Inspection on 20/06/07 for Westwood House

This inspection was carried out on 20th June 2007.

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

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

Other inspections for this house

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Westwood House 9 Westwood Hill Sydenham London SE26 6BQ Lead Inspector David Lacey Unannounced Inspection 10:00 20th June 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westwood House DS0000069363.V338969.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 House DS0000069363.V338969.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westwood House Address 9 Westwood Hill Sydenham London SE26 6BQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8776 7065 020 8659 1327 Barchester Healthcare Homes Ltd Anita Corpuz Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 49 patients, frail elderly persons aged 60 years and above (female) and 65 years and above (male) Chronic sick patients aged 40 years and above, one of which can be under the age of 40. Within the total of 49 patients, up to a maximum of 6 patients with palliative care needs may be accommodated This is the first inspection since change of ownership. Date of last inspection Brief Description of the Service: Westwood House is a modern, purpose built care home providing nursing for 49 people. There are four floors with a shaft lift providing access to all floors. Residents’ accommodation is on the ground floor and first floor. Service facilities are located in the basement and on the top floor there are staff facilities and further communal facilities for residents. Single rooms are provided with all but three having en-suite toilets and there are three shared bedrooms. The home has a secure rear garden. The home is in a residential street in Sydenham, close to local public transport facilities and within a reasonable distance from shops and other community facilities. The fees for this care home are a minimum of £576 per week. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced visit to the home, carried out by two inspectors. The registered manager was not present during the inspection but the deputy manager assisted with our visit. Our inspection visit included a tour of the premises, and discussions with residents, visitors and staff members. We observed practice and examined various pieces of documentation. As part of the inspection, we invited written comments from a sample of residents, relatives and care professionals. Their feedback is included within this report and has been taken into account in forming our judgements about the home. This was the first key inspection since the home’s change in ownership at the beginning of this year. The commission carried out a random inspection in February 2007, and issues arising from that visit have been followed up at this inspection. What the service does well: What has improved since the last inspection? This was the first key inspection since the home’s change of ownership. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 (6 does not apply to this home). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given the information they need to enable them to decide whether the home is suitable. Pre-admission assessments provide enough information to guide staff in meeting the residents’ needs. EVIDENCE: The home’s statement of purpose and its service user guide contain the required information. A copy of the service users guide was seen in residents’ bedrooms. All of the fifteen residents who returned questionnaire responses to the CSCI stated they had received enough information about the home before they moved in so they could decide if it was the right place for them. One resident spoken with said her daughter had chosen the home for her, another said she had chosen the home herself because she knew other people who were already living there. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 9 Of the three relatives who returned questionnaire responses to the CSCI, one stated they or their relative always get enough information about the home to help them make decisions. Two stated this was sometimes the case. A visitor whose relative had recently been admitted said the family visited several homes before deciding on this one. She said, “As soon as she [her relative] walked through the door she had a gut feeling it would work”. She said they got helpful information from the administrator and that staff were “kind and gentle” when they answered their questions and made sure to include her relative in the conversation. She said the staff, “treat people like people”. It was evident that residents are assessed before admission so that a decision can be made whether the home is suitable to meet their needs. Pre-admission assessments were seen on file and relatives of two residents we spoke with confirmed that, before moving in, the residents had an assessment by a social worker and staff from the home. A health care professional stated the home could improve by ensuring all prospective residents had received a continuing care assessment before admission to Westwood House. These assessments were present on the files we viewed but we raised this issue with the home’s acting manager who confirmed the home would continue to try to ensure these assessments are completed for all residents before admission. It was evident the previous requirement about contracts had been addressed, as outlined in the home’s action plan that was given to us by the acting manager on the day of our inspection visit. All of the fifteen residents who returned questionnaire responses to the CSCI stated they had received contracts. A visitor whose relative had recently been admitted said her relative was given a contract with terms and conditions. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have care plans, though these do not always reflect fully all needs. Residents have good access to health care services, including physiotherapy services provided by the home. The administration of medicines was satisfactory. EVIDENCE: Comments received about the care provided by the home were mostly positive. The comments were from residents, relatives and health professionals, both during our visit and from questionnaire responses. An inspector spoke with two relatives, who were visiting their mother. At least one of them visits each day so they had a good knowledge of what goes on in the home. They said it was “definitely good here” and “staff are lovely”. A relative who visits regularly a resident who has been in the home for some years said she is pleased with the care, “they look after mum so well”. Another relative said he had been involved in care, such as helping with feeding his relative, and had agreed and signed care plans. She has her hair and nails done regularly. He said “they’re very patient, the staff”. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 11 Of the 15 residents who returned questionnaire responses to the CSCI, 14 stated they always receive the care and support they need. One resident stated this was usually the case. A resident said she has a bath when she wants it, she just asks. Of the three relatives who returned questionnaire responses to the CSCI, one stated the home usually gives the support or care to their relative that they expected or agreed, two stated this was sometimes the case. One relative stated the home always meets their relative’s needs, one that this was usually the case, and one that the home sometimes meets their relative’s needs. There are handovers between staff twice a day and a daily report is kept for each resident. A nutrition report/audit is kept monthly and the weight of residents at risk is monitored weekly and a monthly report is kept. The home produces a monthly pressure sore report and the progress of residents is monitored. The home’s pressure sore report to the provider (Barchester) for May 2007 was seen. It provided details of the stage of each sore (using the Stirling scale), whether it is healing or not, whether it developed in the home and whether external advice had been sought (such as from the tissue viability service). During May 2007, there were eight residents with a total of thirteen sores. Five of these sores had developed while the resident was in the home. The tissue viability specialist had seen five of the residents, and the podiatrist’s advice had been obtained for two residents who had sores on their feet. None of the thirteen sores were deteriorating and four had healed. Eight were assessed as improving and one as not having changed since the previous month. A resident who had been admitted with a grade four pressure sore had been seen by the tissue viability specialist and the home’s staff were following the treatment guidance given. The resident had a pressure-relieving mattress and was having her position in bed changed regularly. Staff were encouraging fluids and diet, supplemented with protein drinks. The diet was pureed and an inspector observed guidance from the speech and language therapist being followed by a nurse during assisted feeding. The progress of her wound was being monitored, with Waterlow assessments and photographs. Of the 15 residents who returned questionnaire responses to the CSCI, 14 stated they always receive the medical support they need. One resident stated this was usually the case. It was evident from files seen that visits from health care professionals are recorded. These professionals included GP, tissue viability nurse, speech and language therapist, podiatrist and community psychiatric nurse. A resident said he is supported to attend regular health care appointments and the podiatrist visits him at the home. Two health Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 12 professionals who responded to a CSCI questionnaire stated that the home usually seeks advice and acts upon it to manage and improve residents’ health care needs, another stated this was always the case. Two health professionals stated that the home usually meets residents’ health care needs, another stated this was always the case. We positively noted the home has its own physiotherapist, who provides this service several days a week. During our visit, we sampled six residents’ care plans. Generally, these contained some good information and gave guidance to staff about the care and support required to meet the residents’ individual needs. However, care plans tended to focus on physical areas of support and offer comparatively little guidance about residents’ social and psychological needs. There were some brief life histories but more information about individual needs and preferences could enable a more holistic approach to delivering care. Care plan documentation should always reflect all aspects of the resident’s needs (recommendation 1). We received mixed feedback about formal reviews of residents’ care. Two relatives said they had never been asked to attend a review since their relative was admitted to the home over two years previously. Two other visitors said their relatives had had a care management review with the social worker, and the families were involved. Generally, medication administration was satisfactory. Medication is stored securely with records of receipt, administration and disposal kept. We sampled six residents’ medicine administration records (MAR) and there were no unexplained gaps in administration. MAR charts are checked twice daily; this is a visual check and is signed for. The home has a medication audit plan and weekly medication checks take place. Two staff members sign the receipt of individual medicines into the home. The staff members’ signatures and initials list was up to date. The home was not using a running total system on its MAR’s to monitor medication, which would be seen as good practice (recommendation 2). Internal and external medicines are stored separately. The controlled drugs (CD) being stored in the ground floor clinical room were checked and found to tally with the records in the CD book. The ‘sharps’ box was labelled and not overfilled. Some eye-drops in the drugs refrigerator with ‘discard after 28 days’ on the label were not dated with the date of opening, and the nurse on duty said she would remind staff to do this in the future (requirement 1). The room thermometer in the ground floor medicines room showed 23 degrees C. The room has no natural ventilation but has an air-conditioning unit fitted. The homely remedies protocol had been signed by the GP in June 2007 and individual doses had been recorded when given. The home had addressed with its GP a previous requirement about medication prescribed ‘as required’. The Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 13 action taken was confirmed in the home’s action plan provided by the acting manager during our inspection visit. The home’s medication policy and procedure was on file and readily available to staff, together with relevant guidance from the Royal Pharmaceutical Society and the Nursing and Midwifery Council. The home had an up to date (March 2007) copy of the British National Formulary. Residents and relatives we spoke with told us they were treated with respect and that residents’ dignity is maintained while they are being helped with personal care. Staff were seen to knock before entering residents’ rooms and being considerate of the residents’ capacities during interactions. One health professional who responded to a CSCI questionnaire commented that the home always respects residents’ privacy and dignity. Another stated this was usually the case. Residents have the use of a pay telephone on each floor. We noted that the phone on the first floor is in the main corridor, which does not offer much privacy to someone using it (recommendation 3). Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to take part in various activities, though these are not made available at weekends. A balanced diet is provided and residents like most of the food served. However, the home needs to do more to ensure mealtimes meet residents’ individual needs, expectations and preferences. EVIDENCE: Of the three relatives who returned questionnaire responses to the CSCI, one stated the home always supports people to live the life they choose, one that this is sometimes the case and one stated that the home never supports people to live the life they choose. One health professional who responded to a CSCI questionnaire stated that the home always supports residents to live the life they choose, another stated this was usually the case. A resident told us, “it’s my home now, but it’s not like your own home, once you accept that it’s acceptable”. She said she has her own phone and her family are near. Another resident, who has been in the home for some years said, “I love it here, it’s my home”. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 15 An inspector spoke with a visitor who said (positively) he feels like a resident and the staff treat him with respect. Other members of the family visit regularly, and are happy with the service. One who was also visiting said, “Mum loves it here”, “its not stage managed”. They both said they could come in to the home at any time of day. An inspector observed staff ensuring a resident could choose how and where he wanted to spend the afternoon. The resident has restricted verbal communication and staff took time to listen and make sure they understood his requests. Of the 15 residents who returned questionnaire responses to the CSCI, five stated there were always activities arranged by the home they could take part in. Seven residents stated this was usually the case, two that it was sometimes the case and one resident stated there were never activities in which s/he could participate. A visitor commented that her relative “has no wish to socialise with the other residents and that wish is respected”. The home publishes a programme of activities each week. We saw the programmes for each week in May 2007, which contained various activities available to residents. It was noticeable that no activities are provided at weekends, with Saturdays being designated on the programme as ‘Family Day’ and Sundays as ‘Family Visit’. It was not clear why this was the case, given that families can visit any day of the week. The home needs to consult residents to see if they would like planned activities offered at the weekends also (requirement 2). Of the three relatives who returned questionnaire responses to the CSCI, two stated the home never helps their relatives to keep in touch with them, one commenting, “it is self motivated by myself and my mother”. Another relative stated this question did not apply as, “I visit my relative nearly every day”. Two of the relatives said they were always kept up to date with important issues affecting their relative, one stated this was sometimes the case. Of the 15 residents who returned questionnaire responses to the CSCI, seven stated they always liked the meals at the home and eight stated they usually liked the meals. One relative spoken with had no complaints about the food. A resident said the food is nice and he can choose alternatives to the menu. He likes to eat breakfast and lunch in his room, and supper in the dining room and these choices are respected. Another resident said a staff member asks what they want to eat from the menu the day before. She had chosen an omelette. An inspector checked after lunch to see if she had been given her choice and she said she had, probably because the inspectors had been around. A resident said “the food is sometimes cold”. Another resident was going for a hospital Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 16 appointment, and the staff made sure she had sandwiches to take with her in case she was at the hospital for a long time. She told us “there is a good variety of food”. An inspector was invited to take lunch with the residents on the ground floor. All were sitting and in place for about twenty minutes before lunch was brought into the dining room. Staff took a cursory glance at the sheet of paper that recorded who wanted what for lunch, then did not look at it again. One member of staff served lunch on to plates that were covered and put onto trays on a trolley. About eight plates were done this way. Staff then took these to the residents who were having their meals in their bedrooms. Lunch was then served to residents who were waiting in the dining room, with plates of food being put in front of them. Staff assisted some residents to eat and one relative said he came daily to help his wife because so many others needed help. The inspector noted the sitting positions of residents were poor. Because many were still sitting in wheelchairs they could not be pushed under the table, which made eating difficult. Most of the residents were slumped and leaning back in their chairs, making accessing food and getting it onto the utensils difficult. Manoeuvring spoon or forkfuls of food from this position is difficult and many gave up with the effort. When asked by the staff if they were finished most said “yes”. Where possible, residents need to be helped to get out of their wheelchairs to eat and positioned in an upright position (requirement 3). If necessary, residents should be referred to speech and language therapists for eating and swallowing positioning assessments. The inspector was concerned about the amount of food not eaten. When she asked the residents why they didn’t finish their meal, one said it was too early; they liked to eat in the evening. As breakfast was still being eaten when the inspectors arrived at 10am and lunch is served at 12.30pm it was not surprising many residents were not hungry or eating. A previous requirement about mealtime routines has been addressed, as outlined in the home’s action plan that was given to us by the acting manager on the day of our inspection visit. These routines need to be reviewed again, particularly to ensure the interval between breakfast and lunch meets residents’ needs and preferences (requirement 4). While residents were taking their lunch on the first floor, an inspector saw that there were no condiments on the tables and a carer said “we can give it if it’s requested”. The inspector asked that condiments were made available and some of the residents were seen to use them as soon as they were placed on the tables (recommendation 4). The gravy was served from the trolley with the plated meals, without being offered to residents first. It would be better to offer gravy and/or sauces to individual residents, to enable them to choose the amount they have or whether they have it at all (recommendation 5). Action plans to improve the quality of food and residents’ dining experience were given to us on the day of our visit by the acting manager. These are discussed in the ‘Management and Administration’ section of this report. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse. Most residents and relatives know how to make a complaint. The home addresses complaints but the arrangements for complaints records should be improved. EVIDENCE: The home has a complaints policy and procedure that is prominently displayed and is also included in the information given to residents before they move into the home. Of the 15 residents who returned questionnaire responses to the CSCI, 12 stated they always knew who to speak to if they were not happy. Two stated they usually knew this and one resident that s/he sometimes knew who to speak to. Fourteen residents stated they knew how to make a complaint, and one resident stated s/he did not know how to do this. Of the three relatives who returned questionnaire responses to the CSCI, two stated they knew how to make a complaint, one that s/he did not know how to do this. One relative commented, “the home gave us a folder that has all the details”. Two relatives stated the home sometimes responded appropriately if they or their relative raised concerns about their care, another stated this was always the case. One relative commented, “I have to remind them a lot about having her hair done and teeth cleaned”, another that, “I often have brief chats with the staff and this sorts out any minor worries such as about her Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 18 health”. Two relatives told us they had no complaints but if they are not happy “they moan to the staff as they go” and things get done. Two health professionals who responded to a CSCI questionnaire stated that the home usually responded appropriately if they or the person using the service raised concerns about their care. The home had addressed a previous requirement about the recording of complaints, with the action taken being set out in the home’s plan that was provided by the acting manager on the day of our inspection visit. However, the home needs to improve the filing and organisation of its complaints records (recommendation 6). An inspector saw both the complaints book and the complaints folder, noting that information was often duplicated. Concerns expressed by a relative of a resident had been recorded on the ‘Communication Sheet’ in the resident’s file but not in the complaints book or folder. The inspector noted that the months of March, April, and May 2007 had been recorded as “no complaints”. Whereas thirteen complaints had been recorded for 2006, only one complaint had been recorded so far in 2007. The home has a policy and procedures for safeguarding adults, including a copy of Barchester’s POVA flow diagram, which refers to local authority multiagency procedures. Members of staff spoken with showed some understanding about protecting residents from abuse, what procedures to follow and whom they should inform if they suspected or witnessed abuse occurring. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 19 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, 22, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean and comfortable environment for its residents. Storage space needs to be improved. EVIDENCE: The home appeared well maintained and is decorated and furnished to a good standard. On the day of our inspection the home was clean and generally free of unpleasant odour. There was a urine odour in the corridor on the ground floor but cleaners came to shampoo the carpet before the inspector mentioned it. The home was reasonably tidy but appeared to lack sufficient storage space. We noticed communal bathrooms being used to store equipment such as wheelchairs and hoists (requirement 5). Of the 15 residents who returned questionnaire responses to the CSCI, 14 stated the home was always fresh and clean. One resident stated this was usually the case. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 20 An inspector spoke with the maintenance technician, who had worked at the home for several years. He said the managers had a brief meeting each morning to discuss any issues and repairs that needed to be done. He carries out small maintenance tasks but the organisation uses contactors to do the bigger specialised jobs. Bedrooms seen were personalised with the occupants’ own items. The home has three shared rooms, two on the ground floor and one on the upper floor. It was said the residents had made positive choices to share. During our inspection, one visitor said her relative was in a shared room and was happy to share. At the time of admission it was the only room available and they wanted him to be in this home so they took it. They knew about the home and visited it before he came in. They were apprehensive at first but it has worked well and he enjoys the company. She visits daily and says she is very happy with the service and is “pleased with this place”. The home’s laundry was clean, tidy and well organised. It has two washing machines, each with a sluice facility, and two dryers. There is one area for clean laundry and one for dirty laundry, with a sliding door separating the two areas. The appropriate colour-coded laundry bags were in place. Residents’ clothing looked well care for and labelled discreetly, using the laundry’s labelling machine. The laundry person had received training relevant to her job. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. Suitably qualified and competent staff are employed to meet the needs of residents. Training specific to their role is made available to staff. Recruitment practices are satisfactory. EVIDENCE: The staff rota reflected accurately the staff members that were on duty. It was evident through observations and from the rota that there were enough staff members working in the home. On the day of our visit, the deputy manager was in charge. There was a qualified nurse and four carers working on each floor. A nurse and a carer from a nearby hospice were also working in the home, as part of an exchange arrangement to promote staff development. Of the 15 residents who returned questionnaire responses to the CSCI, 14 stated that the staff listen and act on what they (the residents) said. One resident did not respond to this question. Nine residents stated that the staff were always available when they needed them. Five residents stated this was usually the case, and one did not respond to this question. The home had produced an action plan to address a previous requirement about training for staff that is specific to their role. The acting manager gave us a copy of this plan on the day of our inspection visit. An inspector spoke with a qualified nurse and two care staff. They said they had recently had training in coaching skills, POVA, fire safety, and manual handling. Each Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 22 member of staff had an individual sheet recording their training, and copies of their induction training were on their files. Ancillary staff had attended training in moving and handling, and in infection control. Staff are offered training provided by the Care Home Support Team as well as having internal training sessions run by Barchester. Lewisham has offered training in first aid, infection control and food safety. Information provided by the home’s manager before the inspection confirmed that over 85 of care staff (excluding registered nurses) had NVQ level 2 or above, and that 18 staff members held a current first aid certificate. Of the three relatives who returned questionnaire responses to the CSCI, one stated the care staff always have the right skills and experience to look after people properly, one that this was usually the case and one that this sometimes was the case. One relative commented, “they are kind but have no conversational skills and the residents seem very lonely”. One health professional responding to a CSCI questionnaire stated that the home’s care staff always have the right skills and experience to support residents’ health and social care needs, another stated this was usually the case. Four staff members’ files were sampled for inspection of recruitment information. The required information, including CRB disclosures, had been obtained. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 23 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, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has been registered with the commission following a process of assessment of her fitness to manage the home. Quality assurance strategies are evident and the provider visits monthly to monitor the quality of service provision. The health and safety of residents, visitors and staff is promoted, but improvement is needed to door closures and the frequency of fire drills for night staff. EVIDENCE: The registered manager was not present during the inspection visit. She had been away for some weeks and the deputy manager was in charge of the home. The senior nurses on duty were understood to be sharing the deputy’s role and functions. The deputy informed us she had ready access to the company’s area director for any additional management support needed. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 24 A previous requirement about reviews on the quality of care had been partly met at the previous random inspection but the action plan for improving identified areas of shortfall remained outstanding. At the time of that inspection, the timescale for the requirement had not expired. The acting manager provided a copy of the home’s ‘Customer Survey Action Plan’ on the day of our inspection visit. This covered issues regarding the quality and presentation of food, food service in the dining area, quality of tray service, quality and service of beverages and snacks, quality of laundry service, and personal interaction. The acting manager also gave us an action plan to improve specific aspects of residents’ dining experience. We look forward to the outcomes from these action plans, to assess the benefits to residents. There are other systems that enable residents, relatives and staff members to give their views about the running of the home. The most recent staff meeting had taken place in April 2007, chaired by the registered manager and with 16 staff members attending. The minutes for a relatives’ and residents’ meeting held in August 2006 were on file. We found no evidence to suggest there had been more recent meetings for relatives and residents (recommendation 7). The provider carries out monitoring visits to the home each month and supplies copies of the reports of those visits to the commission. It is evident from these reports that monitoring is focused upon consultation with residents, their representatives and staff members on duty. The manager confirmed, in information provided to the commission before the inspection visit, that Westwood House does not hold any personal allowances for its residents. Residents receive any help they need with managing their finances from their families, advocates or other representatives. No staff from the home act as appointee for handling residents’ financial affairs. ‘Extra’ charges, such as for hairdressing, newspapers or toiletries are initially paid by the home, which then invoices the resident or their representative for reimbursement. A nurse spoken with had not had any training in supervision skills but felt it would be useful. Staff did not show understanding of what supervision was even though they said they had it. None of the staff members’ files examined had any records of supervision (requirement 6). The home’s action plan for a previous requirement given to us by the acting manager on the day of our visit outlined an intention to formally supervise ancillary staff but we could not find evidence that this had yet begun. The timescale (September 2007) for this requirement had not yet expired (requirement 7). Health and safety matters are managed adequately, with servicing and maintenance of equipment taking place as required. The home has a health and safety committee; the most recent meeting had taken place in May 2007 and the minutes were available for inspection. A sample of maintenance records was examined and documentation was up to date and within the Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 25 appropriate timeframes. Risk assessments/audits for COSHH, Legionella, fire safety, and the kitchen were seen on file, as well as a risk assessment for the whole home since the change of ownership. The home had produced an action plan to meet requirements made by Lewisham environmental health service at a food hygiene inspection in February 2007. The home’s fire safety logbook was examined, which showed that the alarm had been serviced, call points had been tested regularly and some fire drills had been carried out, most recently in May 2007. However, the most recent fire drill for night staff was in November 2006. The home must make sure there are at least four drills at night each year (requirement 8). It was noted at the last random inspection that residents’ rooms were being propped open with beanbags, which can be easily kicked out of the way. It was also noted this is not good practice but that the home had a rolling programme for the fixing of ‘Dorguards’ for allowing the doors to be automatically closed when the fire alarm is set off. However, we did not find any evidence at this present inspection that Dorguards or similar devices had been installed (requirement 9). Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 26 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 27 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(2) Requirement The registered person must ensure the dates of opening eyedrops are always recorded so the eye-drops are discarded within the period stated by the manufacturer. The registered person must consult residents to see if they would like planned activities offered at the weekends. The registered person must ensure that, whenever possible, residents are helped at mealtimes to get out of their wheelchairs and are positioned appropriately. The registered person must ensure meals are made available at times that residents may reasonably require. In particular, the interval between breakfast and lunch must meet residents’ needs and preferences. The registered person must ensure that suitable provision is made for storage for the purposes of the care home. The registered person must ensure that all nursing and care DS0000069363.V338969.R01.S.doc Timescale for action 31/07/07 2 OP12 16(2)(n) 31/08/07 3 OP15 12 31/07/07 4 OP15 16(2)(i) 31/08/07 5 OP22 23 30/09/07 6 OP36 18 31/08/07 Westwood House Version 5.2 Page 28 7 OP36 18 8 OP38 23 9 OP38 23 staff have regular formal supervision, and that preparation training for supervisors and supervisees is made available. The registered person must 01/09/07 ensure that ancillary staff are formally supervised and receive annual appraisals. The timescale for this previous requirement has not expired. The registered person must 31/08/07 ensure it is evident there are at least four fire drills held for night staff each year. The registered person must 31/08/07 produce a written plan, with timescales, for the installation of devices that allow the doors to residents’ rooms to be automatically closed when the fire alarm is set off. A copy of this plan must be supplied to the commission. 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 4 Refer to Standard OP7 OP9 OP10 OP15 Good Practice Recommendations The registered person should ensure each resident’s care plan sets out in detail the action to be taken by staff to ensure all aspects of the resident’s needs are met. The registered person should consider the use of a running total system on medicine administration records to monitor medication. The registered person should ensure the location of the pay telephone on the first floor offers enough privacy to residents using it. The registered person should ensure condiments are placed on tables at mealtimes, as some residents may wish to add these to their food. DS0000069363.V338969.R01.S.doc Version 5.2 Page 29 Westwood House 5 OP15 6 7 OP16 OP33 The registered person should ensure that, when serving meals, staff members offer gravy and/or sauces to individual residents, to enable them to choose the amount they have or whether they have any at all. The registered person should ensure the filing and organisation of the home’s complaints records is improved. The registered person should ensure meetings for residents and relatives take place regularly. Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westwood House DS0000069363.V338969.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!