster. Two files for new staff were checked. These contained all the information and checks necessary to ensure the staff were the right kind of people to care for vulnerable older people. A new recruit was spoken to and she confirmed that all these checks were done. She also spoke about her induction and she had a very good understanding of her job role after only being in post for three weeks. The training records showed that staff had received training in most of the skills that carers need. Residents thought that the staff were very good at what they did. A requirement was made at the last inspection that staff receive training in both dementia care and how to help and support people with illnesses like depression. Staff had enjoyed their dementia training and said it had given them new understanding. The home now needs to train staff further so they can understand how to help with illnesses like depression.
West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35, 36,37,38 The home was generally being very well managed. The manager had only been in post for some six months but had made improvements to the systems for caring for residents and in managing staff. The fire safety checks and routines were not in line with the guidelines set out by the Fire Service and needed to be completed more frequently to ensure the safety of the residents The staff roster needed to be improved in order to ensure that a true record was kept that showed which staff were caring for the residents at all times. EVIDENCE: Staff, relatives and service users were happy with the way that the manager was running the home. They felt that she had settled well into her role and that the running of the home had improved. There was evidence to show that she had continued to develop by attending training. She had consolidated systems for staff management and had improved the residents’ care planning systems.
West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 17 Money held on behalf of residents was being looked after properly ensuring that it was being spent only as they wanted. Staff said they met with the manager monthly and she talked to them about how they were performing in their job. The care of residents was the main subject recorded in these notes and this showed that staff were supported and encouraged to do their job as well as possible. The policies and procedures gave details of how best to manage things for residents’ safety and wellbeing. The weekly record of which staff worked each shift was not being kept in enough detail and could lead to problems if an issue was raised where the manager had to prove who was responsible on a particular day. The fire log book had a number of gaps in recording of checks on equipment and the fire instructions and drills had not been done as frequently as is necessary to ensure the building is safe and that staff know what to do in the case of fire. It would also be good practice to update the risk assessment for fire in the building. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A 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 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x x x 3 3 2 1 West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 18 30 Regulation 13 (6) 18 (1) Requirement The registered person must ensure that staff complete training in Adult protection. The registered person must ensure that all staff receive traing on supporting people with depression The registered person must keep a copy of the weekly staff roster that shows all changes and absences. 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 Timescale for action 3oth June 2005 30th June 2005 30th June 2005 30th June 2005 3. 37 17 (2) 4. 38 23 (4) 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 38 Good Practice Recommendations it is recommended that the fire risk assessment is updated. West Winds F58 F10 s38992 west winds v216854 180405 ui stage 4.doc Version 1.20 Page 20 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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