Inspection on 27/10/09 for Westwood Park

This inspection was carried out on 27th October 2009.

CQC found this care home to be providing an Poor service.

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 Park 18/01/10

Westwood Park 20/01/09

Westwood Park 23/01/07

Westwood Park 08/11/05

Westwood Park 07/07/05

Westwood Park 07/12/04

Westwood Park 17/08/04

Westwood Park 03/03/04

Westwood Park 19/11/02

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Westwood Park 4 Langholm Close Beverley East Yorkshire HU17 7DH Lead Inspector Beverly Hill Key Unannounced Inspection 27th October 2009 09:00 DS0000019737.V378235.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Westwood Park DS0000019737.V378235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westwood Park Address 4 Langholm Close Beverley East Yorkshire HU17 7DH 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) 01482 862170 01482 888570 Londesborough Health Care Limited Manager post vacant Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51) of places Westwood Park DS0000019737.V378235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th January 2009 Brief Description of the Service: Westwood Park is a privately owned care home that is registered to provide care and support for fifty-one older people, including those with dementia. The company own another care home in a nearby town. The home is close to local amenities such as shops, banks, cafes, public houses and transport facilities. Accommodation is provided in forty-seven single bedrooms and two shared bedrooms. There are a number of communal rooms available on both floors. All areas of the home are accessible to people via the provision of a passenger lift, a stair lift and ramps. The garden has been specially designed to meet the needs of the people living at the home and is attractive and easily accessible. There is a car park available for visitors and staff. Fees paid are between £362.04 and £565 per week and there is an additional charge for hairdressing, private chiropody, toiletries and newspapers. Detailed information about fees can be obtained from the manager. Information is also available in the home’s statement of purpose and service user guide. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means that the people who use this service experience poor quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on 20th January 2009. This includes information from two random inspections, on 17th February by a pharmacist inspector and on 9th July 2009 by a regulatory inspector following a complaint. It also includes information gathered during a site visit to the home on 27th October 2009. This site visit started at approximately 9.30am and finished at 7pm and was completed by pharmacist inspector Steve Baker, enforcement inspector Chris Taylor and lead inspector Bev Hill. We thought that there may still be some requirements outstanding from the last inspections so we explained to the person in charge that we would be collecting evidence under the police and criminal evidence act (PACE) that could be used for enforcement action against the home if regulations continued to be breached. We ensured the person in charge was fully aware of the procedure and gave them a list of all the documents we copied. The staff team was helpful and provided us with the documentation we required. We spoke with the provider during the inspection and we were assured that he wanted to work with the Commission and improve the service for the residents. This is a positive response and we have advised that we will monitor progress closely. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Westwood Park. We also had discussions with the person in charge (the acting manager was unavailable), staff members and the provider. We left some surveys for residents, relatives, staff and visiting professionals to complete and return to us. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We checked how staff monitored the food and fluid intake of those with nutritional risks. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked Westwood Park DS0000019737.V378235.R01.S.doc Version 5.2 Page 6 out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Westwood Park, the staff team and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the service does well: The environment was clean and tidy and people were able to personalise their bedrooms. The home has plenty of space for people to walk around and different rooms for them to sit in. The gardens are well tended. One staff member stated, ‘we do provide a homely environment’. People spoken with liked their home and said that it was a friendly place to live. Visitors were welcomed at any time. Comments were, ‘the home is very nice’, ‘I don’t like these sorts of places but it’s good’, ‘very friendly’ and ‘the home is alright’. The meals provided were well prepared and presented. People that could express an opinion stated they had enough to eat and they enjoyed what was provided for them, ‘the food is very good’ and ‘we get plenty to eat – more than enough’. The home looked after peoples’ finances appropriately and maintained individual records. What has improved since the last inspection? The environment is undergoing a refurbishment at the moment and several areas have been completed. Eleven bedrooms have been redecorated, the stairs have been carpeted and new furniture purchased for the dining room, the events room and one of the lounges. New windows have been installed in the sitting rooms and upstairs dining room. One shower room has been refurbished. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.2 Page 7 The exterior of the building has also had attention with a new roof and the downstairs woodwork repainted. Pathways have been re-pointed. A management structure has been put in place and there are plans to improve the quality of the care provided. It is acknowledged that this will be an ongoing process, as management systems have slipped – see below. The provider has informed the Commission in writing of management arrangements. Staff training needs have been audited so management is aware of what their training needs are and some courses have been booked. Most staff members have received training in how to safeguard vulnerable people from abuse. We have received notifications of incidents in the home and we are assured all accidents have been recorded and reported when required. One person told us that some accidents were not always recorded when they happened at night. The manager is to check this out, as we were unsure if this was something that had happened in the past and has now been addressed. What they could do better: The home needs to make sure that staff members have full information about residents prior to their admission so they can be sure they can meet needs and plan their care properly. The care plans and risk assessments also need to be much more comprehensive so staff members have clear guidance in how to support people. Sometimes monitoring charts are put in place to keep a check on what people are eating and drinking. These are there for a reason but staff members are not completing them properly. This means that there is not a consistent record of nutritional intake for those most at risk. Daily recording must improve so that we can be sure peoples’ health needs are being met. The management of medication needed to improve to ensure safe practice and that residents received their medication as prescribed. People living in the home had very little social stimulation provided by staff and relied on friends and relatives. People said that staff were busy and did not have time to sit and talk to them. Staff members also confirmed this. There needs to be sufficient staff on duty each shift to care for people in accordance with their needs and care plans, and requests to use the toilet must be responded to in a timely manner. This will help promote health, Westwood Park DS0000019737.V378235.R01.S.doc Version 5.2 Page 8 wellbeing, privacy and dignity, and improve the choices people are able to make. The home needs to make sure that all concerns and complaints are recognised as such and dealt with to the complainants’ satisfaction. This will help people become confident that their views will be listened to and acted upon. The provider needs to produce a redecoration and refurbishment plan with timescales for completion so improvements can be monitored. The recruitment of new staff needs to be much better so that all employment checks are in place prior to the start of employment. This will help to ensure that only suitable people are employed to work with vulnerable adults. Now that an audit has taken place of staff training needs, the plan produced needs to be implemented fully and include conditions affecting older people. This will ensure that staff members have the skills and knowledge they need to meet the range of residents’ needs. The way the home is managed needs to improve. This process has started with the employment of a new acting manager, and an audit of some of the management system, documentation and staff practices etc. Staff need to work as a team and divisions need to be addressed. Staff supervisions need to be more frequent and information sharing more effective so that staff know what they should be doing to support people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 9 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 Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to assess and obtain professional assessment information for planned admissions but staff may not have full information about the needs of people admitted in emergency situations. This means there is a risk that care will be missed. EVIDENCE: We checked the assessment process and documentation the home used to decide whether peoples’ needs can be met in the home. The tick box preadmission assessment form with a space for comments, had scope to cover health and personal care needs. The deputy manager also stated that assessments and care plans would be received from the local authority. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 11 One resident was admitted for respite care as an emergency and the home had completed in-house assessment documentation on the day the person arrived. The home had not received the local authority assessment or care plan. The inhouse assessment would give the home enough information to make a decision about whether needs could be met but the comments sections could be used to greater effect to indicate more detail about the persons needs. For example, the section on dressing stated, ‘full assistance’, the section on cognition said, ‘some memory impairment’ and continence said, ‘doubly’. There was no indication of any health condition that would impact on their care other than a paramedic record of a visit to the persons’ home prior to admission due to a fall. No diary notes had been completed on the day of admission or how the person was during their first night in the home or during their second day. The persons’ personal care chart was not started until 26th October, two days after admission. Risk assessments about falls and moving and handling were completed during our visit, three days after the persons’ admission yet there was a history of falls. Another residents’ admission was tracked and it was clear that this was planned with assessment completed three days prior to the admission and the assessment and care plan completed by the local authority had been received. Their daily record showed the person was shown around the home and offered refreshments, and it detailed which bedroom was to be occupied. The home does not provide intermediate care services so standard 6 does not apply. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ health and personal care needs were not fully planned for and met and medication was not managed robustly. These shortfalls place people at risk of insufficient care and could compromise their health and wellbeing. EVIDENCE: We examined five care files during the visit to see how assessed needs were planned for and met. Two of the care plans were for people recently admitted to the home, one was for a person admitted for respite care and the last two were for people that had lived in the home for some time. We found the care plans did not contain all the assessed needs, were not personalised with information about how the person wished to be cared for and were not evaluated for their effectiveness in meeting needs. They were not Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 13 consistently signed by the person formulating them or the resident and we could not be sure that residents were aware of their care plans and had contributed to them. One resident, who would have been able to contribute to their plan of care, told us they had not seen their care plan nor had staff explained it to them. A random inspection carried out on 9th July 2009 and the last key inspection on 20th January 2009 both highlighted shortfalls in care plans and the tasks staff must complete to ensure needs are met. The homes improvement plan requested after the random inspection stated that care plans were being updated to reflect individual needs and this was due to be completed by 9th October 2009. The requirement to develop care plans that will guide staff on how to meet peoples’ individual needs remains unmet. One resident had a new version of the care plan produced in August 2009. It covered mental health, diet, social stimulation, continence and personal care. Each plan did not give clear guidance for staff nor contain personal preferences. For example the plan for continence care stated, ‘requires toileting at regular intervals’, ‘requires bigger pad on a night time and smaller pad during the day’ and ‘respect privacy and dignity at all times’. Similarly the plan for personal care stated, ‘required 2x carers to wash and dress’ ‘required 2x carers to shower as frequently as possible’ and ‘wash and clean teeth regularly’. It did explain that if the resident was agitated staff had to leave them and return later. The plan for social stimulation stated, ‘to put in the day room to stimulate social needs’. The person had no care plan for their mobility, yet this was assessed as being a high risk area and none for how to manage communication. The person was prescribed Diazepam medication, ‘when required’ to alter their behaviour but there was no plan or protocol in place to guide staff as to when the medication was to be given. They were at risk of developing pressure sores due to decreasing mobility, their incontinence, their fluctuating food and fluid intake with a slow loss in weight, and their increased confusion. There was no care plan for pressure area care. A resident was admitted for respite care and staff had written a précis of their needs, ‘short stay care plan’ and supplemented this with a plan for ‘behaviour/agitation’ and another for, ‘personal care’. The short stay plan was not dated or signed. There were no tasks identified for pressure area care but the daily records state the person had a sore bottom and cream was applied. There was no plan to promote continence but daily records state the resident had needs in this area. We were not sure that peoples’ health needs were fully met in the home, as recording was inconsistent and care plans were not always followed. For example, one care plan for nutrition states, ‘encourage adequate fluid intake’ and ‘ensure food/fluid input/output chart is filled in for monitoring purposes’. We checked several monitoring charts and they indicated either very low food and fluid intake or poor recording. For example on the 25th October a resident Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 14 was recorded as having 435mls of fluid all day and 750mls on the 26th. We observed the chart for the 27th October and 150mls of tea was recorded as taken at 8.15am but we saw this still in the residents’ bedroom at 9.30am. Staff members record when they take fluids to people and not when they have actually taken them. Another residents daily record stated on 26th October that they had, ‘eaten well’ but the monitoring chart stated they had consumed 525mls of fluid and ‘tea’ with no amount, a biscuit at 3pm, two sandwiches at 4.15pm and two biscuits at 7pm. There was no record of breakfast or lunch and the resident is a diabetic. Another resident was admitted recently and it was recorded that they may be constipated. Despite this and daily recordings of the person being, ‘very confused’, there was no recording over the last five days of any bowel movement or contact with a health professional to check this out. The resident with low fluid intake on the 25th and 26th of October had complained to staff of a, ‘bad headache’ but the daily notes and medication administration record did not evidence that any pain relief was provided. However, records show that staff members were quick to contact a new residents’ GP to obtain a prescription for a skin condition. There was also evidence of visits by GP’s, district nurses and other health professionals. We saw risk assessments completed for nutrition, falls and behaviour management. There was also guidance for staff for moving and handling that detailed a traffic light system of risk and whether aids were required. The risk assessments in general did not fully analyse the risk nor provide adequate control measures for minimising risk. Information from them was not consistently included in care plans. For example, the tick box nutritional risk assessment for one resident stated they were diabetic, sometimes refused meals, had difficulty chewing and was confused and depressed. There was no analysis of what level of risk this posed. The care risk assessment form, where risk information was collated, identified the risk as, ‘diabetic’, the elimination of risk as, ‘kitchen aware, sugar free diet given, ensure medication administered’ and responsibility as, ‘all staff’. The short stay care plan had no mention of a diabetic diet but stated the person needed assistance to cut food up and prompting with meals and drinks. There was no mention of the need to monitor food and fluid intake and these, when checked, were not completed fully. Staff members told us they did not have time to read care plans and information was not consistently passed between senior staff and care staff. Comments in surveys and discussions with staff members were, ‘all I do is rush from one resident to another’, ‘most of our residents need a lot of care and at the moment I feel they are not getting it’, ‘not enough information on Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 15 arrival’ and ‘we are not given the time needed to give the care required. One person reported that seniors get handovers but important information is not always cascaded to care staff, for example, when a resident has died or a new resident has been admitted. Privacy and dignity was at risk of being compromised by low staff levels in the home. When asked about response times to buzzers one resident stated, ‘if you want to go to toilet quickly you pee yourself’ and another resident told us, ‘this is a problem, sometimes its quick, sometimes half an hour and I’m desperate by then – some staff are better than others at answering it’. Other comments from residents were, ‘they are pretty short-staffed it varies depending on how many people they are dealing with’, ‘they race around and ignore the people who live here – they are concerned with what they are doing’ and ‘the times varies – it depends’. On the whole residents spoken with said that staff were caring and they ‘do the best they can’. During the visit, a pharmacist inspector examined the current medication administration record charts (MARs) and reviewed the medication storage, ordering & disposal arrangements. He also observed medication being given to people at lunchtime. We found nine administration gaps on five of the 36 MARs examined. One person’s MAR showed that they had been supplied with 21 antibiotic capsules to be taken three times a day for one week. 17 doses were given correctly then the MAR states that the course had been completed with no explanation stated why the remaining four does were not given. We also found inadequate records on seven MARs for the use of eight prescribed skincare products. People living in the home may therefore not always receive their prescribed medicines correctly. This was confirmed when we found that six of eleven medicine containers we checked did not contain the expected amount remaining as predicted from the home’s administration records. Some other improvements in record keeping and safe practice need to be made. There is still some inconsistency in the way the use of medicines prescribed ‘when required’ is recorded and in how they are given. Three entries on three MARs contained no administration records at all and we found that different omission codes were used by different staff when these medicines were offered and declined. We found no evidence that the use of these medicines is supported by a written care plan guiding staff in their safe and correct use. The administration of medicines at lunchtime was observed to be in accordance with good practice. Drinks were offered and staff spent time with each person carefully encouraging them take their medication. Regular monthly prescriptions are still not routinely checked by senior staff before the medicines are delivered. This would enable staff to check for any Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 16 omissions and changes to make sure all the correct medicines are received each month. Controlled drugs storage and record keeping meet current regulations meaning that the additional security needed for these medicines is being provided. However we found no evidence that random spot checks of controlled drugs record keeping takes place. General medication storage arrangements have not improved since the last pharmacy inspection. The downstairs storage area remained cluttered and untidy making it difficult for staff to work carefully and efficiently. The upstairs storage area appeared to be accessible to people not authorised to handle and administer medication. This posed a potential security risk which was reported to the senior staff on duty. The temperature of all medication storage areas should be monitored regularly and opening dates of medicines with a limited use once opened, such as creams and liquids, should be recorded. This will make sure that staff members know that medicines are being kept at the correct temperatures recommended by the manufacturer and that they are safe to use when needed. We found several containers of skin creams which had their original pharmacy labels removed but which were still in use. The staff on duty could not confirm when these containers were originally dispensed or whether they were dispensed for the people who were now using them. Medicines, including creams, should always be given only to people whose name is on the pharmacy label and should not be shared with others. We were told that all staff had received an update on medication systems from the pharmacy supplier but that they were still waiting for their competency to be assessed by someone qualified to do so. The risk of medication errors is reduced by ensuring staff members are up to date and are skilled in all the tasks expected of them. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was limited stimulation for people that were unable to make their own decisions or keep themselves occupied. This places people at risk of becoming bored and affects their choices and wellbeing. People were provided with meals that met their nutritional requirements. EVIDENCE: There was a list of activities and forthcoming events on the notice board. This included board games, arts and crafts, exercises indoors, jigsaws, weekly music therapy and a cheese and wine evening. The mobile library visited to exchange books and an entertainer visited monthly. The home did not employ an activity coordinator and staff told us there was very little time to complete any activities with people. The home does not provide sufficient stimulation for residents. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 18 Residents comments about the provision of stimulation were, ‘staff don’t stop to chat’, ‘I do lots of sitting about doing nothing – it could be improved’, ‘I’ve started to take a newspaper’, ‘I see the hairdresser on Mondays’, ‘there’s a sing song on Fridays with the piano’, ‘I used to attend chapel but I can’t get there now’, ‘I prefer my room – they are all asleep in the lounge. I watch TV during the day, Staff pop in but there is no time to chat’, ‘it’s a friendly place, I like the staff very much. I just sit in my room all day but sometimes I go in the lounge’, ‘it’s a nice home. I get bored and go to sleep’ and ‘I like everything about the home, I read, walk about and watch TV but there is not enough to do – it’s alright when the weather’s fine. There are no games at all and a lot of them drive me round the bend’. The inspection report of the site visit on 29th January 2009 stated, ‘People spoken with confirmed they did not go outside very much and trips outside Beverley had not taken place recently. The care plans inspected did contain information regarding people’s hobbies and interests though this was not always considered and acted upon’. We found that this still remained the case. Residents who were able to speak to us told us they were able to make some choices about aspects of their lives. They were able to remain in their bedrooms if they chose to, could get up and retire to bed when they wanted, could choose the clothes they wore and where to have their meals. People told us that visitors were welcomed at any time. Some residents retained their independence and could come and go as they pleased. However, some resident’s choices were limited due to staffing numbers and, according to some staff surveys and discussions, staff practices. For example, how quickly they receive support to go to the toilet, what activities they can participate in, and the times of rising and retiring for those residents unable to make their choices known. This was mentioned to the manager to check out. People spoken with told us they enjoyed the meals and staff members also commented that the home provided quality food and a good choice of menu. The cook advised that the menus were due to be changed in January. They also told us that they visited new residents to find out their likes, dislikes, special diets and allergies and maintained a list. When checked the list was in need of updating. However, a new form completed on admission in some of the files we examined, covered a range of food preferences. Catering staff need to be provided with this information. Residents told us, ‘the food is very good, you get plenty to eat – more than enough’, ‘I like some of the meals’ and ‘the food is good – you get too much’. One resident did tell us that they had never been asked to make suggestions to the menu. The dining rooms were set out with individual tables and chairs; one dining room on each floor. There was space for approximately sixteen residents in each dining room. Staff stated some residents preferred to have their meals in their own bedrooms. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 19 Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have some specific concerns but these may not always be verbalised to staff or management, or recognised and documented as concerns or complaints by staff. This means there may be an under-reporting and/or under-documenting of concerns and complaints, which affects audits and how lessons learned can improve practice. An awareness of safeguarding policies and procedures guides management and staff in protecting vulnerable adults from abuse but shortfalls in recruitment practices could place residents at risk of support by unsuitable staff. EVIDENCE: The home had a complaints policy and procedure on display. Staff members told us in surveys that they were aware of what to do should people raise concerns with them. Some residents spoken with said they would complain to the manager, (one resident thought the previous manager was still in post). The people spoken with said they did not have any formal complaints. However, our conversations with them identified concerns that they had. If these have been raised with staff they have not been treated as complaints or documented as such. For example people told us they had to wait a long time Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 21 when they pressed the buzzer, they told us they did not have enough to do to occupy themselves and one person told us their mattress was uncomfortable and they had mentioned this to staff but it had not been addressed. There was one complaint since the last key inspection recorded in the complaints log. The deputy manager advised that it had been resolved. However, the complaint form had no management signature to sign it off and did not detail if the complainant was satisfied with the outcome of any investigation. The Commission received a complaint in June 2009 and we completed a random inspection in July 09 to check out some of the concerns. These related to staffing issues and some care practices. The inspector issued requirements but we have found at this inspection that not all the requirements have been met. Lessons from complaint investigations need to be learnt so that practice can be improved. The home had a copy of the multi-agency policies and procedures for safeguarding vulnerable adults from abuse. The acting manager is aware of the procedures and has shown their understanding by using them appropriately. Most of the staff team has received training and staff spoken with told us they would report any concerns directly to management. Since the last inspection there has been one safeguarding alert received by the local authority. This was investigated with no further action required, although some recommendations were made regards care plans and risk assessments. To help protect vulnerable people the home must improve its recruitment practices to ensure full checks are carried out prior to staff starting employment, care plans and risk assessments needs to be much more thorough and staffing numbers need to increase to ensure care practices improve. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable environment, though some areas need updating. The refurbishment plans, when completed, will enhance the quality of life for people living in the home. EVIDENCE: The home was clean and tidy and generally free of any malodours. People told us they were happy with their bedrooms and the home in general, and that they could bring in items to make it homely. Comments were, ‘very nice home – I find the corridors confusing’ and ‘I like the home – it’s bright and clean’. One resident told us their mattress was hard and uncomfortable. This was mentioned to the manager to address. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 23 The home was undergoing a refurbishment and new double-glazed windows had been installed in all sitting rooms and the upper dining room, the roof had been repaired, external woodwork had been repainted on the ground floor and footpaths had been re-pointed. Communal areas and bedrooms were decorated in a homely way and individualised to varying degrees with personal items. Eleven of the bedrooms had been redecorated and stairs have been recarpeted. One of the upstairs lounges was quite bare and staff advised it was due for redecoration soon. Some furniture had been replaced in one of the lounges, the dining area and a room used for training and special family events. Bathrooms and toilets were clean, although in need of updating. One shower room has been completed and one of the bathrooms has commenced refurbishment. The home had two shared and forty-seven single bedrooms. Six single bedrooms upstairs had en-suite facilities. In discussion, the provider advised that they were considering reducing the number of bedrooms in order to make some of them en-suite. This would benefit the residents and improve the quality of the environment further. The provider needs to complete a refurbishment and redecoration plan with timescales so we are able to monitor progress. There was plenty of space for residents to use. There was a seating area in the reception, a large room downstairs used as a sitting room, with a dining area sectioned off, a second lounge downstairs and an additional small room for people wishing to smoke. There was also a small visitor’s room and a conservatory, which was currently having a new roof fitted. There were a further two small lounges, a dining room and a kitchenette upstairs. Gardens were well maintained and had walkways and garden furniture for residents to use in warmer weather. The home had sufficient staff offices and a good sized laundry. The laundry needs to be inaccessible to residents when not in use. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ health, safety and welfare are placed at risk by insufficient staff numbers and incomplete recruitment practices. Training audits have identified shortfalls and these were being planned for. When fully implemented the training programme will help to develop the staff skills required in order for them to care for vulnerable people. EVIDENCE: The rotas showed that there were three care staff and a senior carer on each shift during the day and one senior and two carers at night. This meant that the care hours provided were 609 per week. We calculated the total hours required, based on the dependency needs of residents provided by the manager, to be at least 683 hours per week. This is a shortfall of 74 hours per week. The comments from residents, the documentation examined and discussions and surveys from staff all indicate the staff shortages has impacted on the quality of life for residents and in some instances their health and wellbeing. This must be addressed quickly. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 25 The home has a cook, a laundry assistant five days a week, and two domestic staff. Weekend catering hours were currently being covered as extra hours by one of the care staff. Catering hours only extend until 2.30pm so care staff would be responsible for providing the evening meal, further detracting them from their caring duties. The staff spoken with and the surveys received from them highlighted some issues that need to be addressed. We were told that some shifts were long and tiring, twelve hours in total, and very busy. Whilst the senior carer completes medication there are only three care staff members to support the needs of thirty-seven residents and some of the residents have complex needs. Four residents require full assistance when eating and a further three require prompting and supervision. Comments told us that, moral was low, communication could be improved and the staff members were not consistently working as a team. When asked what the home could do better some staff comments were, ‘make sure we have adequate staff on duty to care for the clients needs – on one floor we have five residents who need two staff at all times’, ‘work as a team’, ‘care plans to be made out before they arrive – there is not enough information on arrival’, ‘staffing levels need to be dramatically improved’, ‘accidents at night are not always documented’, ‘put enough staff on duty to cover the needs of our residents’, ‘cover laundry and domestic staff if they are off’ and ‘we need a cook on duty at each mealtime as when we have no cook we have meals to serve also’. Staff commented positively about meal provision. One staff member relayed some poor practice issues to us. There were staff meeting minutes and supervision records that evidenced the acting manager had spoken to staff about some of these issues and a lack of recording. We told the manager about the further comments so they could check out if they were still happening or if the information relayed to us was of past events that had already been dealt with. People spoken with told us the staff were kind and caring but that they did not have time to sit and talk, ‘they are always racing off’, ‘everybody is used to us – they do the best they can’, ‘I like the staff very much’ and ‘the staff are all very good’. The acting manager has started to audit staff records in order to complete a training plan. A staff appraisal has taken place for most of the team to look at their development needs and a four week induction programme has been formulated for new staff. The induction programme covers skills for care standards and the work new staff complete is sent off to be checked by ‘Mulberry House’. This is an external training company. Existing staff are also to work through the induction standards in an effort to get back to basics. The Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 26 acting manager advised that on completion, competence will be signed of by management in the home. The training log showed some gaps in mandatory training but management were aware of these and were planning courses accordingly. Six staff members that administer medication were booked on a safe handling of medication course in November 2009. They have already completed a short course in how to manage the current medication system supplied by the local pharmacy. Practical moving and handling and dementia care training has been arranged. The home has three staff that have completed, ‘train the trainer’ practical moving and handling and this is to be cascaded to care staff. The training plan needs to include conditions affecting older people, such as strokes, diabetes, Parkinson’s disease and sensory impairment. Training is carried out via a range of methods, such as, DVD’s with questionnaires, in-house sessions, external facilitators and distance learning. Records indicated that out of twenty-one care staff two had completed a national vocational qualification (NVQ) in care at level 2 or 3. This equates to 9 . It is acknowledged that staff turnover has affected scores in NVQ. Most of the staff team were now progressing through the course. The home needs to aim for 50 of care staff trained to this level. The recruitment system had some shortfalls that need attention. Potential staff members completed application forms and there was evidence that people attended for interview and were asked a selection of questions. We saw one of the forms for one staff member but there was no date or name on the form. Staff members were employed prior to full employment checks being in place, which could mean that residents are put at risk. For example there was evidence of povafirst checks against the register of people barred from working with vulnerable adults but two staff had started work before the full criminal record bureau check was returned. The same two staff did not have any references in their files. The acting manager told us one of the staff was previously known to the home. Another staff member had two references in place but neither was from their last place of employment, which was another residential home. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is acknowledged that the change in management systems will take time to implement fully and the home is currently in the transition stage. However, a quick resolution to staffing issues and monitoring care practices is required to ensure the safety and welfare of people living in the home. EVIDENCE: The acting manager has been in post since June 2009 and is supernumerary. She is a director of the company and was previously the registered manager of a sister home. She has brought together a management team to improve the Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 28 systems in the home, which have slipped during the previous managers’ employment. It is acknowledged that there are a lot of tasks to complete to ensure the home runs effectively. The acting manager has been focussing on improving paperwork and staff training. However, staff shortage has directly impacted on the care and support for residents and also on recording. This makes it very difficult for staff to complete the tasks they need and it makes it difficult for us to audit that there has been sufficient care. Comments from the staff acknowledge that the management changes have been for the better and that the management team have been concentrating on specific systems. However, the process of management change has left some staff members stating that morale is low and that management is busy and difficult to approach at times. Comments told us that there were divisions in the team that need to be bridged. Management need to find ways of dealing with these concerns and enable staff to speak with them and know that their concerns will be listened to, allayed when necessary and acted upon when required. A formal staff supervision system has been started. Most care staff members have had one session and there was evidence that the manager discussed care and practice issues with staff that had been highlighted as concerns at the random inspection in July 09. There was also a short individual discussion recorded on the supervision form. When the supervision system is fully implemented, for example, every two months, the staff team should have the opportunity they need to make suggestions about the home and supervisors will be able to monitor staff practice. One staff member in the company told us they are responsible for quality assurance and they spend mornings at the home in order to set up a new system – ‘Mulberry House’. This includes questionnaires to obtain the views of residents and their families, staff members and visiting professionals, and audits of the environment and documentation. The staff member advised that questionnaires are usually sent out annually to residents and cover food, staff attitude, laundry and choices about activities. They also confirmed they walked around the home to check the environment. The quality audit system is in place but it is not fully implemented yet. Audits need to cover practice issues, documentation and management systems, for example, administration of medication, the writing and updating of care plans, and staff recruitment. An action plan can then be produced to address the shortfalls identified in questionnaires and audits. This self regulation is important in monitoring the service and rectifying problems. How the home managed the residents’ finances was not assessed at this visit, however, the system remains the same and we have not had any concerns raised with us. The home can hold money for safekeeping on behalf of Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 29 residents for the purchase of toiletries, hairdressing, chiropody or newspapers. Records were maintained for each person and receipts kept for purchases. There was evidence of some environmental audits such as fire safety checks and drills and equipment in the home was maintained and serviced as required. Requirements from the visit by the fire officer in February 2009 have been addressed. However, some health and safety issues we noticed must be improved. The laundry needs to be inaccessible to residents when not in use, as there are regulated products that must be kept secure and the hot water could be a risk. Any resident requiring bed rails to prevent them from rolling out of bed must have thorough risk assessment in line with health and safety guidelines. Hot water checks in bedrooms and bathrooms were completed (a selection each month), but during the last quarter the actual temperature was not recorded. The previous quarter recordings had low temperatures of ranging between 38°C and 40°C, which may be cool for some residents. The temperature needs to be adjusted to 43°C, which is a safe and ambient hot water temperature. Records were maintained securely but some were incomplete and others not up to date. This includes, medication records, care plans, risk assessments, activities participated in, food and fluid monitoring charts, staff recruitment and water temperature checks. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 3 X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 2 2 Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 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 OP3 Regulation 14 Requirement The home must ensure there is sufficient information regarding peoples’ needs prior to admission. This will enable staff to be sure the home is able to meet the needs and also enable staff to plan care that is required. Care plans must be developed that will guide staff on how to meet peoples’ individual needs, describe the needs and preferences of people and be reviewed on a regular basis. Revised requirement, previous timescales 20/02/09 and 09/10/09 not met, which means this requirement is subject to our enforcement processes. 3 OP8 13 Risk assessments must contain sufficient detail about what the risk is and guide staff in managing this and should be regularly reviewed to reflect a person’s current need. This will ensure that risk is managed in a safe way. DS0000019737.V378235.R01.S.doc Timescale for action 15/01/10 2 OP7 12 15/01/10 15/01/10 Westwood Park Version 5.3 Page 32 Previous timescale 09/10/09 not met, which means this requirement is subject to our enforcement processes. 4 OP10 12 People living in the home must be assisted to use the toilet when they need it. This will ensure that people have their personal needs met safely and in a way that promotes their privacy and dignity. Previous timescale 09/10/09 not met. 5 OP9 13 Medication must be given as prescribed from labelled containers provided by a pharmacist or dispensing doctor and an accurate record must be made at the time that it is given. This will make sure that people receive their medicines correctly and the treatment of their medical condition is not affected. Previous timescale 31/03/09 and 31/08/09 not met, which means this requirement is subject to our enforcement processes. 6 OP9 13 Extra guidance must be obtained and recorded about how to use medication prescribed ‘as required’. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. Previous timescale 31/03/09 and 31/08/09 not met, which means this requirement is Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 33 15/01/10 11/12/09 11/12/09 subject to our enforcement processes. 7 OP9 13(2) All medicines must be stored 11/12/09 securely. This will ensure that medication is stored safely and only those who are administering have access to it. Previous timescale 09/10/09 not met, which means this requirement is subject to our enforcement processes. 8 OP12 16 Residents must have their social 15/01/10 and occupational needs assessed to help identify past and current interests and also help to identify current abilities. This will enable activities to be tailored to meet needs, especially of people with dementia or memory impairment. Residents must be protected 15/01/10 from harm by improving staff recruitment, staffing levels, risk management and some care practices. 15/01/10 The current staffing levels must be increased to the minimum levels recommended by the guidance. To ensure that at all times there are suitably qualified, competent and experienced persons working in the care home in such numbers as are appropriate for the health and welfare of people living there, to ensure that peoples’ needs are met in full. Previous timescale 09/10/09 not met. 11 OP29 19 Full employment checks must be 15/01/10 carried out prior to staff starting employment. This includes two written references and the return DS0000019737.V378235.R01.S.doc Version 5.3 Page 34 9 OP18 12 and 13 10 OP27 18 Westwood Park 12 OP30 18 of the full criminal record bureau check. This will help to ensure only properly checked staff support vulnerable adults. Staff must receive training in line 15/01/10 with the specific needs of the people living in the home. It is acknowledged that a staff audit has taken place and a training plan is in the process of being developed. As well as induction and mandatory training the plan must include dementia care and conditions affecting older people such as diabetes, strokes, Parkinson’s disease, sensory impairment, catheter care and pressure area care. The training plan for the next six months to be completed by the timescale for action date. This will enable the home to be sure residents are supported by well informed and competent staff. All records required for the running of the home must be accurate and up to date. To ensure that there are up to date records about the care people receive in the home. People requiring bedrails to prevent them from rolling out of bed must have thorough risk assessments completed in line with health and safety guidelines. This will ensure that all areas are covered and there is a correct match between the resident, the type of bed, the mattress and bedrail. A checking system needs to be in place that monitors the safety of bed rails. 13 OP37 17 15/01/10 14 OP38 13 15/01/10 Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should be signed and dated by the resident or their representative to evidence that they have participated in their formulation and that they agree to the contents. Monitoring charts for food and fluid intake should be completed after the person has consumed the food or fluids and not when initially given to the resident to eat or drink. This will ensure staff members complete the charts with accurate information. The date of opening of all medicines with limited use once opened should be recorded. This includes oral liquids and medication applied to the skin. This reduces the risk of using medication beyond the limited period recommended by each manufacturer. Regular monthly prescriptions should be seen before sending to the pharmacy. This makes sure a check can be made that all the medicines required have been listed and prevents people from being without. Regular checks of controlled drugs, their storage and records should be made to ensure current regulations are upheld. People’s own choices about where & how they prefer to receive their medicines should be clearly recorded to enable staff to meet individual needs. The temperature of all medication storage areas should be monitored so that staff know medicines are being kept at temperatures recommended by the manufacturer People should be encouraged to take part in chosen activities and to retain interests and hobbies. An ‘at a glance’ log of who participates in activities will enable staff to check who has not taken part, investigate why and whether any changes are required to the activity programme. The home should consider the employment of an activities coordinator so that a designated person is responsible for social stimulation. Staff should find ways of increasing the amount of choice and decision making, especially for those residents with dementia. Care plans should detail clearly the choices DS0000019737.V378235.R01.S.doc Version 5.3 Page 36 2 OP8 3 OP9 4 OP9 5 OP9 6 OP9 7 OP9 8 OP12 9 OP12 10 OP14 Westwood Park 11 OP16 12 OP19 13 OP28 14 OP31 15 OP33 16 OP36 17 OP38 people can make for themselves. This will help to promote self esteem and a measure of control for people. Residents should be routinely consulted about any concerns or complaints and information documented to evidence an audit trail of resolution and satisfaction. The provider needs to complete a redecoration and refurbishment plan that details timescales for completion of work. This is so we can monitor progress. The home should continue to work towards 50 of care staff trained to NVQ level 2 and 3. This will help staff understand their responsibilities, and help them develop their skills further. The manager should apply for registration with the CQC. This will enable her fitness to manage a residential care service to be tested. The quality assurance system should be implemented. This will help ensure the service identifies and acts on areas for improvement. Care staff should receive a minimum of six formal supervision sessions each year. This will provide them with an opportunity to discuss issues and enable their practice to be monitored. Records of the temperatures found during the testing of hot water outlets should be made. This will identify any areas where the water is too hot or too cold. Action should be taken to remedy any shortfalls. Westwood Park DS0000019737.V378235.R01.S.doc Version 5.3 Page 37 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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