Inspection on 16/11/07 for Westwood

This inspection was carried out on 16th November 2007.

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

Westwood 22/08/06

Westwood 15/11/05

Westwood 19/07/05

Westwood 17/05/05

Westwood 02/02/05

Westwood 14/10/04

Westwood 03/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Westwood 284 Bath Road Worcester Worcestershire WR5 3ET Lead Inspector Nic Andrews/Rachel McGorman Unannounced Inspection 16,19&22 November 2007 & 29 January 2008 09:00 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 Westwood DS0000018697.V341300.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. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westwood Address 284 Bath Road Worcester Worcestershire WR5 3ET 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) 01905 353866 Mr Anthony Harold Downer Mrs Zinnat Esmail Downer Mr Anthony Harold Downer Care Home 12 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (12) Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate two named people who have needs outside of this category and were resident before 13 December 2005. 22nd & 23rd August 2006 Date of last inspection Brief Description of the Service: Westwood Residential Care Home is registered to provide personal care for up to twelve older people who are frail, who may have a physical disability and who may experience a dementia type illness. The home may also accommodate two people with mental health needs. The premises is a large, detached bungalow that has been adapted and extended for its present purpose as a residential care home, and is situated in a pleasant residential area of Worcester. Local amenities that are within walking distance of the house include a church, post office, and a public house, and the home is also on a bus route to the city centre, which is approximately one mile. The area at the front of the house provides parking facilities for several cars, and there is a large, well-maintained, lawned garden to the rear of the property. The home is owned and run by Mr & Mrs Downer, who live on the premises, in their own private accommodation together with their two children. The fees range from £1400.00 to £1580.00 per month. The stated aim of the home is to provide an excellent standard of personal care, and a sense of belonging, security and comfort as close as possible to that which the individual might enjoy in their own home. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of four days, and included two inspectors and also the Pharmacist Inspector, who looked specifically at the arrangements that are in place for the administration of medication. The home was inspected against the key National Minimum Standards with the help of the registered manager and other members of staff. Time was spent assessing the home’s response to the requirements and recommendations that were made as a result of previous inspections. Various records and policies and procedures that the home is required to maintain were inspected. A tour of the premises was also made. Individual discussions were held with several people living at the home and some members of staff. Several staff files were also seen, in relation to recruitment practices, and to confirm the training and supervision provided. Survey forms were issued to the relatives and representatives of the people living at the home. Some of the comments that were included in the survey forms are reflected in this report. The care of four people was case tracked. The Annual Quality Assurance Assessment (AQAA) for the home had been submitted to the Commission. What the service does well: The service users lived in a clean, comfortable and homely environment. They said they felt that they had choice in regard to their daily lives, that they were treated with respect and that their right to privacy was upheld. The service users were able to maintain contact with their relatives and friends and said that visitors were always made welcome. Relationships between the management of the home and the service users and their families were good. The comments about the standard of the food were very complimentary. The service users enjoyed a positive relationship with the staff and they said they were very kind and helpful. There was evidence to show that service users and their families and friends were very satisfied with the care that was provided at the home, and very positive comments were made in the surveys that were completed. Service users felt confident about making a complaint if necessary. The premises were well maintained and the furnishings and fittings were of a good standard. The home was being managed by an experienced and appropriately qualified registered manager. A pleasant and relaxed atmosphere was evident throughout the house and service users were interested and involved with whatever was happening in the home. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A statement of the terms and conditions of residence was being reviewed and amended but a copy is yet to be provided for every service user. The assessment form used to determine if the home can meet the needs of prospective service users should be more extensive. The protection of all service users would be better promoted if risk assessments were carried out in relation to nutrition and mobility. An Immediate Requirement Notice was issued in respect of the concerns identified by the pharmacist inspector in regard to the administration of medication, and these were discussed with the registered providers. Service users should be enabled to access a range of social and leisure activities in the community if this is their wish. All the policies and procedures, and the information and guidance produced by the home, should be reviewed regularly and dated, and any changes reflected in the documents to ensure that the information is accurate. Improvements to some aspects of the physical environment were needed for the benefit and safety of the service users. The amended policy and procedure on infection control should now be implemented. A more organised approach to staff training and the records that need to be maintained would benefit both the staff and the service users. Staff supervision should be undertaken with the required frequency. The registered manager should ensure that staff are familiar with and participate in formulating the policies and procedures that underpin the philosophy and care practices within the home. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 7 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. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 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 Westwood DS0000018697.V341300.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Relevant information is now available to enable prospective service users to make an informed choice about their future care needs. Further development of the assessment process should enable the staff to know if the care needs of prospective service users can be met at the home. EVIDENCE: Two requirements were made in regard to Standard 1 as a result of previous inspections, in respect of amendments to the home’s statement of purpose and the service users’ guide. The importance of these documents was again discussed with the registered manager during the inspection who confirmed that he was in the process of reviewing them. Subsequently copies of these documents have been submitted to the Commission and were received on 3rd January 2008. These requirements have both now been implemented. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 10 One requirement was made in regard to Standard 2 as a result of the previous inspection. The requirement related to the need for amendments to be made to the statement of terms and conditions of residence (contract). A copy of the contract, which was headed ‘Agreement of Care’, was made available for inspection, and included relevant information, although a few of the details that still need to be reviewed to ensure accuracy, were discussed with the registered provider. He confirmed that all of the service users have a contract, and that a signed and dated copy would also be placed in the service user’s files. The requirement will then be implemented. One requirement was made in regard to Standard 3 as a result of the previous inspection. The requirement related to the form used for the assessment of prospective service users. The assessment form, headed ‘Checklist for Assessment and Care Planning’, referred to many of the relevant aspects of care, but needed further development in accordance with Standard 3.3. In addition, the assessment form should also include the name and address of the home, the name of the prospective service user and the date on which the assessment was carried out. The need to provide sufficient space on the form to record all of the relevant information regarding the service users needs was also discussed with the registered manager, who confirmed that the document would be reviewed in the near future. The requirement now becomes a recommendation. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users said they were treated with dignity and respect by the staff. The care plans contained relevant, but limited information, and needed more detail to ensure that care needs were met appropriately. The service users were not protected by the procedures for dealing with medication that were not being properly followed. EVIDENCE: One requirement was made in regard to Standard 7, as a result of the previous inspection. The requirement was that the service users care plans were reviewed at least every month and for the information to cover all the aspects of the care needed. The requirement had not been fully implemented and now becomes a recommendation. The care plans of four service users were seen during the inspection, and there was evidence to show that they were being reviewed each month, although they did not include all of the aspects of care referred to in Standard 3.3, neither did the monthly reviews. The registered provider confirmed that some additional information in respect of individual service users was also recorded in the daily report, also referred to as a ‘Record of Care Plan’, and that the service users were involved in reading and signing their care plans. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 12 The format of the care plan needed to be amended in order to show clearly the identified needs of the service user, and concerns about the lack of detail were discussed further with the registered manager. Specifically, all of the interventions with the service users needed to be recorded, and the plans define how the care was to be implemented, the outcomes that were intended and the future proposals for the individual. The daily report for one service user, identified the need for assistance with dressing, and referred to an incident which a member of staff found difficult, but there was no guidance in the care plan as to how such a situation should be dealt with. The need for a risk assessment to be carried out was discussed with the registered manager. Three requirements and one recommendation were made in regard to Standard 8 as a result of the previous inspection. The first requirement was that nutritional assessments were undertaken for all service users. The registered providers confirmed that the service users’ weight is monitored, that food supplements are provided, and that their food preferences are noted. However, no specific recorded nutritional assessment had been carried out. The requirement had not been fully implemented and now becomes a recommendation. The second requirement was that a risk assessment must be carried out for two service users who were at risk of choking. The registered providers confirmed that risk assessments had been carried out for four service users, and staff had also been given information and advice on choking. The requirement had been implemented. The third requirement was that a risk assessment must be carried out in respect of all the service users at risk of falling. The registered manager said that the home had a policy on falls prevention and risk assessment. There was evidence of risk assessments on falls in place in some of the care plans, but they had not all been reviewed regularly. A fall sustained by one service user resulted in a change in her mobility needs, but the risk assessment had not been updated to reflect this. The need for a consistent response to risk assessment was discussed at length with the registered manager. The requirement had not been fully implemented and now becomes a recommendation. The recommendation was that a service user should continue to receive the required chiropody treatment from the National Health Service. The registered providers said that podiatry remains a problem, but the service user now ‘does it himself’. The inspector was also told that a chiropodist visited the home every 6 to 8 weeks and provided a fee-paying service to most of the service users. The recommendation had been implemented. The registered providers stated that the service users had access to health care services and received dental and ophthalmic treatment as and when necessary, and also that hearing tests were arranged through the GP when needed. The District Nurse visited to monitor some service users, and one person went to the local surgery to have blood tests relating to medication. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 13 The inspector was told that there were no service users with a pressure sore, and that there were no wheel chair users, although the majority of the people living at the home were physically frail and in need of walking frames, that the Community Psychiatric Nurse visited one service user regularly and that the Continence Adviser was consulted when necessary. The Pharmacist inspector visited the home and discussed the arrangements for the administration of medication with both Mr & Mrs Downer and also the two members of staff who were on duty. Six members of staff were undertaking an accredited medication training course on the safe handling of medication, however only three members of staff had signed a document to agree to administer medication. The medication procedure available was brief and had not been reviewed in order to ensure that people who use the service are safeguarded by an updated medication procedure. Medication storage did not always ensure that medication was secure at all times. The medication keys were not safe or secure and were accessible to unauthorised people. The majority of medication was stored in a locked wooden dresser. It was therefore disappointing to see that some medication was stored in an open kitchen cupboard that was not secure or safe and was accessible to unauthorised people, which means that there was an increased risk of harm to people who use the service. Legislation states that certain types of medication require very specific and special storage arrangements, which the home did not provide. Safe systems were not in place to ensure the safe storage of creams and ointments. They were sometimes stored directly next to liquid medicines and tablets, which means that there was an increased risk of a cream or ointment contaminating medication that a resident would place in their mouth. Safe systems were not in place to ensure that medication was returned when it was no longer needed and also to ensure that safe levels of medication were stored within the home. For example, a cream for one person was available that was dated March 2005 and there were four large tubs of an ointment dating back to April 2007. These storage arrangements increased the risk of an out of date medication being available and used for people living in the service. The majority of the medicine records seen were recorded with a signature for administration. Some of the medicine records did not always document the amount of medication administered. For example, when the directions stated that ‘1 or 2’ tablets can be administered the records did not show how many tablets had actually been administered and therefore did not safeguard people who use the service. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 14 Random medication audits undertaken were not accurate, and showed evidence that medication was not being handled carefully or safely. For example, medication required for administration the next day had been removed from the original pharmacy pack and placed into plastic pots labelled with the time of administration and the name of a person living in the service. The pots had been placed in an open kitchen cupboard to be used the next morning. The reason given by a member of staff for this poor practice was to save time the next morning. This does not ensure that people who live in the service are safeguarded and increases the potential for a medication to be administered in error. Some medication could not be checked to ensure it had been administered correctly because monthly balances of medicines were not available. This means that accurate checks on medication could not be made to ensure that medication has been administered to the people living within the service. The registered manager informed the pharmacist inspector that there were no people looking after their own medication, however the medicine records indicated that at least one person was. The medicine records for one person stated ‘uses herself’ and was written next to a variety of liquid medicines, eye drops and creams. The pharmacist spoke to the resident who appeared to be happy to look after her own medication and also said ‘I am very happy here. They are so kind to me.’ The service had a detailed procedure for the ‘self administration’ of medication, however it did not appear that it was being followed. The service had not completed a risk assessment to ensure the safety of the medication and to ensure the safety of people living within the service. One care plan seen did not contain sufficient information for medication, which was to be administered when required. There was no written information available to inform staff under what circumstances this medicine should be administered. The daily notes seen for the resident did not reflect the reason why the medicine was being administered every evening. This means that due to a lack of specific information the resident was at risk of being given the medication incorrectly and not as the doctor prescribed. The pharmacist inspector discussed the serious concerns relating to the administration of medication with the Registered Providers and an Immediate Requirement Notice was issued to Mr & Mrs Downer concerning the practice of secondary dispensing. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 15 Two requirements and one recommendation were made in regard to Standard 9 as a result of the previous inspection. The first requirement was that all staff involved in the administration of medication must undertake accredited training. It is disappointing that this training was not organised at the time of the previous inspection, and subsequently completed within the timescale given, which was November 2006. This requirement should be implemented when the training course that staff are doing currently, has been completed. The second requirement was that the medication policy should be reviewed to include the procedure to be followed in the event of a medication error being made. It is of concern that the requirement had been outstanding since February 2006, and had not yet been implemented. The requirement still stands. The recommendation was that a Controlled Drug cabinet should be obtained in the event that a Controlled drug has to be stored in the home. The recommendation had not been implemented and still stands. The home had a policy on privacy and dignity that formed part of the induction package for staff. The inspector was told that the personal and health care of service users was undertaken in private, and fixed screening has been provided in shared rooms. One service user had a telephone in the bedroom. The service users with whom discussions were held considered that they were treated with respect and that their dignity was upheld. Service users also confirmed that, ‘the staff were very kind, although they were sometimes tired working long hours’. One service user said, ‘the staff always knocked the door before entering the bedroom’, and another person commented, ‘there are rules, and we abide by them. We don’t complain’. The staff with whom discussions were held indicated that they understood the importance of maintaining the service users’ privacy and that they upheld their dignity in day-to-day practice. It was also confirmed that the service users wore their own clothes at all times. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users expressed their satisfaction with the lifestyle experienced in the home, but some may benefit from having the opportunity to engage in activities in the community. The service users received a wholesome and balanced diet. EVIDENCE: The service users with whom discussions were held stated that they were happy with the daily routine. They said they were free to get up and go to bed when they wished, and that they go to bed at 8pm, after their evening medication, and get up again at 7am. ‘We assemble in the dining room at 8am in time for breakfast’, one person said. The service users also said they were satisfied with the range of social and leisure activities provided in the home. These included music and movement sessions, a visiting musician, bingo, board games including Scrabble, and the television after tea in the evenings. Aromatherapy and manicure sessions are also arranged. An Anglican priest visits the home every month to hold a service. The children of the registered providers do a musical presentation for the service users on alternate weekends. The registered providers stated that the home did not have the staff or the transport facilities to take the service users out. These factors limit the service users’ links with the community. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 17 A recommendation had been made in regard to Standard 12 as a result of previous inspections that the range of social and leisure activities should be expanded. There was limited evidence to show that opportunities for activities outside the home had increased. The service users indicated that they were satisfied, and several went out with their family and friends, but some people may benefit from a wider range of activities. One service user told the inspector that, ‘she would like to go out more’, another person said, ‘she would like to visit a garden centre’, and staff said that, ‘they would be happy to take the service users out’. In addition, a record should be maintained of all the activities that are held. The staff handover book contained a note of the events of the shift, and a reference to activities was found in some of the daily record sheets, but more formal evidence should be maintained. The recommendation had not been fully implemented and still stands. The registered provider stated that visitors were welcome at any time except mealtimes. Both the service users and the relatives with whom discussions were held said that their visitors were always made welcome. It was also confirmed that the service users were able to see their visitors in private and that the service users’ wishes about whom they saw or did not see would be respected. During a late afternoon visit to the home the inspector observed that at least six of the service users received a visit from their family or friends. The comments made to the inspector about the service were very favourable, providing evidence of everyone’s satisfaction with the care that was provided. One relative was so relieved that her mother was, ‘settled and happy’. She spoke of, ‘the benefit her mother had gained just from being at the home’, and ‘how she had thought that she would never again see her mother thinking about the needs of others more than herself’. One visitor also mentioned ‘how much the dedication and commitment of the management and staff was appreciated’. A recommendation was made in regard to Standard 13 as a result of the previous inspection that the service users’ guide should include information about the home’s policy on maintaining relatives and friends’ involvement with the service users. The service users guide had been reviewed, and contained some references to family and friends, although it did not include information about the home’s policy on this matter. The recommendation had not been fully implemented, and still stands. The registered provider stated that the home did not handle any money on behalf of any of the service users. It was also confirmed that the home kept written information about the local advocacy service to give to the service users and/or their relatives if necessary. Prospective service users were entitled to bring personal possessions with them when they were admitted to the home, and the inspection of the service users’ bedrooms confirmed that this practice had been adopted. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 18 A recommendation was made in regard to Standard 14 as a result of the previous inspection that the service users’ guide should include a statement that the service users or a representative acting on their behalf have the right of access to all the personal records held about them by the home in accordance with the Data Protection Act 1998. The statement in the service users guide does not make reference to ‘their representative acting on their behalf’. The recommendation had not been fully implemented, and still stands. The record of the food was made available for inspection, and showed that a wholesome diet was provided. The registered provider stated that the main cooked meal of the day was served at lunchtime, fish was served twice a week, there was always a roast on Sundays, and that an alternative meal could be made available. It was also confirmed that drinks and snacks were available throughout the day, and that during hot weather additional cold drinks were served. Two service users had their food mashed or cut into small pieces in order to enable them to eat it more easily, two other service users were diabetic, and the home catered satisfactorily with all of their dietary needs. The menu indicated that the meal at teatime normally consisted of sandwiches, and it was suggested that the registered providers should try to introduce more variety for tea. The ‘Safer Food, Better Business’ system, produced by the Food Standards Agency had been introduced at the home, and a record of temperatures is kept. The service users with whom discussions were held commented positively about the food. One service user said, ‘We have an excellent cook, and lovely puddings, and there’s always enough’. Another person said, ‘The food is as good as one ever had at home, but they don’t like you leaving your food’. Further comments included, ‘The food is very nice, I’m happy to have what they serve, and we never go hungry. We are not consulted about the food, and I would like something a bit different occasionally, like a cooked breakfast’. Comments from staff confirmed that the food provided for the service users was very good, and that they always had sufficient. The registered providers stated that food was not served in the service users’ bedrooms for health and safety reasons, ‘It adds to the workload for us, and it’s a risk’, and ‘the interaction has a social advantage, because they talk to each other in the dining room’. The registered provider also stated that the mid-morning and mid-afternoon drinks were served at the dining room table, ‘in order to encourage the service users’ mobility and to help ensure their safety and avoid accidents’. The meals were only served in the service users’ bedrooms ‘if a resident was not well’, although one person said they could have breakfast in their own room if they wished. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users were confident about the complaints procedure at the home. To ensure the safety and protection of the service users the policies and procedures should be reviewed regularly amended as necessary and the staff made aware of them EVIDENCE: The complaints log contained three complaints of a minor nature that had occurred during a week in July 2007. The inspector was told that all the concerns were dealt with quickly and resolved, and this was confirmed in conversation with several of the service users. It was also pleasing to note that the service users felt confident about making a complaint, and that it would be dealt with appropriately. Two recommendations were made in regard to Standard 16 as a result of the previous inspection. The first recommendation was that the complaints procedure should be reviewed and amended, and a copy submitted to the Commission. The second recommendation was that all the service users and their relatives were made aware of the complaints procedure, and that it had been discussed with all the staff. Several people confirmed that they knew how to make a complaint. The recommendations had both been implemented. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 20 Two requirements and one recommendation were made in regard to Standard 18 as a result of the previous inspection. The first requirement was that the homes policy and procedure on the protection of vulnerable adults from abuse must be reviewed and amended. The second requirement was that the home’s whistle blowing policy must be reviewed and amended. The requirements had both been implemented. During discussion with the inspector two members of staff said that they did not know what a ‘whistle blowing’ policy was. The registered providers were reminded that all the policies and procedures, information and guidance produced by the home, should be reviewed regularly and dated, and any changes should be reflected in the documents to ensure their accuracy. In addition, they should ensure that the staff are made aware of the content, and also that the service users are consulted and participate in formulating the policies and procedures that underpin the philosophy and practices of the home. The recommendation was that the staff, service users and visitors are informed that the staff are not permitted to receive gifts or bequests or assist service users to make their wills. There was no written evidence available to show that these people had been informed. The recommendation had not been implemented and still stands. The registered providers were advised that a policy and procedure that includes all of the issues referred to in Standard 18.6 should be developed and a written record maintained to show that a copy has been provided to all of the staff, service users and their visitors/relatives. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 21 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, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users lived in a pleasant and well maintained environment that is clean and comfortable, and nicely decorated and furnished, but to fully ensure the safety and security of the people who live and work at the home, the outstanding work should be completed EVIDENCE: Westwood is a large, detached bungalow that has been adapted and extended for its present purpose as a residential care home, and is situated in a pleasant residential area of Worcester. Within walking distance of the house there is a church, a post office, and a public house, and the home is also on a bus route to the city centre, which is approximately one mile. The area at the front of the house provided parking facilities for several cars, and there was a large, well-maintained, lawned garden to the rear of the property, which was a safe and sheltered area accessible by ramps on both sides of the property. The location and layout of the home was suitable for its stated purpose, and maintained in a comfortable and homely manner. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 22 The service users were accommodated on one level in eight single and two double bedrooms. The bedrooms were clean, well maintained and nicely personalised, and nine of the rooms had en suite facilities. The communal areas of the house included a quiet room, a dining room, two lounges and a large covered patio. Several improvements had been undertaken since the last inspection and included, two new recliner chairs, new furniture and new blinds in the bottom lounge and new furniture in the conservatory, refurbishment of a bathroom, decking on the patio, a new front fence and gate, a new roof on the annexe and the outside of the house had been repainted. Four recommendations were made in regard to Standard 19 as a result of the previous inspection. The first recommendation was that a programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced. A document entitled ‘Westwood forward planning, regular maintenance and new projects’, had been produced, but the matrix was not sufficiently detailed. The recommendation had not been fully implemented and still stands. The second recommendation was that the fire-resisting door in the main corridor should be reinstated in accordance with the recommendations of the Fire Safety Officer. The registered manager confirmed that the door is with the carpenters and will be fitted in the near future. The recommendation had not been fully implemented and still stands. The registered manager had also been advised at the previous inspection that if any of the service users wished to have their bedroom door open, an approved closure device must be installed. Five closures had been provided. The advice is repeated in respect of the remaining rooms and now becomes a recommendation. The third recommendation was that a part of the kitchen should be repainted. The fourth recommendation was that the bathroom should be refurbished. These recommendations had both been implemented. One requirement was made in regard to Standard 24 as a result of the previous inspection. The requirement was that all the items of furniture specified in Standard 24 must be provided in rooms occupied by the people living there. The registered manager was advised that an audit of the service users’ bedrooms should be undertaken and, if the provision of any item posed an unacceptable risk to the service user or they declined the provision, details of the discussions and decision about this should be recorded in their care plan. The inspector was told that the service users had been consulted, and that two service users had been provided with a lockable facility. The requirement had been implemented. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 23 Two requirements were made in regard to Standard 26 as a result of the previous inspection. The first requirement was that the home’s policy and procedure on the control of infection must be reviewed and revised. A copy of the updated document was submitted to the Commission, and included a reference to all of the relevant issues, namely, the safe handling and disposal of clinical waste, dealing with spillages, provision of protective clothing and hand washing. The second requirement was that liquid soap and disposable towels must be provided in the laundry and in close proximity to all of the hand-washing facilities in the communal bathrooms and toilets. The requirements had both been implemented. The home was clean and tidy and there were no unpleasant odours. The comments from service users were very positive about the standards of cleanliness, ‘The cleaning here is stupendous. They do it thoroughly’. ‘The laundry is done as often as we wish’. The home had a suitable laundry that was situated in a small, separate building at the side of the premises. There were two washing machines and two tumble driers, but there was no sluicing facility. The level of incontinence in the home would indicate the need for a more appropriate means of dealing with soiled linen. The registered manager was advised that the matter should be discussed with the Environmental Health Officer. Further action should also be taken by the registered manager to ensure that the practices within the home are implemented in line with the infection control policy statement and the procedures produced by the registered providers. A further observation was made in bedroom 4 where there were two radiators, one of which was very hot and had not been guarded. In addition the radiators in the main corridor were not guarded, therefore action must be taken to ensure that the risk to service users of contact burns is eliminated. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users stated that the staff were very good, and kind and helpful, but the arrangements for staff training should be more organised to ensure that the changing needs of service users are understood and met EVIDENCE: A copy of the staff rotas covering two weeks was made available for inspection. In addition to the registered providers, five other members of staff were employed at the home. The registered providers stated that staffing levels were adequate for the needs of the people who live at the home, and several of the service users were very complimentary in their comments about the staff and the care they receive. However, one service user said, ‘staff sometimes get tired’, and a relative noted in their written response to a questionnaire, ‘staff sometimes seem rather impatient’, and one of the staff remarked, ‘We have enough time to talk to the service users in the afternoon, but the mornings are busy’. There were two care staff on duty throughout the waking day, and at night there was one member of staff awake, on duty in the home, supported by the registered providers who lived on the property. Two recommendations were made in regard to Standard 27 as a result of the previous inspection. The first recommendation was that consideration should be given to providing additional staff at peak times of activity during the day. The registered providers stated that they were available when necessary. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 25 The second recommendation was that the practice of staff working long shifts should be discontinued. The recommendations had both been implemented. Concerns were discussed with the registered proprietors about the number of hours that they both worked each week, during the day and in also providing cover at night, but they explained that this was necessary in order to ensure that the home was appropriately staffed at all times. One requirement was made in regard to Standard 28 as a result of the previous inspection. The requirement was for arrangements to be made for staff to receive training for the National Vocational Qualification Level 2 in Care or equivalent. The registered manager confirmed that two staff had completed the NVQ level 2, and three staff were working towards this qualification. The requirement had been met. Five requirements were made in regard to Standard 29 as a result of the previous inspection. The first requirement was that two relevant, written references must be obtained for prospective staff, prior to their appointment. The second and third requirements related to obtaining enhanced disclosure checks from the Criminal Records Bureau for all existing and prospective staff. The fourth requirement was that staff files must contain proof of identity in accordance with Regulation 19 and Schedule 2. i.e. a photograph, a copy of the birth certificate and a current passport. The fifth requirement was that a statement of the terms and conditions of employment and a copy of the Code of Conduct and Practice set by the General Social Care Council must be issued to all the members of staff. The requirements had all now been implemented. The home provided accredited induction training through a Consultancy. The inspector was told that dementia training was completed in July 2007, medication training was being done currently, and infection control training was to be arranged after this. Since the last inspection one person had done fire awareness training, and two staff had done training in moving and handling. Some of the staff informed the inspector that some training had been undertaken during their previous employment with other providers. Two recommendations were made in regard to Standard 30 as a result of the previous inspection. The first recommendation was that individual training and development assessments and profiles should be provided. The recommendation had been implemented. The second recommendation was that the training matrix should record the dates of the proposed and completed training provided for staff, and be kept up to date. The recommendation had not been fully implemented and still stands. The registered providers were advised that a training and development programme should also be produced to help them to know that the staff are competent to fulfil the aims of the home and to meet the changing needs of the service users. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 26 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): 31,32,33,36,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is appropriately qualified and experienced for the role but the safety and well being of the service users would be better assured if all care management practices were fully and consistently implemented EVIDENCE: Westwood Residential Care Home is owned and run by Mr & Mrs Downer who are the registered providers. Mr Anthony Downer is also the registered care manager with responsibility for the day-to-day running of the home. Mrs Downer who has completed an NEB course in Supervisory Management assisted her husband with running the home. The registered manager had obtained the Registered Managers’ Award in June 2004, and confirmed that he had also undertaken various other training to update his knowledge and skill, including first aid, abuse awareness, moving and handling and fire safety. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 27 It was pleasing to note that the service users, relatives and staff with whom discussions were held stated that the registered providers were approachable and supportive. A recommendation had been made in regard to Standard 32 as a result of the previous inspection that a staff meeting should be held at least twice a year with a written agenda and recorded minutes. The registered manager said that as the staff group is so small regular discussions were held informally with all the staff, and that comments were recorded in the communication/handover book. The recommendation had not been fully implemented and still stands. The registered providers were advised that it is good management practice to hold regular staff meetings, and to involve staff in the decision making process would also enable them to influence the way in which the service is delivered. One requirement and one recommendation were made in regard to Standard 33 as a result of the previous inspection. The requirement was that quality assurance must be further developed. A questionnaire, based on Inspecting for Better Lives – A Quality Future, had been developed and given to service users, relatives and other visitors to complete. The results, all of which were positive, had been collated and put up on the notice board in the home. The inspector would wish to acknowledge the work that had been undertaken, but the surveys should now be extended to incorporate the views of other people involved with the home. The requirement had not been fully implemented and now becomes a recommendation. The registered manager was advised that the surveys should be undertaken annually, include how well the home succeeds in achieving the stated aims and objectives and cover every aspect of service provision. An AQAA, the Annual Quality Assurance Assessment document had been submitted to the Commission and was discussed with the providers during the course of the inspection. The registered manager was advised that the AQAA is a requirement that enables providers to demonstrate how well the home meets the needs of the people who live there, but in order to do this effectively, it was necessary to include the information requested in greater detail. The recommendation was that an annual development plan for the home should be introduced, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. The document was said to be incorporated in the maintenance plan for the home, but this only relates to the property and does not include the many aspects of social care that form part of the service provision and the purpose of the home. The recommendation had not been fully implemented and still stands. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 28 A requirement was made in regard to Standard 36 as a result of the previous inspection that care staff must receive formal supervision at least 6 times a year. The registered manager confirmed that this had not been done as frequently as necessary, and he was reminded that the format should reflect the process recommended in the National Minimum Standards, and cover care practice, philosophy of care in the home and career development needs. The requirement had not been fully implemented and now becomes a recommendation. A recommendation was made in regard to Standard 37 as a result of the previous inspection that a full range of policies and procedures should be available to inform and guide staff in their duties. The AQAA showed that a number of policies, procedures, codes of practice and guidance remained outstanding. The registered providers were reminded that further attention should be given to undertaking a full review of the present provision and to ensure that all the appropriate documentation was in place. In addition, staff should confirm in writing when they had read and understood all of the policies and procedures. The recommendation had not been fully implemented and still stands. Four requirements were made in regard to Standard 38 as result of the previous inspection. The first requirement was that training must be undertaken by all of the staff in basic first aid, fire safety, basic food hygiene, moving and handling and health and safety. The registered providers stated that medication training had been completed and that training in infection control was planned, and they also acknowledged the need for a more organised approach to staff training arrangements. The requirement had not been fully implemented and now becomes a recommendation. The second requirement was that risk assessments must be carried out and recorded in respect of all safe working practice topics covered in Standard 38. The requirement had been implemented. The third requirement was that thermostatically controlled mixer valves must be fitted to all hot water outlets used by service users. The requirement had not been fully implemented and now becomes a recommendation that an assessment of the risk to service users is carried out. The fourth requirement was that the Commission must be notified without delay of any serious accident or any event in the home that adversely affects the wellbeing or safety of any service user. The Commission had not received notifications under Regulation 37 about injuries suffered by three service users who had required treatment at hospital during recent months. One person had sustained a fractured arm that was not reported to the Commission. The requirement had not been implemented and is repeated. Contracts are in place for the regular servicing and maintenance of equipment. The Fire Log Book was viewed and indicated that the appropriate procedures were being followed, and the equipment checks were recorded. The registered manager said that he had produced a questionnaire for staff to increase their Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 29 knowledge and awareness in regard to fire. During a recent visit from the Fire Safety Officer the registered manager had been complimented about the high standard of the Fire Risk Assessment that was in place at the home. Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 30 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 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X 2 1 2 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X x 1 2 1 Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 31 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 Regulation 13 Requirement Suitable arrangements must be made to ensure that medicines are stored securely with restricted access to authorised members of staff to ensure that people who use the service are protected from harm Risk assessments must be available for people who look after their own medication to ensure that all medication stored in the service is safe and to protect people living in the service from harm Suitable arrangements must be made to ensure that medication is administered from the original pharmacy container on the correct date and time as stated on the medicine records in order to ensure that people who use the service are protected from harm DS0000018697.V341300.R01.S.doc Timescale for action 29/02/08 2 OP9 13 29/02/08 3 OP9 13 29/02/08 Westwood Version 5.2 Page 32 4 OP9 13 5 OP9 13 6 OP38 37 Staff must ensure that medicine 29/02/08 records for the administration of medication accurately document what has been administered in order to ensure that the people who use the service are safeguarded and medication has been administered as prescribed by a General Practitioner A system for the safe return of 29/02/08 unwanted medication should be followed to ensure that all unnecessary medication is removed from the service. This will ensure that adequate storage levels of medication are available to administer to the people who use the service The Commission must be notified 29/02/08 without delay of any serious accident or any event in the home that adversely affects the wellbeing or safety of any service user 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 OP3 OP7 OP8 Good Practice Recommendations The home’s assessment form should be revised to include all the aspects of care listed in Standard 3.3 The care plans should include the specific action that needs to be taken by staff to ensure that all aspects of the needs of the service users are met. Nutritional assessments should be undertaken on all service users and reviewed regularly, to ensure their health care needs are met DS0000018697.V341300.R01.S.doc Version 5.2 Page 33 Westwood 4 5 6 OP8 OP9 OP9 7 OP9 8 OP9 9 OP9 10 OP9 11 12 13 OP12 OP13 OP14 14 OP18 15 OP19 A risk assessment should be carried out, reviewed and recorded in respect of all service users at risk of falling to ensure their changing needs are met The medicine policy should be reviewed and updated in order to ensure that the health and welfare of service users taking medication are safeguarded Documentation should be available which describes the care to be given to residents who require the administration of medication prescribed ‘when required’. This is in order to ensure that medication is given as prescribed by a doctor A safe system should be introduced to ensure the safe storage of creams and ointments in order to prevent possible cross contamination with other medicines and therefore protect the people who use the service from harm A system should be introduced to ensure that balances of medicines are carried over onto a new medicine chart in order to ensure accurate medicine audits can be done and check that people who use the service have been administered medication according to the directions of a General Practitioner There should be an up to date signature and initial list of all trained staff who administer medication in order to ensure accuracy of records and that people who use the service have their medication administered by trained and competent staff Controlled Drug Storage should be available in order to meet The Misuse of Drugs (Safe Custody) Requirements 1973, to ensure that medication requiring special storage arrangements can be stored correctly The range of activities in the community should be increased to suit the service users wishes and a record of all the activities that take place should be maintained The service users’ guide should include information about the home’s policy of maintaining the relatives and friends’ involvement with the service users The service users’ guide should include a statement that the service users or their representative have the right of access to all the personal records held about them by the home in accordance with the Data Protection Act 1998 A policy and procedure that includes details of all of the issues referred to in Standard 18.6 should be developed and a copy provided to all of the staff, service users and their relatives A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produce DS0000018697.V341300.R01.S.doc Version 5.2 Page 34 Westwood 16 17 18 19 20 21 22 23 24 25 26 27 28 OP19 OP19 OP25 OP26 OP26 OP30 OP32 OP33 OP33 OP36 OP37 OP38 OP38 The FD3S fire-resisting door in the main corridor should be reinstated in accordance with the recommendations of the Fire Safety Officer Door closures should be fitted to the remaining bedrooms where the service users wish to have their door held open The risk to service users from unguarded radiators and exposed hot water pipes should be assessed and action taken to prevent injury from contact burns The advice of the Environmental Health Officer should be sought regarding the need for a sluicing facility to be provided in the laundry The policy and procedure on the control of infection should be implemented to ensure the protection of service users A training programme should be developed and the staff training matrix should be kept up to date and include the dates of proposed and completed staff training A staff meeting should be held at least twice a year with a written agenda and recorded minutes The quality assurance system should be further developed in accordance with the requirements of Regulation 24 and Standard 33 An annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users should be introduced Care staff should receive formal supervision at least six times a year that covers care practice, philosophy of care in the home and career development needs A full range of policies and procedures should be available to inform and guide staff in their duties and evidence provided to confirm that these have been read Training should be undertaken by all of the staff in all of the core areas in accordance with Regulation 18 The risk to service users from the hot water outlets should be assessed and appropriate action taken to prevent burns Westwood DS0000018697.V341300.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. 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